CQL | The Council on Quality and Leadership

CQL and Tennessee:

Person-Centered Practices, Directed by Data

With a focus on people through CQL’s Personal Outcome Measures® and a focus on data through CQL’s Online Data Tool, Tennessee’s Department of Intellectual and Developmental Disabilities (TN DIDD) utilizes in-depth analysis to improve their supports and services. This person-centered approach culminated in Tennessee becoming the first in the nation to achieve statewide network accreditation. Whether working with individual support plans (ISPs), provider organizations, state systems, CMS reporting or managed care organizations, TN DIDD collects and evaluates information about personal outcomes to enhance the quality of life and the quality of supports in their state.

Measuring Outcomes At The Individual Level

TN Advocate Quote

TN Advocate
TN DIDD puts people in the driver’s seat, and CQL’s Personal Outcome Measures® interviews help steer ISPs and person-centered approaches. “There was a lack of dynamic plans. There was a lack of vision for people,” says Laura Vegas, (former) Assistant Commissioner of Policy and Innovation for TN DIDD, adding “we talked about using Personal Outcome Measures® to help people figure out a vision for their life, and how the whole ISP helps support that vision for their life.”

The Personal Outcome Measures® process gathers information about what really matters to the person regarding relationships, rights, social roles, employment, housing and more. After a person’s outcomes are identified and life priorities are defined, provider organizations help people develop their ISPs and establish action steps to support them in achieving their own goals and dreams.

“With CQL we found that we could quantitatively define what quality of life was for people,” states Vegas, “When you write these annual plans, you won’t be the same person in 365 days as you are now. The Personal Outcome Measures® helps us identify an individual's changing priorities to be more responsive.” Along with collecting information about the outcomes and supports for the ISPs, TN DIDD is able to gather other essential information. “The CQL data system is so amazing because it has so many different data points” says Vegas.

Organizations, states and systems are able to collect and analyze data using a wide range of demographic information and enhanced Personal Outcome Measures® data at the individual level, to identify differences in outcomes based on:

  • Funding Type
  • Service Type
  • Decision-Making Authority
  • Gender
  • Age
  • Ethnicity
  • Geographical Differences
  • Support Needs

The information gathered from the Personal Outcome Measures® interviews not only drives the ISPs at the individual level, but is also collected so that TN DIDD can improve quality at the provider level.

Measuring Outcomes At The PROVIDER Level

“We’re not just asking providers to do a Personal Outcome Measures® interview. We’re asking for the important part. We’re asking for proof of how this is going to make a difference in the person’s life through their ISP. That’s required,” says Vegas. After the annual ISPs are created, the state’s quality assurance team reviews the plans to ensure that they are truly person-centered. The quality assurance team then works with the providers to confirm that the ISPs are being followed and implemented properly. 

TN Advocate Quote

TN DIDD is reinforcing this focus on person-centeredness through a revised provider manual being released in 2016, which details consistent guidelines and expectations. Along with data from Personal Outcome Measures®, TN DIDD also evaluates Basic Assurances® for providers, which measure policies and practices for ensuring health, safety and security for people. 

Based on the analysis of Personal Outcome Measures® and Basic Assurances® data, TN DIDD is laying out some priority areas for improvement in their new provider manual, including the following examples:

Rights Policies may have been in place surrounding rights, but the data shows that practices were not always present. The provider manual now details what the policy specifically has to address, how to inform people of their rights, lists expectations for ongoing training and requires a rights assessment.
Natural Support Networks Natural supports were previously defined essentially as volunteers in a person’s life. There was a lack of resources and insight into the establishment of true natural support networks. The provider manual now redefines natural supports as meaningful relationships in a person’s life, lays out requirements for natural support policies, and guides providers in establishing new natural supports and helping existing natural supports.

“Wherever we had gaps in Basic Assurances®, we addressed those in our provider manual in terms of expectations for providers” says Vegas, adding “we’re not just throwing those expectations out there. We’re actually going to measure from the quality assurances perspective that they’re being implemented.”

Measuring Outcomes At The Systems Level

Instead of the system in Tennessee inhibiting action in person-centered approaches, TN DIDD has a number of foundational factors that have contributed towards its success over the years, including organizational structure, resources and personnel:TN Advocate Quote

  • In 2011, the Tennessee legislature designated TN DIDD as its own standalone department
  • The Commissioner of TN DIDD is on the governor’s cabinet
  • Self-advocates and advocacy mentors promote person-centered practices
  • Dedicated communications team shares valuable information with key stakeholders
  • Accreditation team collects data and ensures the accreditation plan is implemented
  • Quarterly quality management committee meetings review data and develop strategies

In addition to foundational factors contributing to TN DIDD’s accomplishments, they have also been able to utilize CQL tools in effective ways beyond just the services that it directly oversees. “We were able to use our Basic Assurances® self-assessment as the self-assessment for the CMS reporting that is required” says Vegas, “you can take the CMS rules, use the CQL tools and make sure that you’re being compliant.”

CQL CMS Toolkit for StatesFor example, CMS requires that HCBS regulations be met surrounding choice in where someone lives and who they live with. “We were able to directly correlate those requirements with ‘people choose where and with whom they live’ in the Personal Outcome Measures® and the ‘rights and choices’ section of the Basic Assurances®” adds Vegas. CQL’s Toolkit for States provides a very clear crosswalk, in how CQL tools assist systems, states and organizations in compliance with the reporting to CMS for HCBS regulations.

The benefits of the CQL Toolkit for States have extended beyond reporting to CMS. Starting July 1st, 2016, Tennessee will implement the first managed care waiver for its long-term services and supports for people with intellectual and developmental disabilities. Managed Care Organizations (MCOs) in Tennessee are looking to provide person-centered services, and their state’s Medicaid office, TennCare, recommended they turn to TN DIDD for insight. “The CQL Toolkit for States really got us a lot of credibility with the MCOs” states Vegas, “because we’ve had the opportunity to partner with CQL, TN DIDD has had an important seat at the table with TennCare and MCOs in the development of person-centered expectations.” Connected to promoting person-centered practices to MCOs, TN DIDD has created advocacy panels for each MCO. These panels provide MCOs with direct insight into the lives of the people they serve, through a forum where self-advocates can share expectations, needs and desires.

From developing an ISP at the individual-level to developing strategy at a systems-level, TN DIDD helps improve quality of life and quality of services throughout the state of Tennessee. Whether it’s a person, provider, CMS or an MCO, TN DIDD utilizes CQL tools to carry out best practices and embrace person-centered excellence through data-based decision-making.

“You just have to stay consistent in your message, consistent in your mission, consistent in your vision, and don’t waiver. Everything you do has to be within the lens of person-centered excellence, and the lens is defined by CQL.”

TN DIDD Network Accreditation Highlights



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