By Jessica Briefer French
Editor’s note: The SCAN Foundation, The John A. Hartford Foundation, the Administration for Community Living, the Gary and Mary West Foundation, the Marin Community Foundation and the Colorado Health Foundation have united to fund a three-year grant to develop and establish the Aging and Disability Business Institute, housed within n4a. Under the grant, ASA and n4a are collaborating on a series of articles and case studies in Aging Today that will help to prepare, educate and support community-based organizations and healthcare payers to provide quality care and services. Across the country, budget shortfalls have put pressure on state Medicaid programs that provide most publicly funded long-term service and supports (LTSS). Simultaneously, many people are unprepared for the expenses related to aging and for their probable need for LTSS.
NCQA’s LTSS Accreditation programs help MCOs and CBOs work together in this changing landscape to provide person-centered, integrated care for people with complex needs and to ensure that organizations offering LTSS safeguard patients’ rights and continuously improve quality. When considering measuring quality for individuals with complex needs, NCQA strove to keep the person at the center of the critical processes of assessment and care planning.
NCQA has followed two tracks. The first involves working with organizations to build the structures and processes they need to deliver person-driven care and services, and to generate the data required to calculate quality measures. Part of this capacity-building work is NCQA’s accreditation program, launched in July 2016, and the Roadmap to Success in LTSS, a compendium of practical “how-to” examples. The second track involves developing measures of person-driven outcomes: measures based on what is important to individuals. National reviews of quality measures have found very few that address the primary concerns of older adults and people who use LTSS. For people with complex needs, “quality” means medical care and LTSS that are designed and executed to address their priorities, such as maintaining independence and decision-making autonomy, living in their own homes, interacting with friends and family or staying out of the hospital.
With The SCAN Foundation’s support, NCQA developed a framework for measuring LTSS quality and drafted standards for integrated care. The framework (see figure, above) describes an infrastructure that underpins the clinical care process and comprises quality improvement systems, effective population management, health information technology and beneficiary engagement and rights. Clinical care and services begin with screening and assessing a person’s strengths, resources, needs and goals. Screening and assessment inform an individualized care or service plan that is shared with the interdisciplinary care team, which uses it to coordinate care and services—ultimately resulting in achievement of the quadruple aim: healthy people, healthy communities and better and more affordable care.
With support from The SCAN Foundation and The John A. Hartford Foundation, NCQA has undertaken a series of projects to develop measures for quality improvement and accountability. But before national measures can be implemented, organizations caring for the dual eligible and LTSS populations must be able to deliver care and services efficiently and to demonstrate their effectiveness through data and quality measures. NCQA’s early work found that many organizations require significant capacity-building to fulfill this requirement.