State Project Evaluation Activities. The Role of the State s Evaluations in the ADRC Program s Success

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1 State Project Evaluation Activities Tuesday October 5 th, 8:30-10:00 Moderator: Karen Linkins, Ph.D., Co-Director, ADRC Technical Assistance Exchange, The Lewin Group The Role of the State s Evaluations in the ADRC Program s Success John Wren, Director of Center for Planning and Policy Development, AoA New Hampshire s Logic Model Mary Maggioncalda, Administrator for Planning, Policy, and Community Development for the New Hampshire Department of Health and Human Services, Bureau of Elderly and Adult Services New Jersey s Evaluation Activities Pat Polansky, Commissioner for the Division of Aging and Community Services, New Jersey Department of Health and Senior Services Initial Process Evaluation Findings Karen Linkins, Co-Director, ADRC Technical Assistance Exchange, The Lewin Group Experts in the Audience Mark Meiners, Ph.D., Professor and Director of the Center for Health Policy, Research, and Ethics, George Mason University and California evaluator Kathy Leith, Ph.D., University of South Carolina and South Carolina evaluator

2 Speaker Biographies Karen W. Linkins, Ph.D., a Vice President at The Lewin Group, has over fifteen years of technical assistance and program evaluation experience in the areas of long term care and mental health systems and providers, the elderly, disabled, children, and other vulnerable populations. In particular, she specializes in issues concerning the impact of the policy and regulatory environment on organizational behavior, performance, and outcomes. Over the past decade, Dr. Linkins has conducted numerous national, state, and local technical assistance projects and evaluations for innovative long term support services interventions, such as family caregiver support programs, integrating primary care and behavioral health services for elders, and financing evidence-based mental health practices. She is currently designing a national evaluation of the CMS Direct Service Community Workforce demonstration and is directing a statewide evaluation of The California Endowment s Mental Health Initiative, which examines the effectiveness and cultural competence of different treatment approaches in 46 nontraditional community-based settings (e.g., schools, child care, hospice agencies, and primary care clinics). She is also the Co-Director of the Administration on Aging s national technical assistance effort for the Aging and Disability Resource Centers demonstration program. Dr. Linkins recently completed a national assessment of the effectiveness of the preadmission screening process (PASRR) for nursing facility residents with mental illness. Prior to joining Lewin, Dr. Linkins held a faculty appointment at the University of California, San Francisco (UCSF) where she investigated the impact of policy and regulatory changes on access to Medicare certified and uncertified home health agencies, as well as adult day health and other alternative, community-based sites of care. Dr. Linkins earned her Ph.D. at UCSF in Medical Sociology. John Wren, Director of Center for Planning and Policy Development, joined the U.S. Administration on Aging in October 2000 currently serves as the Director of the Center for Planning and Policy Development where he oversees the agency s strategic planning, program development and policy development functions. Prior to joining AoA, Mr. Wren was a Vice President for the National Council on the Aging (NCOA), and Director of the National Aging Program at the Pew Charitable Trusts. He also served as chief staff to the NY Governor s Interagency Coordinating Council on Long Term Care. He developed nationally recognized reports on Social Security, Medicare and Family Caregiving, and helped to lead New York State s participation in the 1981 and 1995 White House Conferences on Aging. John has served on the Board of Directors for the National Senior Citizen s Law Center and is a member of the National Academy of Social Insurance

