Continuous Quality Improvement (CQI) Planning. Board Training May 5, 2010

Transcription

1 Continuous Quality Improvement (CQI) Planning Board Training May 5, 2010

2 If you can t describe what you are doing as a process, you don t know what you are doing W. Edwards Deming

3 History: Planning prior to July, 2004 Incremental or Status Quo approach, characterized by pouring resources into existing services for the same client population based on previous service utilization, even though it is recognized that other groups who need a different type of service will continue to go un-served. Led to budgeting and contracts based primarily on historical service utilization and relatively hold harmless agency budgets

4 History: Planning prior to July, 2004 Mental Health & Alcohol/Drug service and population priorities are reflected in initial allocations by Service Group and via program/service specifications in the non-medicaid contract A Service Group (SG) is merely a way of categorically capturing various Board population or program and/or service priorities. examples: Youth/Family-Erie; Benchmark

5 History: Planning prior to July, 2004 In theory, funds allocated to any given non-medicaid Service Group were capped In reality, agencies were allowed maximum flexibility to shift funds among the various services within a given SG as well as to request transfers from one Service Group to another within their contract This flexibility meant that dollars followed utilization within and between agencies despite where they were allocated based on identified needs As a result, what actually ended up being reimbursed any given year was often very different than what had been planned; in other words, a get what we pay for, not what we plan for scenario

6 The Case for Change 1. Incremental or Status Quo Approaches to planning do not take into account the need to determine a direction or strategy or vision for the future. 2. Allocating resources on the basis of previous years service usage resulted in an emphasis on agency budget and staffing needs as the driver for the funding and structure of the public behavioral health system instead of community needs as the basis for priorities. 3. Precluded statutorily required central planning at the Board level as the primary driving force for the allocation of funds or for changes to the system of care.

7 The Case for Change In other words, with a finite budget the Board cannot plan for and fund a system of care based on changing priorities and or results AND based on historical service utilization and static agency budgets at the same time

8 Adoption of a New Framework The selection of a Continuous Quality Improvement (CQI) Planning model as opposed to others was deliberate because it offered the best framework to address identified issues. These included: Lack of clarity of local system priorities paramount in times of limited funds Communication with Stakeholders (Consumers, Family members, Referral Sources and others) structured means to obtain and/or incorporate input from varied sources

9 Adoption of a New Framework Need for flexibility, adaptation and innovation in service mix and delivery Need to shift the focus to the people being served Are their needs being identified? Are the right services available? Are they getting better? While providers and other service agencies are important partners, the public behavioral health system is primarily set up to serve consumers and serve as a safety net for community residents; all decisions must be driven by the best interest of those we serve, not by the interests of those of us who serve them

10 Continuous Quality Improvement (CQI) Planning The model is based on continual reassessment of the conditions and constraints that define the need for mental health and alcohol and other drug services and how they will be used to direct the plan for the system of care, including : the needs of clients, the needs of families, and the needs of the community

11 Continuous Quality Improvement (CQI) Planning the environmental and legislative context for MH and AOD prevention, treatment & Recovery support services the determination of specific service or program needs, populations and other priorities the identification of outcomes and benefits coordination and collaboration procedures

12 Continuous Quality Improvement (CQI) Planning In short, adherence to the CQI planning process weaves the golden thread from the various needs assessment processes through the determination of specific priorities for the system within current fiscal, environmental and legislative contexts

13 Continuous Quality Improvement (CQI) Planning to the translation into individual agency budgets and program requirements through routine monitoring, oversight and evaluation procedures into recommendations for system adjustments in dollars or program and/or target population priorities

14 Continuous Quality Improvement (CQI) Planning: The Golden Thread Fast forward to today What tools, processes and other mechanisms are in place to ensure the continuous part of CQI planning is occurring?...to preserve the accountability and transparency of the Board process for needs assessment and prioritization & decision-making around funding and program allocations? to balance programming and funding across the system of care and the various service and population priorities with finite resources and earmarked funding streams?

15 Continuous Quality Improvement (CQI) Planning: The Golden Thread to ensure the integration of Board values/priorities and state & federal priorities and performance targets within the context of policy and budget realities? to ensure the alignment of resources with planned service and population priorities? In other words, to get what we plan for, not what we pay for.

