Project HERO General Overview Briefing

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Project HEROGeneral Overview Briefing
January 23, 2008
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Agenda

• Overview and Background
• Specialty Care Provider Network Overview
• Expected Benefits of Project HERO
• Contract Administration and Governance
• Contract Status
• Governance Structure and Administration
• Demonstration Evaluation and Reporting
• Quality of Care Metrics
• Accreditation and Performance Measurement
• Assessing Patient Satisfaction
• Information Resources

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Overview and Background

• Developed in response to House of Representatives
  Committee on Appropriations Conference Report
  109-305 in November 2005, which directed VA to
• Focus on cost-effective purchasing of care and
  develop a competitive award with at least three
  objectives-oriented demonstrations to encourage
  collaboration with industry and academia
• The Demonstration Objectives were developed based
  on the recommendations set forth in the Committee
  on Appropriations Conference Report, and include
  the following
• Provide as much care for veterans within the VHA
  as possible
• Efficiently refer veterans to high-quality
  community-based care, when necessary
• Improve exchange of information between VA and
  community providers
• Increase veteran satisfaction
• Foster high-quality care and patient safety
• Sustain partnerships with university Affiliates
• Secure an accountable evaluation of Demonstration
  results

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Specialty Care Provider Network
Project HERO will enhance the opportunity for VA
to conduct effective medical management, improve
continuity of care, and establish complete
patient records

• Statement of Need
• Specialty care provider services will only be
  contracted for when VA does not have the internal
  capacity or capability to provide the service
• Each Veterans Integrated Service Network (VISN)
  team identified specialty care needs by
  geographic location
• Based on historic data regarding care that is
  consistently purchased and ongoing care needs as
  identified by each VISN team
• VISN teams documented existing contracts for
  specialty care to ensure that Project HERO does
  not conflict with existing contracts
• Geographic Scope
• Contracts will be limited to VISNs 8, 16, 20, and
  23
• Veterans will have access to a network of
  pre-qualified, credentialed providers that meet
  VA standards for quality
• VHA will be able to monitor the quality of care
  veterans receive in the community
• VHA providers will have access to patient records
  documenting care received in the community
• Improve continuity of care between VHA facilities
  and community facilities

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Project HERO Demonstration Sites
Note This map displays the Department of
Veterans Affairs Veterans Integrated Service
Network (VISNs), including the four VISNs
participating in Project HERO (circled).
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Specialty Care Provider NetworkCare Needs
Purchased health care needs have been identified
by geographic area (VISN and VAMC) and by type of
specialty care needed. VA will purchase the
services outlined below ONLY when VA staff cannot
provide the service

• Medical/Surgical
• Improve VAs access to outpatient services of
  credentialed specialists
• Improve VAs access to inpatient hospital care
• Mental Health
• Provide access to credentialed mental health
  outpatient services
• Improve access to inpatient hospital care
• Provide access to substance abuse treatment
• Diagnostic
• Provide access to a network of diagnostic service
  providers
• Dialysis
• Provide access to a network of credentialed
  dialysis services. This includes inpatient and
  outpatient care and routine ongoing dialysis care
• Dental
• Provide access to a Network of credentialed
  dental specialists

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Expected Benefits

• Contracted provider networks will meet
  VA-specified quality standards
• All contracted care facilities are required to
  meet accreditation standards for inpatient and
  outpatient facilities
• Contracted provider networks will be required to
  submit clinical information to VA to improve
  continuity of care
• Contracted provider networks will provide a
  centralized vendor coordinated referral and
  appointment process
• Veterans living in underserved areas will have
  improved access to specialty care services

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Contract Status

• Contracted services are now available through
  Project HERO
• As of January 1, 2008 contracted services are
  available through Humana Veterans Healthcare
  Services (HVHS) for medical/surgical,
  diagnostics, mental health, and dialysis services
  in VISNs 8, 16, 20, and 23
• As of January 14, 2008 contracted services for
  dental care are available through Delta Dental
  Federal Services (Delta Dental) in VISNs 8, 16,
  20, and 23
• During November and December 2007, kick-off
  meetings were held with VISN representatives,
  HVHS, Delta Dental, and the Project HERO Program
  Management Office (PMO) on-site at Demonstration
  VISNs
• Key topics of discussion included an overview of
  VISN purchased care, details of contractual
  information, HVHS and Delta Dental business
  processes, and Project HERO processes and
  oversight

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Governance Structure
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Governance and Contract Administration

