Patty Jones of CHPW talks about the NCQA Person-Driven Outcome Measures Demonstration

In September, Community Health Plan of Washington (CHPW) was chosen to partner with National Committee for Quality Assurance (NCQA) to pilot the Person-Driven Outcome Measurement demonstration project. The $2.1 million national project aims to measure health care quality by evaluating how effective organizations are at helping individuals achieve their self-defined health goals.

Recently, I talked with Patty Jones, the Chief of Health Services at CHPW, to learn more about the program, its implementation, and its anticipated goals.

This Q&A has been edited for length and clarity

Marjie High: What prompted CHPW to apply to be a part of the NCQA Person-Driven Outcome Measures Demonstration?

Patty Jones: Well a couple things. One is that I have been a surveyor for NCQA for over 15 years, so I have worked with and been affiliated with NCQA for a long time. CHPW is a NCQU accredited health plan so we consider NCQA to be a leading organization in terms of quality improvement.

But this particular project actually came to us through the Washington Health Care Authority.  The HCA actually reached out to organizations that are leads for the health homes programs in the state and said that the state had become aware that this pilot project was out for consideration and it wanted the health home leads to be aware of it. I in my role as Chief of Health Services I oversee the health homes program so when we saw this opportunity to work with the NCQA I was excited to apply.

I also saw that the project was a really well designed nationally-based evaluation project with the opportunity for us to learn from others across the country.  The project is really focused on complex and venerable members and we of course support the needs of the Medicaid population, but we also have Medicare and the Special Needs Program where we have a dedicated team who helps folks who are complex seniors with Medicare and Medicaid.

So, there was a highly credible leading organization, an opportunity to participate in a national effort to improve tools and techniques, and working with complex populations just really fit where we are headed from a strategic perspective. It was just a really good opportunity.

MH: Could you tell me a little bit more about what the demonstration will entail?

PJ:  Sure – so the demonstration is focused on testing some tools with case managers to establish person-driven goals and person-driven outcome measures for people who are in case management.  There are two types of tools involved. One is what NCQU calls Goal Attainment Scaling or GAS, and the other is what they call Patient Reported Outcome Measures or PROMs.  So how the pilot is structured is that we identified eight case managers who are in different settings. Two are coming from our health plan, CHPW, and six others are coming from our Community Health Clinic partners Health Point and Yakima Neighborhood Health Services, and AAA for SW Washington.  So a combination of health plan, community based clinics, and Area Agency on Aging participants.

As part of the pilot, those case managers go through a training in terms of using very specific tools. The training was completed in August. The tools guide the case managers discussion with the member to determine the members’ priorities in terms of addressing their health care and social determinant needs. The idea is the tools really engage the member and put the member in the driver’s seat of setting the priorities and goals that they want to achieve as part of working on addressing their health care concerns and other concerns.

MH: When does implementation begin?

PJ: The training was held in August and we start implementation this week. The case managers all have an iPad that they use in addition to their regular tools. The intent is for them to fold this into their regular work flow, but they do have a dedicated tool that they are using.

The pilot will run for about a year and then there will be an evaluation process in September 2019. Along the way NCQA will be interviewing the members and interviewing the case managers. The evaluation is a combination of evaluating the result of the pilot as well as input from participants in the pilot.

MH:  What are the goals and outcomes that you are hoping to achieve with the demonstration?

PJ: Well NCQA has a couple goals, we have some shared goals, and then CHPW has some additional goals.

NCQA’s goal is to evaluate whether this structured tool in fact results in a more effective person-driven care plans.

For example, you might have a case manager who is aware of the clinical needs of a member and they might end up setting goals related to their diabetes or their hypertension.  But in fact, the person really would like to be able to participate in their daughter’s wedding in six months and be able to walk in the wedding. This relates to helping with the diabetes, but the patient is much more interested in being able to get better functioning of some sort or quite smoking.

One of the interesting results will be to see if the tool really results in member driven establishment of the goals. Then secondarily, to see whether this methodology actually results in better outcomes for the member.

Because case management is one of our programs here in health services, at CHPW we are very interested in whether or not this type of approach engages members in a more meaningful way and is a positive and meaningful experience for the case managers.

So we want to find out the reaction of the case managers and the members to using this tool. Do they find it helpful? Did it create an even more effective relationship between the participants working together as a team? And can it be folded into our work flows in an efficient and an effective way?

MH: So for someone like me who is more of a lay person, would it be fair to say that the demonstration is designed to connect those practical outcomes the members are interested in with clinical outcomes?

PJ: Yes – I think that’s a great way of putting it. I would say that, yes, the goal is to fold those two together. To take the practical, member-driven outcomes – I want to be able to walk, I want to stop smoking –  and attach those so to also achieving clinical outcomes.

MH:  How many members do you anticipate participating in the demonstration?

PJ: We are working with about 200 patients over eight care managers. The case managers and care managers are a mix of nurses, social workers, some with non-clinical backgrounds.

One thing that will be interesting is that we are testing this tool with across managers with different qualifications and credentials, because one of the things we are looking to achieve in health care today is how to we optimize the use of a variety of resources. Traditionally, we have thought of case managers as needing to be nurses, when in fact we know that non-clinical, community based team members can be really effective in helping people.

What’s also distinctive about our model is that we are testing it with clinic-based care managers as well as health plan based care managers.

MH: Who are the other organizations that are piloting this program?

PJ:  The three other program partners include Kaiser Permanente Northwest in Portland, Oregon, Priority Health in Grand Rapids, Michigan, and MedStar Good Samaritan Hospital Center for Successful Aging in Baltimore, Maryland.

MH: Are you collaborating at all with any of the other demonstrators regarding the implementation?

PJ: We hope to. That’s actually something we did request of NCQA  – regular meetings or check-ins. They are managing the pilot, so that’s up to NCQA.

We are in the very beginnings of the pilot right now, but we are excited to share what we are getting done and learning.  We should have preliminary data and feedback in about six month and we are excited for that.