Public Health Approaches to QI Projects Integrating the Health Care Delivery

11/9/2015
Integrating the Health Care Delivery
System and Public Health
Rebecca Nevedale
Judy Shaw, EdD, MPH, RN
Peggy Stemmler, MD
Barbara Wirth, MD, MS,
NIPN Annual Meeting  November 9-10, 2015
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Public Health
Approaches to QI
Projects
Welcome to a Parallel Universe
Rebecca Nevedale
Manager, Health System Strategy
The FrameShift Group
Best Care for Kids
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Who’s in the room?
• Work for a health department
• Work for a government agency that is not a
university
• Working on QI in public health
• Comes from an “accredited” state
Welcome to a Parallel Universe
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Why is Public Health SOOO different?
Immunization Financing System
317
State $ - NOT
AHCCCS
Uninsured
VFC
CDC
Providers
Co-pays
Kids Care
Schools
Pvt Insurance
ACA
?
Underinsured
ADHS
IHS
FQHCs
County $ - NOT
Pts
-Dr. Bob England, Maricopa County Public Health
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Organizational culture
Assurance VS Improvement
• Checking boxes
• Following Protocol
• Having changes happen to them
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The Role of Partnership (and how
to QI it)
Other opportunities for “new QI”
• Meetings (and meetings… and meetings… and
meetings…)
• Summits (and summits… and summits….)
• Policy
• Our existing competencies:
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•
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Departmental procedures
Clinical integration
Driver diagrams
Data – the right kind!
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State Implementation Grants for
Enhancing the System of Services
for CYSHCN through Systems
Integration (SIG)
BARBARA WIRTH, MD, MS
PROJECT DIRECTOR
NATIONAL ACADEMY FOR STATE HEALTH
POLICY
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National Academy for State Health Policy
26-year-old non-profit, non-partisan organization
with offices in Portland, Maine and Washington,
D.C.
Academy members:
 Peer-selected group of state health policy leaders
 No dues—commitment to identify needs and
guide work
Working together across states, branches and
agencies to advance, accelerate and implement
workable policy solutions that address major
health issues
www.nashp.org
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State Implementation Grants (SIG)
 Three year project 9/2014 – 10/2017
 Funding for States from Maternal and Child
Health Bureau (MCHB), Health Resources
and Services Administration (HRSA)
 Technical assistance provided through
NASHP and NIPN
SIG Goal and Objective
Goal:
Achieve a comprehensive, coordinated
and integrated state and community system of
services and supports for CYSHCN.
Objective:
By 2017, increase the proportion of
CYSHCN who receive integrated care through
a patient/family-centered medical/health
home approach by 20% over 2009/2010 levels.
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State Implementation Grants
 Twelve states completing three year project;
four states joining in year 2 and 3
 Convene and work with key partners
including Title V, Medicaid, families, heath
officials, providers, evaluators and others
 Emphasis on quality improvement and
collaborative innovation within a cross-state
learning community
Participating SIG States
16 States: AK, CO , CT, IA, IN, KS, MA, MN, MS, NJ, OR, RI, UT, VT, WA, WI
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“CoIIN-like” Model
“
Collaborative Improvement and Innovation Network
Critical elements:
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Collaborative Learning
Common, Coordinated Strategies
Measurable Outcomes
Continuous Rapid Cycles of Change
Supporting the SIG States Year 1:
Systems Integration Academy (SIA)
 Convened states within a learning community:
 In-person Meeting
 All State Calls
 Monthly Strategy Team calls with worksheets
 Common shared platform “SIA GroupSpace” and Digest
 Calls with Team Leads and Evaluators
 Supported three Strategy Teams to develop Aim
statements for following common strategies:
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Cross systems Care Coordination
Integration
Development or Expansion of Shared Resource
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Agreement on Common Aim Statements
 Cross-Systems Care Coordination: By October 2017,
increase by 20% over baseline - or, for states starting with a
baseline of 0, achieve 20% - the % of targeted CYSHCN who have
a Shared Plan of Care.
 Integration: By October 2017, an agency-level written
agreement will be developed between two or more state, or
regional-level entities to improve the timely receipt
of information following the initial referral of a CYSHCN by a
medical home.
 Shared Resource: By October 2017, 50% of families and
medical home providers of CYSHCN contacting the shared
resource (SR) for a needed specialist, support or service will
obtain a needed specialist, support, or service
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Aim Measures, Drivers and Activities
 Measure/Method to Assess Progress towards Aim
 Original intent: common measure for each Aim
 States now selecting their own outcome measure or interim
measures and the method to collect
 All Three Strategy Teams agreed upon common set
of Drivers (5-6) for their different Aims
 State Activities to impact Drivers
 States select own activities to impact Drivers and use QI
approach to report monthly (BAR/AAR or PDSA)
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Lessons Learned
 Creating a Virtual Learning Community with Cross-
state Strategy Teams
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Engage key partners within the states on teams
Recognize varied resources and priorities for states
Engage in activities between convenings – keep process moving
 Applying a QI Methodology
 Acknowledge state agencies may need support to understand
QI methodology
 Reinforce how QI differs from previous experience with federal
evaluations and a focus on accountability
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