16 Continuous Quality Improvement (CQI) Planning Needs Assessment & Prioritization Process (Incidental) Monitoring, Oversight & Evaluation-- Agencies, ENDS, CP (Monitoring) CQI Planning Process Coordination & Collaboration (Incidental, Monitoring) Budget & Contracting Process (Decision-Making)

17 Needs Assessment and Prioritization Process Qualitative & quantitative data sources, types & strategies: Key Informants: regular and active involvement, coordination and collaboration with providers, service agencies, referral sources, and others; includes routine (but essential) & topic-focused, deliberate interactions Public Forums, Commentary: dedicated time prior to/during regular Board meetings for community input Focus Groups: targeted group feedback on specific issues Surveys: Erie Co.& Ottawa Co. Community Health Assessments; Fair Surveys (i.e. Attitudes toward Persons with Mental Illness and/or Alcohol/Other Drug Addiction )

18 Needs Assessment and Prioritization Process Demographic and Social Indicators, Penetration Rates, and other Data Sources such as: Service and fiscal utilization data Service Group Usage Reports; Agency Program Reports Access & capacity management reports Client demographics and other characteristics U.S. Bureau of Census data population demographics, poverty, households, employment, income Care Management Indicator Data (provided through OACBHA) i.e. Percentage of population employed now or student at discharge ; Percentage of clients with improved symptoms

19 Needs Assessment and Prioritization Process ENDS (Policy IV-A): Principles, Values and Organizational Purpose ODADAS & ODMH Priorities (Prevention, Treatment & Recovery Support); Investor Targets (essentially, what is being funded; should relate to the State s targets as well as address the Board s priority populations or initiatives) National Outcomes Measures (SAMHSA s federal reporting requirements for state tied to block grant funding to address accountability & performance-monitoring)

20 Coordination and Collaboration As part of the effort to develop and ensure an efficient and comprehensive system of mental health and alcohol/drug services and supports; maximize resources; and improve customer outcomes, staff of the Board regularly interacts, coordinates and collaborates with provider agencies and other community partners and stakeholders. Ongoing, timely and current feedback is obtained as a result of this routine but essential interaction and coordination with Key Informants, service and referral agencies and other community stakeholders.

21 Coordination and Collaboration Benefits derived from intersystem collaboration include: Information sharing Joint funding of particular programs or initiatives Increased understanding of the roles, barriers and opportunities relative to various systems Enhanced communication and streamlined referral protocols Consensus around community needs Identification of gaps in the service continuum Development of strategic plans to address identified community needs.

22 Coordination and Collaboration The following list serves as a brief representation of just some of the entities the board interacts with regularly: Family and Children First Councils (i.e. Fiscal, Executive and Clinical committees; ad hoc work groups, H.B. 289 Planning) Providers (i.e. Systems Integration meetings, joint meetings with stakeholders, agency specific issues and/or specialized meetings that are topic driven, such as home-based services,) Erie Co. and Ottawa Co. Health Departments Community Health Assessments, other shared planning initiatives Ottawa Co. Board of Social Concerns Consumers and General Public

23 Court Programs: The Golden Thread Coordination and Collaboration --Erie Co. Juvenile Drug Court & Erie Co. Family Dependency Court (i.e. monthly meetings, programming Seven Challenges, Case Management) --Ottawa Co. Juvenile Court (i.e. Juvenile Court Assessment Program) -- Erie Co. Common Pleas (mental health court planning, Benchmark) -- Municipal Courts various (IDAT referral/funding protocols) Elected Officials local, state County Commissioners semi-annual reports, special meetings (i.e. around submission of grants, levy) Civic groups presentations

24 Budget and Contracting Process Entire budget based on State, Federal, Local Funds The following is taken off the top: Medicaid federal portion (FFP) and the Board s match Crisis services Out of county provider Medicaid Residential placements Board administration and operating budget The remainder constitutes the Non-Medicaid dollars available

25 Budget and Contracting Process State Federal Medicaid Local

26 To illustrate the process: The Golden Thread Budget and Contracting Process TOTAL DOLLARS AVAILABLE: $9,220,000 Remove local Medicaid Portion: $9,220,000 - $2,570,000 = $6,650,000 Remove crisis services: $6,650,000 - $525,000 = $6,125,000 Remove out-of-county provider services: $6,125,000 - $901,000 = $5,224,000 Remove residential services: $5,224,000 - $462,020 = $4,761,980 Remove Board administration and operating budget: $4,761,980 - $702,000 - $132,000 = $3,927,980

27 Budget and Contracting Process Total dollars available for Non-Medicaid Services: $3,927,980 The amount left is what is available for allocation according to the Board s planning process

28 Budget and Contracting Process Service and Population Funding Priorities; Investor Targets ENDS Policy (IV-A): defines the underlying principles and beliefs supporting the determination of local priorities and the values that serve as organizational purpose principles and beliefs = environmental, political and fiscal constraints values = affirmation of population and service priorities that serve as the core focus of the system of care

29 Budget and Contracting Process Essentially, contract recommendations to the Board are a translation of these beliefs, principles and values into specific budget and programming recommendations for the system of care for a given fiscal year. At the same time, they represent implementation of identified mental health and alcohol/drug prevention, treatment and recovery support service needs, priorities and investor targets as per the applicable biennial ODMH/ODADAS Community Plan. (Fiscal & Political Constraints) + (Local, State & Federal priorities) = General System Budget and Programming + Investor Targets in Community Plan

30 Budget and Contracting Process Service and Population Funding Priorities; Investor Targets In turn, these system-level funding and service priorities are translated into individual agency allocations and program requirements through the non-medicaid contracting process. As such, each agency and provider contract serves as a piece of the whole as a means of implementing system values.

