1. Leiza Johnson, BSN, RN
NH Quality Improvement Specialist
Mountain-Pacific Quality Health
Alaska state hospital & nursing home association chief nurse executive meeting December 2017

2. Mountain-pacific quality health
Serve as the Medicare Quality Innovation Network- Quality Improvement Organization (QIN-QIO) for Alaska
Five offices: Alaska, Hawaii, Montana, Wyoming and Guam
Contracted by the Centers for Medicare & Medicaid Services (CMS) to achieve the triple aim: 1) better care 2) better population health 3) lower costs
We have expert staff who facilitate various quality improvement projects across the state

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

4. OUR ALASKA TEAM IS…
STRONG
DIVERSE
DYNAMIC
EXPERIENCED

5. 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 Coodination
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

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

7. Reducing ADEs Screen patients in outpatient settings to prevent ADEs
Track/ monitor ADEs
Provide tools for ADE education
Engage/ empower patients in their own care & medication management
Three high-risk drug classes:
Anticoagulants
Opioids
Diabetic agents

8. Leiza Johnson nursing home project
Establish 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 goals for this work:
Enrollment target: 35% of all Alaska nursing homes
Composite score of <6 target:
Rolling targets of 15%, 25%, 45% and 50% of nursing home partners achieving target by established dates (2016, 2017, 2018)
Antipsychotic use reduction target:
Reduction in rate (RIR) from baseline targets established of 3%, 9%, 15% and >15% each year (3% RIR by March 2016, etc.)
Note: Alaska has failed this measure the past two quarters.

9. Project goals
Exceeded Goal!
Exceeded Goal!

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

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

12. Sample composite report state of Alaksa

13. State of Alaska QMs

14. Current status Alaska vs. Mountain-Pacific’s other states vs
Current status Alaska vs. Mountain-Pacific’s other states vs. national rates
Quality Measure
Alaska
Sept.
Aug.
Montana
Wyoming
Hawaii
Nation
11/9/17
Antipsychotic Use
11.15
10.33
14.49
12.64
6.80
15.9
Incontinence
41.41
37.63
44.36
41.94
46.82
47.6
Late Loss ADLs
16.26
15.03
14.97
15.62
13.33
18.3
Pain
28.42
28.08
13.17
13.29
6.56
5.9
State Average
9.03
8.65
8.90
8.40
5.94
N/A
Goal for all measures is <6. ANHTs have chosen Antipsychotic Use, Incontinence, Late Loss ADLs and Pain as QMs to focus on at the state level.

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

16. Thank you for your time!
Developed 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-C