• Project HERO has formed a Governing Board to
  oversee the Demonstration to ensure veterans
  continue to receive high-quality care and to
  communicate Project HERO activities and status to
  VISN teams
• The Governing Board will review and approve any
  change in terms, quantities, or conditions of
  contracts and meet monthly throughout the
  implementation phase
• Project HERO is planning to convene a Contract
  Administration Board (CAB) to provide further
  guidance concerning changes to the scope of the
  contract
• The CAB will review major modifications that
  impact the scope of the contract approved by the
  Governing Board to provide input to the
  Contracting Officer prior to exercising contract
  modifications
• Membership includes the Project HERO Contracting
  Officer (CO), Contracting Officer Technical
  Representative (COTR), Program Manager, and
  members of the Office of Acquisitions and
  Logistics (OAL) and the Office of General
  Counsel (OGC)
• The CAB will meet on an as needed basis

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Demonstration Evaluation and Reporting

• To ensure a comprehensive evaluation of Project
  HERO, the PMO will measure
• Cost, volume, and type of care provided through
  both Project HERO and the Fee Program
• Any change in volume of Fee care in the
  participating VISNs
• Quality of care provided through Project HERO to
  include the following metrics
• Patient Safety
• Patient Complaints/Issues
• Clinical Information Sharing
• Accreditation
• Performance Measurement
• Patient Satisfaction (with the care provided
  through partnerships with contractors)
• Contractual status including spending against
  contract minimum and maximum and results of
  claims audits
• The baseline evaluation strategy includes
  collecting and reporting private sector quality
  data to demonstrate that Project HERO contracted
  facilities and providers are meeting industry
  established standards for quality of care
• The PMO will produce reports documenting the
  results of the evaluation in each of these areas
• Monthly, quarterly, and annual reports will be
  distributed to internal and external stakeholders
  to ensure that they are updated and informed of
  Project HERO Demonstration activities
• Audiences include the CBO, Governing Board, VHA
  Leadership, VSOs, Academic Affiliates, and Labor
  Unions

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Quality of Care Metrics

• Patient Safety and Complaints/Issues
• Tracks the number and severity of patient safety
  events in hospitals that are contracted by
  Project HERO networks
• Tracks the number and type of patient
  complaints/issues with contract provider network
  providers and facilities
• Information is provided within 24 hours by the
  contracted provider network and reported to the
  COTR, who then immediately reports to the VISN
  and VAMC POCs
• Clinical Information Exchange
• Monitors the percent of clinical information
  being returned to VA in the contractually
  required timeframe
• This surveillance activity is performed by the
  COTR who will compile the findings and report on
  a quarterly basis

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Accreditation and Performance Measurement
The private sector uses accreditation and
performance measures to evaluate the quality of
clinical care.

• Accreditation
• Accreditation requirements include standards for
  continued quality improvement and organizational
  structure, and processes that promote quality and
  ensure patient safety
• The PMO will monitor the accreditation status of
  inpatient and outpatient facilities where Project
  HERO veterans receive care
• Performance Measurement
• Project HERO will utilize secondary sources to
  evaluate quality of care performance information
• The PMO will obtain and report on the performance
  measurement data available for Project HERO
  facilities and providers. This information will
  be reported annually

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Assessing Patient Satisfaction
Project HERO will conduct satisfaction surveys to
assess the quality of specialty care services
delivered by contracted provider networks to
veterans.

• CAHPS survey report patients satisfaction with
  services and providers of health plans and
  inpatient facilities that collect and report
  CAHPS
• Data Source CMSs Hospital Compare for inpatient
  survey data
• Local surveys Project HERO will distribute local
  surveys to report veteran satisfaction with
  inpatient and outpatient services rendered by
  non-VA providers and facilities through Project
  HERO
• Survey method
• Mail-based survey provided to veteran within
  30-60 days of service date
• Follow-up reminder/thank you cards after two
  weeks of initial distribution
• Centralized survey distribution by VA staff to
  eligible veterans using random sampling strategy
  a veteran who received another VA survey within
  the year would be excluded from the final sample
• Survey reporting
• Surveys will be collected and reported in annual
  reports
• Project HERO PMO will complete survey analysis

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Performance Assessment Comparable to VHA Measures
Project HERO will report quality of care
performance data comparable to VHA Office of
Quality and Performance
Project HERO
VHA-Office of Quality and Performance (OQP)

• Survey questions assessing patient satisfaction
  with access to primary care and specialty care
• Access to specialty care including dental, mental
  health, and substance abuse services

• Patient Satisfaction
• Access to specialty care (audiology, mental
  health, cardiology clinic, orthopedics, primary
  care)
• Substance Abuse Care

• Quality of Cardiac Care

• Quality of Cardiac Care

• Quality of Diabetes Care

• Quality of Diabetes Care

• Pneumonia Care

• Pneumonia Care

• Surgical Site Infection Prevention

• Surgical Site Infection Prevention

• Tobacco Cessation

• Tobacco Cessation Counseling and Medication
  Assistance

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Information Resources

• Visit the Project HERO web site
  (http//www.va.gov/hac/HERO) to obtain publicly
  released information. For additional information,
  contact any of the Project HERO team members
  listed below