Improving Assisted Living Quality through Collaborative System Change

By expanding the coalition’s reach, we can make tremendous headway in improving care for more of Wisconsin’s seniors.

– Kevin Coughlin of the Wisconsin Department of Health Services

At a Glance

This project, Improving Assisted Living Quality through Collaborative System Change, aimed to expand current Wisconsin Coalition for Collaborative Excellence in Assisted Living (WCCEAL) efforts to establish a comprehensive and robust quality infrastructure for Wisconsin Assisted Living Communities (ALCs).The Center for Medicare and Medicaid Services has developed a comprehensive system to measure and monitor quality of care received in nursing homes, but ALCs are typically not included in these efforts to measure, monitor and improve quality of care. The absence of a quality measurement system for ALCs is underscored by the fact that they are not regulated by the federal government, and as such, the standards of care and training and even the definitions of “assisted living” vary from state to state. Over the course of the project, WCCEAL membership was increased by 28 percent and three important policies were adopted by the Division of Medicaid Services (DMS) at the state level to help sustain the initiative. Additionally, new partnerships were cultivated and existing partnerships were strengthened over the course of this project.

The Challenge

Health care organizations strive to provide quality care to their patients, clients or residents, and these efforts are supported by systems and organizations that measure and monitor quality outcomes. These outcomes range from clinical and financial indicators of performance to satisfaction with provided services; however, the breadth and depth of these systems vary across the healthcare spectrum. The Center for Medicare and Medicaid Services has developed a comprehensive system to measure and monitor quality of care received in nursing homes, but assisted living communities (ALCs) are typically not included in these efforts to measure, monitor and improve quality of care. This is despite the fact that ALCs represent a rapidly growing segment of the long term health care system. The absence of a quality measurement system for ALCs is underscored by the fact that they are not regulated by the federal government, and as such, the standards of care and training and even the definitions of “assisted living” vary from state to state. As a result, ALCs are less likely to be involved in organized, systemic quality improvement efforts.

Project Goals

The goal of this project was to expand current Wisconsin Coalition for Collaborative Excellence in Assisted Living (WCCEAL) efforts to establish a comprehensive and robust quality infrastructure for Wisconsin ALCs. This goal was addressed through five specific aims:

1. Expand the reach of WCCEAL by working with community partners to implement specific strategies to expand active participation by Wisconsin ALCs.
2. Improve the WCCEAL data infrastructure to enable ALC to make data driven quality improvement decisions.
3. Evaluate and assess how to integrate WCCEAL participation into the Division of Long Term Care Quality Strategy.
4. Establish quality improvement collaboratives and informational resources to support ALCs in targeting and improving their individual quality performance.
5. Assess the impact of WCCEAL participation on changes in quality indicators and in regulatory enforcement outcomes.

Results

Over the course of the project, WCCEAL membership increased 28 percent, from 409 to 524 assisted living community members spanning 55 of the 72 Wisconsin counties. This compared to almost 4,200 assisted living communities statewide. This rise in participation was attributed, in part, to a number of videos produced by the project team to help raise awareness including “What is WCCEAL”, “Why WCCEAL” and four association-specific videos.

The project contributed to the adoption of three important policies by the Division of Medicaid Services (DMS) at the state level advancing the long-term sustainability of the program. First, DMS continued to support WCCEAL in the biannual budget with several increases. Second, DMS added an assisted living pay for performance incentive for managed care organizations (MCOs) who have WCCEAL members in their provider network, and most of the $1 million incentive went from the MCO to the WCCEAL assisted living community. Lastly, DMS was able to secure a federal match based on the percent of Medicaid residents living in WCCEAL communities.

In addition to policy achievements, new partnerships were established with organizations such as Milwaukee Area Allied Provider Network (MAAPN) and five Wisconsin MCOs. MAAPN’s role was to support, mentor and sponsor their assisted living association members who are part of WCCEAL. These partnerships provided access to information technology data and aggregate reports of the provider network, enabling a performance initiative focused on quality. Additionally, existing partnerships with organizations like the Board on Aging and Long Term Care (BOALTC), LeadingAge Wisconsin, Wisconsin Center for Assisted Living (WiCAL), Wisconsin Assisted Living Association (WALA) and the Disability Services Provider Network are focused on education, resource development, training and quality improvement. These collaborations have worked toward enhancing quality of care and life in assisted living communities.