ddrs advisory council august 21, 2019 2019 ddrs... · advance self-direction and community...
TRANSCRIPT
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DDRS Advisory Council
August 21, 2019
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Welcome and Today’s Agenda
• Welcome and Introductions
• NCI Update and Connection with Living Well
• New Mortality Review Platform
• BDDS Communication Material Review
• System Re-Design Updates
• Next Meeting: September 18th
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Using
National Core Indicators (NCI)
for Quality Assurance
DDRS Advisory CouncilAugust 21, 2019
Presented by:Shelly Thomas, Assistant Director, Bureau of Quality Improvement Services
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What is NCI?• NCI is a collaborative effort between the
National Association of State Directors of Developmental Disabilities Services (NASDDDS) and the Human Services Research Institute (HSRI).
• Supports state agencies in gathering a standard set of performance and outcome measures that can be used to track their own performance over time, to compare results across states, and to establish national benchmarks.
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NCI Surveys
In-Person Survey (IPS)
Adult Family Survey
Family/Guardian Survey
Child Family Survey
Staff Stability Survey
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NCI in Indiana
Staff Stability Survey • 2015
• 2016
• 2017
• 2018 (report coming!)
In-Person Survey (IPS) • 2012-13
• 2013-14
• 2014-15
• 2015-16
• 2016-17
• 2017-18
• 2018-19 (report coming!)
*Indiana’s NCI reports are available on the BQIS webpage.*National NCI reports are available at www.nationalcoreindicaators.org
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In-Person Survey
• IPS has more than 100 standard measures (or ‘indicators’) used across states to assess the outcomes of services provided to individuals with Intellectual and Developmental Disabilities (IDD).
• Indicators address key areas of concern including employment, rights, service planning, community inclusion, choice, and health and safety.
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In-Person Survey• Face to face conversation
• Only adults 18 and older
Indiana’s 2017-18 average age = 34 yrs
• Individuals must receive one service in addition to Case Management
• Currently Indiana only surveys individuals on the Family Supports (FS) and Community Integration and Habilitation (CIH) waivers
• A statistically valid random sample is implemented for the survey
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Staff Stability Survey
• On-line survey of provider agencies supporting adults (age 18 and older) with IDD.
• Collects comprehensive data on the Direct Support Professionals(DSPs) related to volume, stability, compensation, and benefits.
• Assists states in benchmarking workforce data to those of other states so they can measure improvements made through policy or programmatic changes.
• Currently Indiana only surveys waiver providers.
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How has Indiana used NCI Data?
• Comparisons to National Average
• Annual Trends
• CMS Waiver Requirements
• Quality Assurance/Improve Services
• Reports to State Legislatures
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What we have learned
• Individuals participate but are not provided any feedback
• Providers who complete the survey invest a large amount of resource into the project
• Many providers do not participate
• Data needs to be shared continually with all stakeholders in a variety of modalities
• Data needs to be used for measuring improvement and quality
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How can we make better use of this information?
• CMS Waiver Performance Measures• Assessing compliance with the Settings Rule• Using the data to support policy and
legislative changes• Improving quality assurance – Living Well
Grant
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Education, Engagement,
& Empowerment
Supports & Services
Quality
Metrics
Well-Informed
Individuals and Families & Good Life Outcomes
Waiver Re-Design
Living Well
Aligning Living Well and Waiver Redesign
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Alignment Approach
Charting the LifeCourse Principles
All people have the right to live, work, play, and love in their community
Policy Intentions
Promote person-centered thinking
and practice, comply with setting rule, & promote efficiency
Collaborative Thought and
Action
Collaboration with state staff
throughout, but also with CMS, service recipients, their
families, and providers
Find balance between our best intentions to advance self-direction
and community integration with the
discipline needed to field an efficient, equitable, and effective system
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Identifying Areas of Impact
Increase Person-Centered Planning
Increase Person-Centered Planning
Improve Coordination of Care
Increase Community Engagement
Enhance Member Experience
Maintain Qualified Providers
Comply with HCBS Rule
Promote Efficiency
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Sharpening Our Focus
• Comprehensive Compliance Oversight*• Preventative• IR• Complaint
• Quality Metrics / Outcomes of Services Defined
• Education of System to achieve “good life”• Choice• Active, Informed Decision Making
• Supporting Providers and Case Managers / Community Monitoring
A System that Supports the
Individual as the Primary Driver of their Life and the
System as a Whole
• Purpose of Reporting• CMS Requirements • Research• How things are documented if not critical
• How it informs• Plan development• Risk needs• Supports
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Sharpening Our Focus:
Initial Action Steps
Define Quality Metrics• What Indiana Currently Does Around Quality Metrics
• CMS Quality Assurances
• National Core Indicators
• Based on Our Good Life Vision, What Are Three Outcome Areas We Would Want to See Impacted by Our Work?
• Within Those Outcome Areas, How Would We Define and Measure Progress?
