Public Health Solutions HIV Care Services (HIVCS)
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Transcript of Public Health Solutions HIV Care Services (HIVCS)
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Public Health SolutionsHIV Care Services (HIVCS)
Subcontractor Site Visits 2011February 8, 2011
Bettina Carroll Director for Programs and Contract Management
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HIVCS’ “Charge”
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HIVCS Contract Monitoring
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Service Verification - Site Visits
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Types of Site VisitsVisit Type Contract Reimbursement Methodology
Cost Performance Deliverables
Initial X X X
Routine X X X
Fiscal X X* X*
(Performance-based) Reimbursement Documentation
X
(Expenditure) Support Documentation
X
Single Payer Verification (SPV)
X
RW Payer of Last Resort (POLR)
X X
RW PCSMs X X X
Technical Assistance X X X
Event/Occurrence X X X
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Arranging a Site Visit
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What should you expect at a site visit?
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Who needs to attend the site visit?Visit Type Program Staff
Program Director Fiscal Director
Initial X X
Routine X X
Fiscal X* X
(Performance-based) Reimbursement Documentation
X X
(Expenditure) Support Documentation
X* X
Single Payer Verification (SPV)
X X
RW Payer of Last Resort (POLR)
X X
RW PCSMs X
Technical Assistance X* X*
Senior Administrator is usually only present for the Entrance and Exit Conferences
Billing Department staff may be needed for POLR and SPV visits
*Shared responsibility specific to PB contracts and/or dependent on nature of TA
After the entrance conference, staff are not required to be present while HIVCS reviews are conducted
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Improved Coordination of Site Visits
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DOHMH
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AIDS Institute Quality ProgramSite Visits/Performance Reviews
Dan Belanger, Director, New York State Quality ProgramTracy Hatton, Director, Part A Quality Management Program
February 8, 2011
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Quality Management Program
NYSDOH AIDS Institute Quality Program experience:
– Clearly defined HIV quality of care clinical indicators for adults and adolescents
– Clinical Advisory Committee of New York State experts refine clinical indicator definitions to reflect current standards
– Annual quality indicator reviews (ehivqual) at 200 HIV ambulatory care facilities throughout New York State, including New York City
– Organizational Assessments conducted at HIV clinics throughout NYS
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ORGANIZATIONAL ASSESSMENTS
Assess the program’s capacity to effectively manage and improve the quality of care and evaluate the element necessary for an effective quality improvement program:
Organizational leadership Program infrastructure Staff participation and buy-in Resources allotted to QI
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Organizational Assessment Tool
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Organizational Assessment (OA)
AIDS Institute staff and quality consultants conduct an assessment of these elements and then work with programs /organizations to develop a capacity-building plan to address any elements that need strengthening.– Offer recommendations to inform:
• Areas for Improvement• Annual Goals• Capacity building
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Elements of the OA
Quality Structure Quality Planning Quality Performance Measurement Quality Improvement Activities Staff Involvement Consumer Involvement Evaluation of Quality Program Clinical information Systems
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Organizational Assessment Process Contact in advance of scheduling to outline the purpose and
goals of assessment; On site interview conducted by AI quality staff with key
representatives from programs (medical director, program director, QI staff person, administrator, program staff, consumer)
Assessment should include brief listing of recommendations for program
Collect any examples of best practices, QI projects, quality plans
Written feedback sent to participants after completion of OA
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Part A Performance Measurement Program
Currently reviewed programs:
Mental Health Care Coordination Supportive Counseling Tri-County Medical Case Management Harm Reduction Food and Nutrition Early Intervention Services
Chart reviews conducted by IPRO/NYCHSRO
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Performance Review Process
Indicators Developed
Review planned with providers
Data collection strategy developed
Case List requested from each program
Sampling plan derived from facility case size
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Performance Reviews-On Site Activity
Review date scheduled (generally 2-4 days)
List of records to be reviewed requested (review sample)
Entrance interview conducted at program site
Charts/records reviewed by professional analysts on site
Exit interview conducted when reviews complete
Data scored according to indicators
Performance measurement reports prepared—both aggregate and facility specific results
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Using Performance Measurement
Prioritizing areas for improvement Identification of common issues through
performance data Measuring progress Benchmarking and goal setting to improve the
care for PLWHA in NY EMA-not about measurement, about improvement!
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Comments
What suggestions do you have?
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Contact Us
Daniel R. Belanger, LMSWNew York State HIV Quality Program [email protected]
Tracy HattonPart A Quality Management [email protected]