3 Mary Maggioncalda has been working on policy issues impacting long-term care for elderly and disabled adults since She wrote the plan for reforming New Hampshire s long term care financing and service delivery system, Shaping Tomorrow s Choices. She has staffed legislative study committees, written grants, served as an expert reviewer for national competitive grants and developed demonstration projects related to long-term care. Currently the Administrator for Planning, Policy, and Community Development for the New Hampshire Department of Health and Human Services, Bureau of Elderly and Adult Services, she oversees the organizational unit responsible for policy and program development for home and community support programs for elderly people and for persons with disabilities and chronic illness, including New Hampshire s ADRC grant. Patricia A. Polansky is Assistant Commissioner for the Division of Aging and Community Services in the New Jersey Department of Health and Senior Services. Coupled with public and private sector experience in health care, management and policy-making, Ms. Polansky brings a unique community health and nursing perspective and expertise to the Department of Health and Senior Services. Previously, Ms. Polansky was Executive Director of the New Jersey Board of Nursing under the Division of Consumer Affairs in the Department of Law & Public Safety. For two decades, Ms. Polansky worked at Union Hospital in Union, N.J. where she first served as a Vice President, Nursing; then as Vice President, Administration; and finally as Executive Vice President and Chief Operating Officer. As of October 1, 2004, Mark R. Meiners, Ph.D., took a position as a Professor and Director of the Center for Health Policy, Research, and Ethics at George Mason University. He is also the Director of two Robert Wood Johnson Foundation initiatives: 1) the Medicare/Medicaid Integration Program, an initiative designed to help states develop new systems of care that better coordinate acute, post-acute, and long-term care; and 2) the Partnership for Long-Term Care, an innovative state-based long-term care insurance program, and has led this initiative since its beginning in Previously, he was Associate Professor and Associate Director of the University of Maryland Center on Aging in College Park. He holds a Ph.D. and M.A. in economics from Georgetown University and a B.A. in economics with distinction from the University of Wisconsin. Dr. Meiners specializes in the areas of aging and health with emphasis on financing and reimbursement issues. He is nationally recognized as one of the leading experts on financing and program development in long-term care. He also serves as the evaluation director for the California ADRC pilot programs in San Diego and Del Norte

4 Katherine Leith, Ph.D., LMSW is a Research Associate at the USC Center for Health Services and Policy Research (CHSPR), with a doctorate in Health services policy and management. She also holds the USC graduate certificate in gerontology. Dr. Leith is a licensed MSW who has many years of direct services and case management experience in mental health and medical social work with older adults with physical and/or mental disabilities. She has been conducting research at USC CHSPR since 2000, primarily in the areas of long-term care, consumer direction, and quality of life related issues. Dr. Leith functions as project evaluator for various projects at USC CHSPR. She is currently assigned to two projects: (1) SC Access Plus a project designed to pilot an Aging and Disability Resource Center (ADRC), which will serve as a visible single point of entry for older adults and persons with physical disabilities and to streamline and simplify the eligibility determination and service application process; and (2) the South Carolina Public Health Consortium a collaboration between USC and the SC Department of Health & Environmental Control designed to improve public health practice by providing better structure and organization to academic/practice partnerships. Dr. Leith recently completed the evaluation for a third project, the SC Family Caregiver Support Program (FCSP) a project created under the Older Americans Act to address the needs of older family caregivers by encouraging states to increase the availability of caregiver support services. She also participated in a recent USC CHSPR research and evaluation project, Client-Centered Long Term Care for the Elderly A South Carolina Initiative a project designed to assess the options for older South Carolinians for long term care services under the current system, and specifically to expand their opportunities to have choices and take a more active role in managing their own care status of the long-term care system in SC. Finally, she also participated the qualitative data collection for another USC CHSPR project, the Traumatic Brain Injury Follow-Up Registry evaluation to assess the service needs for persons with traumatic brain injury and their families living in South Carolina. She has also conducted qualitative research on (1) the translation of aging research into aging policy and programs and (2) the meaning of home for older women in assisted living

