Quality Management For Ryan White Parts A and B

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Quality ManagementFor Ryan White Parts A and B

• Johanne Messore
• Chief, Southern Branch, HRSA/HAB Division of
  Service Systems
• For the Feb 5-7, 2008 Administrative Overview

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Definition

• Qualitythe degree to which a health or support
  service meets or exceeds established professional
  standards and user expectations
• Evaluations of Quality should consider
• The quality of personnel resources available
• The quality of the service delivery process and
• The quality of outcomes

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QM Legislative Requirements

• All Ryan White Treatment Modernization Act
  (RWTMA) Grantees are required to establish
  clinical quality management programs.
• Quality Management was re-emphasized in the 2006
  reauthorization
• The term clinical was added in the 2006
  reauthorization to further emphasize use of PHS
  Clinical Guidelines as standard of care

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Legislative Intent

• To ensure that treatment and health related
  support services provided persons living with HIV
  disease have a positive effect on their health
  status.

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Quality Management Funding

• Part A and Part B Grantees may use 5 of their
  grant award or 3,000,000, whichever is less, for
  quality management activities.

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Grantee/Planning Body Roles

• QM is the responsibility of the Grantee
• Part of Contractual Agreement with Providers
• Grantees should provide any planning bodies
  making funding decisions with quality data by
  service category for planning purposes
• Standards of Care may be developed by the Part
  A/Part B Planning Body and/or the Grantee to be
  used in the QM Program.
• Part A Grantees at a MINIMUM should inform PC of
  plans for and results of QM program
• Part B Grantees should develop standards to be
  used for directly provided services and for
  services provided through consortia. Standards
  should be consistant throughout the state.

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Goals of a Quality Management Program

• Answer critical questions about the quality of
  care and services provided by the Ryan White
  community.
• Identify areas for improvement and
• Make changes to improve care and services.

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Characteristics of QM Programs

• Systematic process with identified leadership,
  accountability, and identified resources
• Uses data and measurable outcomes to determine
  progress toward relevant, evidence-based
  benchmarks
• Focus on linkages, efficiencies, and provider and
  client expectations in addressing outcome
  improvement
• Continuous, adaptive process that fits within the
  framework of other activities

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Quality Improvement

• May focus on individual providers rather than
  service category
• Achieves quality care through provider buy-in and
  people working in teams
• QI activities are based upon objective, measured
  data, may include process measures.
• QI provides for routine and periodic
  re-measurement of performance
• Does not need to focus on Standards of Care but
  may focus on Provider improvement, i.e, fiscal
  monitoring tools.

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Getting Started3 Goals of Clinical QM Programs

• Clinical Services adhere to PHS Treatment
  Guidelines
• How many providers in your state/EMA/TGA have met
  this standard?
• What is the goal for the FY 08 grant year?
• What needs to be done to achieve this goal?

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Getting Started3 Goals of Clinical QM Programs

• To ensure the inclusion of appropriate support
  services that contribute to improved health
  status of clients
• To identify which services are most effective in
  improving health status
• To measure how well these services achieve the
  identified goals?

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Getting Started3 Goals of Clinical QM Programs

• Use of demographic data, clinical utilization
  data and healthcare outcomes data
• What current data does the Grantee collect from
  providers consumers?
• How is that data used?
• How can you use data to improve your current
  system of care?

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Quality Basics

• Collaboration between the grantee, planning
  bodies, providers and consumers enhances the
  process
• Buy in from providers will be of great benefit
  when trying to develop and implement these
  programs.
• Buy in from consumers will aid in maintaining
  provider adherence to quality.
• Keep the programs as simple as possible and the
  goals as attainable as possible. This sets the
  scene for quick success and enthusiasm for the
  program by your partners

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Outcomes and Outcome MeasuresWhat are They?

• Outcomes are benefits or other results (positive
  or negative) for clients that occur during of
  after program participation
• Outcome measures or indicators observable,
  measurable data sets used to assess a programs
  success in reaching desired outcomes

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HRSA/HAB Expectations

• Quality is a major HRSA/HAB focus both internally
  and externally
• Grantees must develop health status outcomes and
  measures for primary medical care and other
  health related services
• Focus and ultimate goal of QM is improved client
  health status

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Outcome Measures for Primary Medical Care

• HAB Quality Measures First Group focused on
  clinical outcomes
• Five clinical measures are ARV Therapy for
  Pregnant Women CD4 T-Cell Count HAART Medical
  Visits and PCP Prophylaxis
• HAB will soon release 20 or more additional
  outcome measures for such services as ADAP, Case
  Management, Dental Care and Systems Level
  outcomes.

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HAB Quality Measures

• Grantees are encouraged to include the core
  clinical performance measures in their quality
  management plan.
• Grantees are not required to submit performance
  measurement data to HAB.
• FAQs developed as a companion guide
• http/hab.hrsa.gov/special/habmeasures.htm

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Whats in it for You?

• Use QM to improve the way services are provided
  in your program by improving the performance of
  each provider
• Fund the providers that are most efficient and
  effective in providing a service
• Eliminate services or providers that do not meet
  quality standards or show positive outcomes for
  clients

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Whats in it for You?

• Outcome data for individual service categories or
  entire systems of care can aid grantees in using
  funds more efficiently in shaping a system that
  will ultimately improve health outcomes for all
  clients.

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Need Help???

• Check the list of available resources on the
  TARGET Center at http//careacttarget.org
• Ask for TA from your project officer or the
  National Quality Center at http//nationalqualityc
  enter.org
• See the Quality Page on the HAB Website at
  http//hab.hrsa.gov