PEAK 2.0 is changing the way long-term care facilities are doing business in Kansas
There has been significant national debate surrounding fee-for-service versus pay-for-performance reimbursement systems in the health care arena, and long-term care services are no exception. For example, starting in 2019, a Skilled Nursing Facility’s Medicare reimbursement rate will depend on that facility’s performance on identified quality indicators. While there is general consensus that quality should be rewarded, the devil is in the details. Quantifying quality is hard. In order to capture nuance across diverse patient populations, pay-for-performance models are generally complex and administratively time consuming for providers and payers alike.
PEAK 2.0 and the new Kansas Model
Kansas, however, has taken a different approach to the metrics of quality improvement. In 2012, the Kansas Department for Aging and Disability Services (“Medicaid”) partnered with Kansas State University to form the PEAK (Promoting Excellent Alternatives in Kansas) 2.0 program. Designed to promote a culture change to person-centered care, PEAK 2.0’s model eschews patient outcomes and instead focuses on basic benchmarks of effective, patient-centered operations. Participants who meet the simplified benchmarks are entitled to enhanced Medicaid reimbursement rates, which run from fifty cents to four dollars per resident. Currently 320 Kansas facilities are enrolled in this voluntary program.
How it Works:
PEAK 2.0 also represents an example of an innovative public-private partnership. While fully funded by Medicaid, this voluntary program is administered through the Kansas State University Center on Aging, which is responsible for the education and evaluation of participants. Its overarching goal is to improve the lives of long-term care facility residents through innovations in patient care and, interestingly, by providing staff with more independence and giving them a vested interest in resident outcomes. To this end it is structured with four main categories: Resident Choice, Staff Empowerment, Home Environment, and Meaningful Life.
Once a long-term care provider enrolls in the PEAK 2.0 program, they receive extensive training concerning patient-centered care from PEAK 2.0 staff at Kansas State University. At the end of the training, which typically lasts a year, the long-term care facility chooses one component from the four categories to adopt. This allows the facility to slowly implement the program and to devote the necessary time and resources to truly change the culture to provide patient-centered care. Each participating facility must provide an action plan outlining how they will successfully implement their chosen component.
Kansas State University’s Center on Aging monitors each participating provider to ensure that they are progressing towards the ultimate goal of achieving patient-centered care and improving the lives of residents. The participants slowly phase in all four components of the program until they are fully compliant.
A Closer Look at the Four Components of PEAK 2.0
The Four Components of the PEAK model (Resident Choice, Staff Empowerment, Home Environment, and Meaningful Life) and how they are evaluated merit a closer look.
Resident Choice is designed to put the power in every day choices back in residents’ hands. Facilities are evaluated based on standing protocols and policies that support a resident’s autonomy in the areas of eating, sleeping, bathing and daily routine. Examples include basic indicators such as: diversity in menu options, demonstrated training of care providers in alternative bathing protocols, and collection of patient preferences for daily routine at time of admission.
Staff Empowerment aims to create an environment where staff can both support residents’ choices and where staff has autonomy and room for growth. Staff can become empowered by making their own schedules, having staff-led teams, and having non-managerial staff attend training programs.
Home Environment seeks to ensure that each resident has the opportunity to feel like the long-term care facility is his or her home and that their space is treated with the respect and privacy a person’s home deserves. This can be achieved by allowing residents to participate in the design of their personal space, by providing private spaces for residents to gather with their families, and by reducing interference from the facility by removing carts from hallways and turning off overhead pages.
The final category, Meaningful Life, targets the residents’ emotional well-being and community integration. Facilities are evaluated based on the support accorded to residents’ in planning their own social activities, participating in chores, and forming community connections.
PEAK 2.0: Investing in Organizational Infrastructure
The two most often cited complaints about value-based purchasing for providers are (1) complexity and (2)(despite the complicated algorithms) that the benchmarks don’t accurately reflect the patients’ diagnostic complexity and the actual cost of care. Kansas’ approach to value-based purchasing is novel in that it focuses not on the clinical outcomes of individual patients, but instead focuses on investing in cultural organizational change. While incremental, the effect that this investment in broad organizational change can have is incalculable. This non-punitive, collaborative approach to quality improvement serves as a model for effecting change.