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Identifying Areas of Impact
Self Advocates
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Identifying Areas of Impact
Case Managers
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Identifying Areas of Impact
State Staff
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Identifying Areas of Impact
Providers
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Focused Areas of Impact
• Informed Choice
•Social Connectivity
•Employment
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Connecting NCI Data and Living Well
Example: Employment
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59.0%
41.0%
IPS 2017-18Gender N=739
Male
Female
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0%1% 11%0%
85%
1%1%1%0%
IPS 2017-18Race/Ethnicity N=739
American Indian or Alaska Native
Asian
Black or African American
Pacific Islander
White
Hispanic/Latino
Other race not listed
Two or more races
Missing
Dont Know
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82% of respondents have Mild or Moderate ID
IPS 2017-18N=739
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IPS 2017-18N=739
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78%
22%
Has a Job in the Community (%): INDIANA (N = 614)
No Yes
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54%40%
6%
No job in community but would like one (%): INDIANA (N = 432)
No
Yes
In between
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74%
26%
Has community employment as a service goal, among those with no job but would like a job, (%): INDIANA (N
= 190)
No
Yes
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Potential Applications to Living Well
• Prioritize this population (not employed, want
a job, no goal)
• Investigate case manager practices related to
goal setting and person-centered practices
• Consider exploration/education opportunities
for the 54% that state they have no job and
don't want one
• Establish benchmarks/metrics to assess
improvement
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Potential ways to use NCI Data
• Ensure individuals understand the importance of participating in the survey
• Supported Decision Making (SDM) – utilize NCI data to promote the need for SDM
• Include NCI tidbits in communications to stakeholders
• Present NCI information and data to advocacy groups
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Potential ways to use NCI Data
• Establish a dedicated webpage for sharing of NCI data in a variety of formats
• Develop education and technical assistance based on the data
• Share Staff Stability with other divisions of state government – potentially to increase funding of DSPs
• Use Staff Stability data to develop training/technical assistance for provider agencies
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For more information:
Indiana’s Living Well Grant CoordinatorGeena LawrenceDirector of Provider [email protected]
Indiana’s NCI CoordinatorShelly ThomasAssistant DirectorBureau of Quality Improvement [email protected]
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Review:
New Mortality Review Platform
Jessica Harlan-York
BQIS Director
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Clarity Mortality Review
• Operated/housed by BQIS Quality Vendor Advocare
• Goal: Ease the mortality review process for providers, as well as emphasizing timely identification of others at risk, and ensuring protective measures are in place.
• New IT platform; not a new mortality review process
• No change in rules, regulations, or requirements are being added
• Testing with a provider before full implementation
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BDDS Communication Material:
Review and Discussion
Cathy Robinson
BDDS Director
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New BDDS Communication Materials
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System Re-Design Updates
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System Re-Design Updates
• Waiver Re-Design
– Review New Service Definition Options
– Update on SFC Recommendations
• Employment Array
• Institutional Modernization
• Living Well
– Review Steering Committee Meeting
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Waiver Re-Design Timeline
04/2019 05/2019 06/2019 07/2019 08/2019 09/2019 10/2019 11/2019 12/2019 01/2020 02/2020 03/2020
04/2020 05/2020 06/2020 07/2020 08/2020 09/2020 10/2020 11/2020 12/2020 01/2021 02/2021 03/2021
Task 1 –Convene Kick-Off Task 2 – Research: Indiana Context
Task 3 – Research: Innovation
Task 4 – Findings/Outline Approach Stakeholder Feedback
Task 5 – Final Concept Paper
04/2021 05/2021 06/2021 07/2021 08/2021 09/2021
Task 6 – Waiver Development
Task 7 – Waiver Finalization
Stakeholder Feedback and Public Comment
Initial HSRI & Milliman Meeting – Regular Meetings Scheduled
on On-Going Basis
Milliman Rate Methodology Development
Concurrent Rate Methodology Public Comment
Concurrent CMS Review Period
FSW / CIHW Renewal Development and Public
Comment
FSW / CIHW Renewal Submission to CMS and Review Period
Renewals
Begin
For Discussion Purposes – Timeline Subject to Change
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Service Definition Options &
Considerations
• Assistive Technology / Remote Supports
• Homemaker / Personal Care
• Housing Counseling
• Mentorship
• Parenting Support
• Retirement Services
• Socialization and Sexuality Education
• Supported Living Coaching
• Wellness Services
• SFC Workgroup Recommendations
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Sharpening Our Focus
• Comprehensive Compliance Oversight*• Preventative• IR• Complaint
• Quality Metrics / Outcomes of Services Defined
• Education of System to achieve “good life”• Choice• Active, Informed Decision Making
• Supporting Providers and Case Managers / Community Monitoring
A System that Supports the
Individual as the Primary Driver of their Life and the
System as a Whole
• Purpose of Reporting• CMS Requirements • Research• How things are documented if not critical
• How it informs• Plan development• Risk needs• Supports
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DDRS Advisory – Next Meeting
• Next Meeting:
– Wednesday, September 18th
– 10:00 am - Noon
– Indiana Government Center
– Topics Include:
• Guest Presenter: Jan Kulick, ISDH Director of Survey
Supports and Guidance
• First Steps Quarterly Update