5 Indicators of Operating Efficiencies of Proposed Model for ServiceLink Resource Centers (SLRCs) Structure Process Output Outcome Impact Goal: Efficiency Consolidation of some functions between ServiceLink, Assessment & Counseling, and DEAS nursing programs - Add long term support (LTS) counselor to ServiceLink contract - Consolidation of three different RN job descriptions into a single standard job scope for a LTS nurse - Redeploy current DEAS RNs for clinical oversight - Outsource for regional LTS nurses - Eliminate Assessment & Counseling coordinator role - # of LTS counselors /workload - # of LTS nurses /workload - Increase in breadth of job scope and level of expertise per function -Availability of all functions in each region statewide - Elimination of duplicative job functions -Reduction in duplicative administration overhead -Reduction in the number of points of entry into service delivery system - Increased opportunity for nursing facility diversions: delayed admission or utilization of less costly long term supports - Increased opportunity for informed consumer choice on Logic Model: Efficiency Goal- Draft mgg, 3/11/04 Page 1 of 5

6 Goal: Efficiency Structure Process Output Outcome Impact Co-location of I&R specialists, LTS counselors, LTS nurses (& potentially DFA eligibility specialists) at regional ServiceLink RCs Utilization of a statewide, integrated I&R system and resource database - Increase size & configuration of ServiceLink sites - Develop work agreements for contracted office hours - Allocate grant funds to selection & implementation of new system, including data maintenance tools, at SLRCs - Implement integrity standards & distributed model for data updating of resource information # of regions with integrated ServiceLink Resource Centers # of SLRCs with new system #I&R contact # of resources in database - Integrated cross-functional work flow processes - Regional control over date-to-day operations - Standardized data and reports for operations analysis, activity benchmarking, cost management communitybased long term support options -Improved communication and operating effectiveness - Decreased time spent on researching and updating resource information - Reduction in duplicative data capture at multiple points in process - Increased timeliness, accuracy, and comprehensiveness of community resource information - Decision Logic Model: Efficiency Goal- Draft mgg, 3/11/04 Page 2 of 5

7 Goal: Efficiency Structure Process Output Outcome Impact Defined process protocols, training & performance standards for all functions Selection of a single tools and process for determining clinical Level of Care (LOC) status - Documentation of consumer case scenarios, policies, and staff process guidelines - Development of job roles, and corresponding qualifications - Defined training curriculum & staff development plans Standardized outcome measures and performance goals by region - Discontinue use of CAF in Belknap, Cheshire, Sullivan, & Merrimack counties; discontinue use of #276 form in all other counties - Implement MDS-HC statewide for4 all LOC determinations # Documented process guidelines # of qualified staff in each role # of staff training sessions & development activities # of LOCs based on MDS-HC - Decreased confusion on policies, and processes - Increased employee accountability, empowerment and motivation - Elimination of duplicative and redundant process management - Uniform, face-to-face clinical determinations statewide -Standardized data available for reporting & analysis making based on objective, timely data analysis - Reduction in process errors - Increases in operations efficiency - Increased consistency & accuracy of determinations - Foundation for automation of tools Prescreening of consumers for program - Inclusion of all program & services in resource database, # of services in resource data base - Decrease in the # of inappropriate consumer - Decreased time of DFA Logic Model: Efficiency Goal- Draft mgg, 3/11/04 Page 3 of 5

8 Goal: Efficiency Structure Process Output Outcome Impact & service eligibility Active state oversight of operations performance against standards and Continuous Quality Improvement of outsourced functions including details on eligibility requirements -Strengthen awareness and relationships between SLRCs and community providers of elderly, disability, and mental health services -Structured training of I&R specialists and LTS counselors on program s - Implementation of Continuous Quality Improvement methodologies in all operations and contracts - Regularly scheduled service reviews with outsource contractors (case mgt, nursing) and reported performance status -Regularly scheduled operations review with SLRC contractors and reported performance status w/eligibility criteria # of pre-screens completed % of connections to services per referral # of appointments with DFA eligibility specialists to complete a single Medicaid application # of CQI work sessions # published performance reports applications - Decreased length of time of applications in pending status - Effective process for receiving contractor feedback and ongoing program evaluation and enhancements - Timely data for policy & financial decision making - Increased contractor accountability, empowerment and motivation specialists and service providers completing consumer applications Higher service quality and contract value Logic Model: Efficiency Goal- Draft mgg, 3/11/04 Page 4 of 5

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