The HHQI National Campaign Phase 3

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Slide 1

The HHQI National Campaign Phase 3

Looking Forward and Building on Past Successes

Charles P. Schade, MD, MPH
West Virginia Medical Institute (WVMI)

Images: Two photographs show caregivers with elderly persons.

Slide 2

Disclaimer

The analyses upon which this publication is based were performed under Contract Number HHSM-500-2011-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-8.15.12. App. 8/2012.

Slide 3

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.

Slide 4

Outline

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

Slide 5

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.

Slide 6

Recent Growth of Medicare Home Health Services

Image: A bar graph shows the number of persons served (in thousands) and payments (in millions) from 2000 to 2010. While the number of persons served rises slightly during this period, payments increase sharply from ~7,000 million to nearly 20,000 million.

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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.
• 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.

Source: Centers for Medicare & Medicaid Services (CMS), Home Health Compare: http://www.medicare.gov/homehealthcompare/About/What-Is-HHC/What-Is-HHC.aspx.

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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.

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Outline

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

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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.

Slide 11

Acute Care Hospitalization Rate
Participants and Non-Participants

Image: A line graph compares acute care hospitalization rates for participants and non-participants from January 2004 to October 2007.

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Percent of Agencies Using Specific BPIPs* and Improvement in ACH**

Image: A bar graph shows the following improvements or worsening for packages used:

Hosp. Risk Assessment:

• Better, 71.1.
• Little Change, 78.2.
• Worse, 74.4.

Emergency Plan:

• Better, 63.2.
• Little Change, 70.9.
• Worse, 66.7.

Medication Management:

• Better, 76.3.
• Little Change, 52.7.
• Worse, 46.2.

Phone Mon. Frontloading:

• Better, 63.2.
• Little Change, 61.8.
• Worse, 564.

Teletriage:

• Better, 28.9.
• Little Change, 29.1.
• Worse, 15.4.

Telemonitoring:

• Better, 42.1.
• Little Change, 30.9.
• Worse, 30.8.

Physician Relationships:

• Better, 31.6.
• Little Change, 27.3.
• Worse, 15.4.

Fall Prevention:

• Better, 71.1.
• Little Change, 63.6.
• Worse, 56.4.

Patient Self Management:

• Better, 50.
• Little Change, 45.5.
• Worse, 35.9.

Disease Management:

• Better, 50.
• Little Change, 41.8.
• Worse, 33.3.

Transition Care Coordination:

• Better, 21.1.
• Little Change, 21.8.
• Worse, 17.9.

*Best Practice Intervention Packages.
**Acute care hospitalization during home care.

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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.

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Lessons Learned HHQI 1

• Focus on fewer packages.
• Address management concerns.
• Statewide involvement.
• Success stories help.
• Multiple channels for education.
• User instruction on BPIPs.

Slide 15

HHQI National Campaign 2 (2010-2011)

• 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.

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Acute Care Hospitalization Rate

Image: A line graph compares percentage of acute care hospitalization rates for respondents, downloaders, participants, and non-participants from January 2009 to October 2010. A red arrow notes the point at which BPIP was released, in January 2010.

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Medication Management Improvement

Image: A line graph compares percentage of acute care hospitalization rates for respondents, downloaders, participants, and non-participants from June 2009 to December 2010. A red arrow notes the point at which BPIP was released, in March 2010. A yellow note is superimposed over the graph, stating "No data due to OASIS-B to OASIS-C conversion."

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Changes in ACH and ALOS by Participation Intensity Quartile

Image: A bar graph compares percentage of agencies that increased/decreased their acute care hospitalization (ACH) rate per quartile:

ACH Rate Improved:

• First Quartile, 52%.
• Second Quartile, 54%.
• Third Quartile, 56%.
• Fourth Quartile, 66%.

ALOS* Decreased:

• First Quartile, 46%.
• Second Quartile, 49%.
• Third Quartile, 51%.
• Fourth Quartile, 63%.

Average length of service for home health patients in agency.

Slide 19

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 participation quartiles averaged 1,600 episodes/year.
• These HHAs reduced hospital admissions 0.5% more than lower groups.

→

1,560 fewer readmissions than expected.

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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.

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New Initiatives for HHQI 3

• Understanding and addressing health care disparities.
• Reaching smaller agencies.
• Accelerating improvement.

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Outline

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

Slide 23

Comparison of Campaigns

Slide 24

Comparison of Campaigns

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New Organization of Local Activities

Image: At the center of the figure is a circle captioned "Network Development Committee"; a red arrow labeled "Network Development Committee" also points to this circle from the outer edge of the figure. Around the "Network Development Committee" is another, larger circle captioned "Network Coordinators"; a red arrow labeled "Network Coordinators" also points to this circle from the outer edge of the figure. Around these central circles are five circles, all captioned "Grassroots Networks"; a red arrow labeled "Grassroots Networks" also points to one of these circles. A large circle captioned "Campaign Participants" encompasses all the smaller circles.

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More Emphasis on Eliminating Health Care Disparities

Image: A bar graph shows acute care hospitalization rates for Medicare home health patients by race:

• White: 26.2%.
• Black: 32%.
• Others: 25.9%.

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More Topics for Interventions

• Flu and pneumonia immunizations.
  • Receipt of vaccine, not just advocacy.
• Dual eligible beneficiaries.
  • Focused interventions.

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More Improvement

Image: A bar graph shows acute care hospitalization rates (percent) for HHQI National Campaign respondents by number of agencies, for 2009 and 2010.

2009:

• 0-8% - 1 agency.
• 8-16%- 13 agencies.
• 16-24% - 98 agencies.
• 24-32% - 143 agencies.
• 32-40% - 74 agencies.
• 40-48% - 29 agencies.
• 48-56% - 15 agencies.
• 56-64% - 6 agencies.

2010:

• 0-8% - 1 agency.
• 8-16%- 18 agencies.
• 16-24% - 106 agencies.
• 24-32% - 146 agencies.
• 32-40% - 63 agencies.
• 40-48% - 28 agencies.
• 48-56% - 14 agencies.
• 56-64% - 4 agencies.

A bell curve and a red arrow pointing left also appear on the graph.

Slide 29

Outline

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

Slide 30

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.

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Outcome Measures

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

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Identifying and Reducing Disparities in Outcomes

• By race.
• By gender.
• By dual eligible status.
• By agency size.

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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.

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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.

Slide 35

Just Downloading Isn't Enough

Image: A graph shows changes in ACH rate (percent) by number of topics.

Slide 36

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.

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Issues

• Externalities.
• Respondent fatigue.
• How to engage smaller agencies.
• Larger changes—sustaining change.

Slide 38

Outline

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

Slide 39

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.

Slide 40

Questions? Comments?

Thank you for coming to this presentation.

Contact information:
http://www.homehealthquality.org
cschade@wvmi.org

Slide 41

Image: The HHQI logo is shown.