The HHQI National Campaign Phase 3 Looking Forward and Building on Past Successes Charles P. Schade, MD, MPH West Virginia Medical Institute

Disclaimer The analyses upon which this publication is based were performed under Contract Number HHSM WV10C, funded by the Centers for Medicare & Medicaid Services, an agency of the U.S. Department of Health and Human Services. The content of this publication does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government. The authors assume full responsibility for the accuracy and completeness of the ideas presented. Publication number: 10SOW-WV-HH-BK App. 8/2012.

Acknowledgements Co-authors of HHQI-2 report – Shanen Wright – Bethany Knowles – Karen Hannah – Eve Esslinger WVMI/QI analytic staff – Jill Manna – Yinghua Sun – John Bowers Cynthia Pamon, Government Task Leader Almost 5,000 participating HHAs

Outline HHQI National Campaigns 1 and 2 Changes in HHQI Campaign 3 How we will evaluate it How you can help

Introduction 12 million individuals received home health care in 2010 from 33,000 providers – Medicare providers are approximately 1/3 of the total Medicare (41%) and Medicaid (24%) paid approximately 2/3 of cost of home health services in 2009

Recent Growth of Medicare Home Health Services Source: CMS, Medicare Home Health Agency Statistical Summary 2011

Medicare’s Take on Home Health Home health care is a wide range of health care services that can be given in your home. Home health care is usually less expensive, more convenient, and just as effective as care you get in a hospital or skilled nursing facility.skilled nursing facility. The goal of home health care is to treat an illness or injury. Home health care helps you get better, regain your independence, and become as self-sufficient as possible. In general, home health care includes part-time or intermittent skilled nursing care, and other skilled care services like physical therapy, occupational therapy, and speech therapy. Services may also include medical social services or assistance from a home health aide. Usually, a home health care agency coordinates the services your doctor orders for you.skilled nursing care,physical therapy,occupational therapy,speech therapy.medical social serviceshome health aide. Source: CMS, Home Health Compare HealthCare.aspx

Medicare Home Health Services Opportunities for Improvement* 27 % of patients were admitted to the hospital from home health care 48% of patients improved self-administration of drugs during home health care 57% of patients got better at walking or moving around during home health care *Source: Home Health Compare, national outcome data covering April 2011-March 2012

Outline HHQI National Campaigns 1 and 2 Changes in HHQI Campaign 3 How we will evaluate it How you can help

HHQI National Campaign 1 (2007) Collaboration of QIOs, state associations, national organizations Almost 5,600 Medicare Certified HHAs participating Over 9,600 continuing education participants QIOs and state-level projects ACH-focused Data feedback and intervention packages

Acute Care Hospitalization Rate Participants and Non-Participants

Percent of Agencies Using Specific BPIPs* and Improvement in ACH** *Best Practice Intervention Packages **Acute care hospitalization during home care

Summary Findings HHQI 1 Decline in ACH masked by changes in ALOS* Agencies that improved used more campaign tools On average, agencies used 3-5 intervention packages The campaign was cost effective *Average length of service

Lessons Learned HHQI 1 Focus on fewer packages Address management concerns Statewide involvement Success stories help Multiple channels for education User instruction on BPIPs

HHQI National Campaign 2 ( ) 4,721 (43% of all HHAs) registered for the campaign Potentially impacted about 3 million home health patients Focus on ACH, medications, disparities BPIPs broader, less frequent National scope, social media Data feedback continued and expanded

Acute Care Hospitalization Rate BPIP released

Medication Management Improvement No data due to OASIS-B to OASIS-C conversion BPIP released

Changes in ACH and ALOS by Participation Intensity Quartile *Average length of service for home health patients in agency

Cost Implications Project cost $1.4 million Average Medicare hospital admission cost $11,000 Project cost equivalent to 127 admissions 195 HHAs in top 2 partici- pation quartiles averaged 1,600 episodes/year These HHAs reduced hospital admissions 0.5% more than lower groups 1,560 fewer readmissions than expected

