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Implementing Patient-Centered Quality Metrics in Medicaid Plans

Published on January 22, 2019 at patientengagementhit.com.


As the healthcare industry continues to embrace value-based payment models that reimburse based on care quality and patient satisfaction, state Medicaid plans are beginning to follow suit.

These programs, which cover nearly 72 million patients nationwide, are state-operated and therefore have flexibilities when implementing value-based care and patient-centered care initiatives. Through CMS waivers, Medicaid agencies can design the value-based care programs that fit the specific needs of their patient populations.

In Tennessee, those efforts are already underway. TennCare, the state’s Medicaid agency, has begun one value-based care program targeted at adding value to its long-term care services and nursing home care. The Quality Improvement in Long Term Services and Support (QuILTSS) program looks at how the state reimburses nursing homes based on key clinical quality measures.

“We launched an initiative several years ago called QuILTSS, or Quality Improvement in Long Term Services and Support,” Patti Killingsworth, the assistant commissioner and chief of Long Term Services and Supports for TennCare, said in an interview with PatientEngagementHIT.com. “Which is really about aligning the way that we paid for long term services and support with quality.”

In other words, QuILTSS looks at different factors that constitute a valuable care experience and engages those organizations in quality improvement. Those organizations’ reimbursements depend on quality care and improvement activities.

“The reason for collecting the data really are about helping improve quality of care and quality of life for people who receive nursing facility services,” Killingsworth added. “And we’ve defined quality in ways that are important to the people who receive their services.”

To achieve those ends, TennCare first had to determine which quality measures it would collect and analyze. Central to this was determining which quality measures were important to the patients themselves. After all, it is the patient who is the first consumer of healthcare and who ultimately makes the decision about their own care.

“We conducted stakeholder forums in nine different locations across the state,” Killingsworth reported. “We had forums with people who received services and their family members. We also had forums with providers and advocacy groups, because they’re sort of stakeholders.”

Ten days, 18 meetings, and over 2,000 miles of travel later, TennCare was able to leverage this stakeholder input into tangible quality measures. Through structured interviews that generated hard data, TennCare and its colleagues in the nursing home and patient advocacy sectors developed quality measures that are valuable to patients.

That three-month process resulted in a quality framework characterized by patient satisfaction and patient-centered care principles.

“This included patient satisfaction, their family members’ satisfaction, and the satisfaction of staff who work for providers because happy staff do a better job of providing care,” Killingsworth said.

“The second key measure is really around culture change and quality of life,” she continued. “Changing care in ways that truly improve people’s day to day lives is essential.”

Staff competency and clinical performance are also key QuILTSS measures, according to the TennCare website.

Next, TennCare needed to put these quality measures to work. How were different facilities going to collect this information, send it to the Medicaid agency, and use the data to make quality improvements?

TennCare partnered with NRC Health, a health IT vendor that specializes in consumer and patient experience intelligence tools. The tool will help TennCare standardize its approach to collecting patient-reported outcomes measures at various nursing homes. This will ensure that every nursing home is measuring patient satisfaction in the same way, Killingsworth explained.

“Then we’re able to compare their performance against a benchmark and know if we’re improving on each of those measures over the course of time,” Killingsworth explained. “That includes both on a statewide basis and on a facility-by-facility basis. Then we can take into account what we’re paying nursing facilities and calculating the amount of pay that they will receive, as well as the level of performance they’ve been able to demonstrate in each of these areas.”

But the job isn’t over yet, Killingsworth said. TennCare will administer the patient surveys in January and February 2019, and from there different care facilities will receive care quality data, analyze the results, and begin improvement projects.

“It really is about actionable information, so every facility will receive their own facility-specific report,” Killingsworth said. “Our survey vendor will conduct sessions to help them understand how to interpret their data. But the most important part is that they will also help nursing home facilities then understand how to use the data to drive quality improvement.”

The patient satisfaction and care quality surveys also come complete with tools to train nursing home facilities in creating quality improvement plans in the areas that the survey deemed most pertinent.

“The great thing is that we’ll do the exact same survey a year out,” Killingsworth continued. “Then we’ll be able to measure how successful we were in actually driving that quality improvement. Do facilities need to focus on a certain area of improvement again? Do they need to focus on other areas?”

“We’ll also measure performance on a statewide level on an ongoing basis,” she added. “And that will help us to know if, over the course of time, we’re continuing to improve quality in these areas that people have said matter most to them.”

Ultimately, this will help TennCare institute value-based care across the state. And by looking at clinical quality measures that are important to patients, the Medicaid program hopes that this new program will drive patient satisfaction and value for healthcare consumers.