Presentation by: Leiza Johnson, BSN, RN, CDP Nursing Home Quality Improvement Specialist Mountain-Pacific Quality Health Alaska state hospital & nursing home association chief nurse executive meeting April - 2018

Mountain-pacific quality health Serves as the Medicare Quality Innovation Network- Quality Improvement Organization (QIN-QIO) for Alaska Five offices that serve Alaska, Hawaii, Montana, Wyoming and U.S. Pacific Territories of Guam, American Samoa and the Commonwealth of the Northern Mariana Islands We have expert staff who facilitate various quality improvement projects across the state

Contracted by CMS Better Health Better Care Lower Costs Centers for Medicare & Medicaid Services (CMS) Three Aims for Health Care Better Health Better Care Lower Costs

Role of the QIN-QIO Drive recognition of quality improvement Enhance quality of health care delivery Provide technical assistance Partner with statewide stakeholders to align efforts Provide tools and resources Share best practices (learning & action networks)

Our Alaska Team Is… STRONG DIVERSE DYNAMIC EXPERIENCED

The Alaska team Sharon Scudder State Director, Alaska Preston Groogan Quality Reporting Leiza Johnson Nursing Home Task Lead Kyla Newland Adverse Drug Events Lori Chikoyak Antimicrobial Stewardship Coleman Cutchins Care Coordination QIN-QIO is Quality Innovation Network – Quality Improvement Organization CMS created QIOs essentially to help make sure their money is spent wisely. Role of QIN-QIO: CMS contracts with QINs across the US. Various contracts all with ‘triple aim’ of improving patient experience, reducing cost, decreasing HACs/improving clinical outcomes MPQH has task leads (in Alaska!) working on: Antimicrobial stewardship/CDI – across settings Diabetes self management Reducing readmissions Safe medication practices (ADEs, cardiac, diabetic) Role in reducing HACs – part of the contract is related to nursing home QI. Goals set by CMS are: 50% of collaborative will achieve composite of <6 Antipsychotic RIR Etc. ANHT collaborative – 100% commitment by all AK nursing homes. Etc etc Partners to support ANHTs: licensing & certification, ASHNHA, Alz Resource of AK, GWEP, ANTHC, Mental Health Trust, etc. Oh and I like to say we have a big state, little mascot…  * Leiza – began in QA in 1990’s – worked in Nome – came to Anch began to ‘specialize in JCAHO’ – went to school to get RN – worked in adolescent psych – full circle back to quality Miranda Burzinski Quality Reporting Cathy Colwell Diabetes Self-Management

Current Initiatives from CMS and Mountain-Pacific Staff Quality Reporting (Hospitals & Outpatient – QPP, MIPS, eCQI) Miranda Burzinski Improving Coordination of Care Coleman Cutchins Improving Antimicrobial Stewardship Lori Chikoyak Reducing Disparities with Diabetes Cathy Colwell Reducing Adverse Drug Events (ADEs) Coleman Cutchins & Kyla Newland Improving Cardiac Health Kyla Newland Improving Adult Immunization Rates Improving Long-Term Care Leiza Johnson

Leiza Johnson nursing home project Establish a collaborative of nursing homes to work with the QIN-QIO on quality improvement initiatives In Alaska, this collaborative is called the Alaska Nursing Homes Together or “ANHT” group CMS established three main goals for this work: Enroll 35% of all Alaska nursing homes to participate in the work **Reach a composite score target of <6 Rolling goal of 15%, 25%, 45% and 50% of nursing home partners achieving the target by established dates (2016, 2017 and 2018) Reduce antipsychotic use Reduction in rate (RIR) from baseline targets established of 3%, 9%, 15% and >15% each year (3% RIR by March 2016) Note: Alaska has failed this measure the past two quarters **more on the Composite Score later

Project goals Exceeded Goal! Exceeded Goal!

Project goals – antipsychotic reduction We are NOT meeting contract goal(s) – Root Cause Analysis to evaluate failure.

Issues with antipsychotic measures Small sample size – half of the ANHTs are less than 20 beds Small numbers ‘skew’ the data making it more difficult to identify those nursing homes with legitimate quality issues The CMS Quality Measure does not take into account the Gradual Dose Reduction (GDR) process Many antipsychotics started in acute care or the community prior to the nursing home admission

Issues with antipsychotic measures GDR process takes time – until all antipsychotics are discontinued a resident will continue to trigger this QM Alaska began the contract with the second lowest antipsychotic rate in the nation, leaving less “low-hanging fruit” and highlighting the good practice(s) we have in our state

composite score measure Represents quality indicators selected to characterize nursing homes’ performance Includes 13 quality measures (QMs), which are summed to get an overall composite score Data is pulled from the nursing home Minimum Data Set (MDS) submission When setting quality improvement (QI) targets, CMS recognized the best nursing homes had a composite score of <6, so this was established as the goal

Sample composite report state of Alaska

State of Alaska QMs

Questions? Leiza Johnson, CDP, BSN, RN Mountain-Pacific Quality Health ejohnson@mpqhf.org

Thank you for your time! Ddeveloped by Mountain-Pacific Quality Health, the Medicare Quality Innovation Network-Quality Improvement Organization (QIN-QIO) for Montana, Wyoming, Alaska, Hawaii and the U.S. Pacific Territories of Guam and American Samoa and the Commonwealth of the Northern Mariana Islands, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. 11SOW-MPQHF-AK-C2-18-57