Summary Findings HHQI 2 Campaign was successful, engaging nearly 5,000 home health agencies Agencies used campaign materials and many adopted recommended practices Quality of care measures improved – Acute care hospitalization – Medication self-management Participation intensity linked with improvement

New Initiatives for HHQI 3 Understanding and addressing health care disparities Reaching smaller agencies Accelerating improvement

Outline HHQI National Campaigns 1 and 2 Changes in HHQI Campaign 3 How we will evaluate it How you can help

Comparison of Campaigns AttributesPhase 1: Phase 2: Phase 3: Duration12 Months18 Months22 Months ThemeACH Reduction ACH Reduction, Improvement of Oral Medication ACH Reduction, Improvement of Oral Medication, Immunizations Customized Data Reports Via USPS Mailing Via Secure Electronic Transmission Via Secure Electronic Transmission with Raw and Risk-Adjusted Data Participant Communication State-based QIOs HHQI Contractor Team HHQI Contractor Team and Grassroots Networks Local Area Networks for Excellence (LANEs) QIOs and State Associations QIOs, State Associations and Corporate Leaders The HHQI Network

Comparison of Campaigns AttributesPhase 1: Phase 2: Phase 3: Primary Resource Best Practice Intervention Packages (BPIPs) BPIPs BPIPs and Focused BPIPs Other ResourcesNone Webinar Education and Participant Social Networking Webinar Education Plus Virtual and Grassroots Social Networking BPIP PublicationMonthlyQuarterly Periodically Per Online Schedule Cost to ParticipateFree Cross-Setting FocusLimitedExtensive Special Populations Focus NoneLimitedExtensive

New Organization of Local Activities Grassroots Networks Network Coordinators Network Development Committee

More Emphasis on Eliminating Health Care Disparities Acute Care Hospitalization Rate Medicare Home Health Patients, 2010

More Topics for Interventions Flu and pneumonia immunizations – Receipt of vaccine, not just advocacy Dual eligible beneficiaries – Focused interventions

More Improvement

Outline HHQI National Campaigns 1 and 2 Changes in HHQI Campaign 3 How we will evaluate it How you can help

Evaluation Topics HHQI 3 Extent and intensity of home health agency participation in the campaign Participating agencies’ satisfaction with campaign materials and activities Improvement in campaign-related outcomes among patients of agencies participating in the campaign Reduction in disparities in health outcomes across racial groups and between dual eligible and non dual eligible patients of agencies participating in the campaign.

Outcome Measures Acute care hospitalization Improvement/stabilization in medication management Pneumonia immunization Influenza immunization Emergency department utilization (maybe)

Identifying and Reducing Disparities in Outcomes By race By gender By dual eligible status By agency size

Process Measures I Agency enrollment in campaign Agency downloads of campaign materials Number of HHQI Network Coordinators recruited Agency enrollment in HHQI Networks HHQI Networks-number of participating agencies HHQI Networks-meetings/events held

Process Measures II Agency extent of use of campaign materials Agency satisfaction with campaign materials Agency extent of participation in HHQI Networks Participation in national Web events Agency satisfaction with HHQI Networks Agency satisfaction with outcomes feedback reports

Just Downloading Isn’t Enough

Linking Processes with Outcomes Agencies with more intense involvement in grassroots networks Agencies with more use of best practices Agencies with greater satisfaction with campaign resources

Issues Externalities Respondent fatigue How to engage smaller agencies Larger changes – sustaining change

Outline HHQI National Campaigns 1 and 3 Changes in HHQI Campaign 3 How we will evaluate it How you can help

Four ways you can help the campaign succeed: Develop and test better interventions – Simple but effective interventions for small agencies Research to help us understand causes of disparities Organize or join a network Support cross institutional approaches to improving care transitions

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