31 Budget and Contracting Process Service and Population Funding Priorities; Investor Targets Specifically, annual recommendations are made: From a system perspective (vs. an individual agency budget perspective) built around identified population and service priorities In consideration of a broader context of (a) local system development; (b) infrastructure/staffing realities; and (c) adjustments in the service continuum based on changing needs & priorities

32 Budget and Contracting Process Service and Population Funding Priorities; Investor Targets Consistent with State and federal funding mandates (i.e. SMD, Medicaid, ODMH/ODADAS certified providers) and eligibility requirements Aligned with Board values/priorities and with State and federal performance goals, investor targets and NOMS, implemented via Service Groups Data-informed Informed by ongoing review and analysis of quantitative and qualitative data

33 THE GOAL: balance programming and funding across system program & population priorities within the context of state and federal funding and policy constraints. Non-Medicaid covered services Services to persons not eligible for Medicaid

34 Monitoring, Oversight & Evaluation The Board routinely uses a variety of methods and criteria to monitor and evaluate the benefits of the system and to provide information about its goals or values (ENDS), service and program activities, outcomes, & costs, such as: Patterns of service use in the Board area, including amounts and types of services by specific client demographic and diagnostic characteristics Cost of services delivered by unit of service, service pattern, client characteristics and provider agency Consumer outcomes by treatment episode, program Access, waiting list and capacity management data

35 Monitoring, Oversight & Evaluation Results of the various evaluation activities are integrated into the CQI planning process and inform individual service/program decisions as well as the development of and changes to the overall continuum of care

36 Monitoring, Oversight & Evaluation The board works with providers and others to continuously review, refine and amend the process and methods used in our system evaluation efforts, addressing issues such as: what data or information is collected how various data & information is reported; timelines use of data and information dissemination of program & service information for the system This is an important component of the system CQI process as we work collaboratively to develop useful reporting and monitoring report formats and timelines while minimizing unnecessary administration.

37 Monitoring, Oversight & Evaluation Alignment and integration of both the format and content of data and information used in conjunction with the various components of our planning process, from needs assessment and prioritization through budgeting and contracting to the mechanisms for monitoring such as: (a) procurement (Request For Information) and contracting (Program Attachment 1: Appendix to Agency contract) (b) routine agency reporting to the board (i.e. quarterly program reports) (c) Agency and System Progress Reports (ENDS monitoring, Impacts relative to General System Budget/Programming) (d) Community Plan

38 Monitoring, Oversight & Evaluation Progress Reports Monitoring of outcomes, performance, service/fund utilization & other factors occurs via the ongoing CQI planning process and is routinely reported to the Board via the quarterly Agency and Board/System Progress Reports Specifically, these reports serve as monitoring tools for the evaluation of: General System Budget & Programming (system-level funding and service priorities, implemented via Service Groups and program requirements in provider contracts) Board Values/ENDS (locally defined beliefs, principles and values) Community Plan (Investor Targets)

39 Monitoring, Oversight & Evaluation Progress Reports Board System Report Impact of and/or progress toward implementation of funding priorities, planned service/program goals and performance expectations Planned Services/Programs by Population (Service Group) Fiscal Fund Utilization (Contract Caps, Revenue Mix) Outcomes and Performance Targets

40 Monitoring, Oversight & Evaluation Progress Reports Agency Reports Impact of and/or progress toward implementation of systemlevel funding and service priorities as translated into individual agency contract allocations and program/service requirements Contract Compliance Information on key Fiscal, Program, Reporting & Administrative Requirements Program/Service Requirements (i.e. specified # of group cycles or programs to be offered, staffing expectations) Actual vs. projected service goals (i.e. # of persons served, units of services provided) Outcomes

41 Monitoring, Oversight & Evaluation The feedback and integration of information at each point in the planning cycle helps to ensure that continuous quality improvement occurs. Info/data on needs & priorities, outcomes Qualitative & quantitative info on fiscal /service usage Info/data continuously obtained, shared, analyzed Board deliberated and approved General System Budget & Programming Funding/Service adjustments across system of care Determination of future program/pop. priorities Translation into agency contract requirements Reflected in system goals or values (ENDS) & Investor Targets (Community Plan) Adjustments to methods/criteria for monitoring and evaluation

42 Continuous Quality Improvement (CQI) Planning In summary, the activities related to planning that occur on a daily basis--- informal and formal opportunities for community feedback; regular collection, analysis and use of data and other information to monitor service delivery and outcomes and inform practice; focused reviews and response to identified issues; flexibility and adjustments to system funding and/or programming in response to changing needs or other data related to efficiency and effectiveness; and explicit and open deliberation and decision-making processes ---are regularly incorporated into the process used by the Board to determine its most important investment areas.

43 Taken together, these components comprise our efforts to provide a community behavioral health care system that is responsive, flexible and outcome-oriented and is based on the changing needs of the communities and the persons experiencing mental health, alcohol and/or drug addiction problems.