ARRA Delivery System Initiative: Background and Funded Applications (Text Version)

Slide 1

ARRA Delivery System Initiative: Background and Funded Applications

Michael I. Harrison
Dina Moss
AHRQ, Center for Delivery, Organization, and Markets
AHRQ Annual Meeting
9/27/2010

Slide 2

Goals

• Build evidence base for successful, large-scale delivery-system transformation.
• Gain evidence on effects on wide range of outcomes, including quality, efficiency, cost, access, disparities, and population health.
• Develop infrastructure for further work in this area.
• Provide lessons for policy makers and delivery system decision makers about successful delivery system organization and improvement strategies and how best to promote or implement them.
• Improve care for priority populations and people with multiple chronic conditions.

Slide 3

Consultations—Many thanks!

• CP3—David Meyers, David Lanier, Joe Clift, Jon White, Teresa Zayas-Caban, Bob Mayes, Matt Quinn
• CDOM—Irene Fraser, Mike Hagan, Barry Friedman, Cindy Brach, Ryan Mutter, Jan De La Mare; Peggy McNamara, Denise Nguyen
• CQUIPs—Jim Cleeman
• OEREP—Francis Chesley, Debbie Rothstein, Kish Wadhwani, Nghia Vo, Andrew Louden, Rebecca Trocki, Maureen Gallagher.
• COE—Jean Slutsky

Slide 4

Delivery System FOAs

1. RFA 10-012—Comparative Effectiveness Delivery System Evaluation Grants—R01
   (Michael Harrison)
   Research on existing designs or redesigns (interventions) in payment, reporting, and organization of care delivery.
   CER= compare alternative designs or redesigns; compare one redesign to status quo accepted as current policy.
   
2. RFA 10-013—Comparative Effectiveness Delivery System Demonstration Grants—R18
   (Michael Harrison)
   
   1. Demonstration of redesigns in:
      • Primary care.
      • Care continuum.
      • Payment and reporting.
   2. Research on implementation and effectiveness of these redesigns.
3. 3. RFA 10-014—Accelerating Implementation of Comparative Effectiveness Findings on Clinical and Delivery System Interventions by Leveraging AHRQ Networks—R18
   (Dina Moss)
   • Purpose: Spread of CER findings by leveraging the capacities of multi-stakeholder or multi-site networks: Goal is implementation of existing evidence, not creation of new evidence.
   • Reporting of progress in achieving project goals is required—evaluation is not; Evaluation to be conducted by external contractor.

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Delivery System Evaluation FOA

10-012. Delivery System Evaluation Grants—R01 (a.k.a. "Evaluation grants") (Harrison)

• Evaluate ability of alternative system designs, change strategies, and interventions to enhance system performance (quality, efficiency, etc.); evaluate applicability of change strategies across diverse settings.
• 3-year projects with no extensions.
• $7 million allocated for 6-10 awards.
• Support Contractor—Econometrica.

Slide 6

Delivery Demos (1)

10-013. Delivery System Demonstration Grants—R18 (a.k.a. "Redesign Demos") (Harrison)

• Implement and evaluate large-scale system improvement strategies—aimed at quality, efficiency, etc.
  • Primary care redesign for multiple chronic conditions.
  • Redesign of administration and care across multiple settings.
  • Payment and other incentives (e.g. public reports) for care.
• 3-year projects with no extensions.
• $12 million allocated for 3-6 awards.
• Contractor provides support and TA.

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Delivery Demos (2)

10-014. Implementation by Leveraging Networks—R18 (a.k.a. "Spread Demos") (Moss)

• Use multi-stakeholder and/or multi-site networks or other networks to roll out and spread�existing CER findings (e.g., PBRNs, CVEs, ACTION—others welcome!)
• 3-year projects.
• $13 million allocated for up to 10 awards.
• External contractor will conduct evaluation.

Slide 8

A Note about Funding

• Awards for all of the ARRA FOAs will be announced tomorrow, Sept. 28. Until then, we cannot publish the names of any awardees. The following three slides describe characteristics of applications that were recommended for funding, but have not yet been awarded.
• Applicant presentations are meant to illustrate the types of projects sought by the three Delivery System FOAs. They cannot be considered to be indicative of award decisions.

Slide 9

ARRA Delivery System FOA Applications: Impacted Sites of Care
(1-2 sites per study)

• Hospital—7
• Other Specialty—3
• Primary Care—13

Slide 10

ARRA Delivery System FOA Applications: Primary Health Conditions

• Orthopedics—1
• Pediatric Health—1
• Chronic Kidney Disease—1
• Asthma—1
• Cardiological conditions + hypertension- 2
• Mental Health + substance abuse—4
• Multiple Chronic Conditions—6

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ARRA Delivery System FOA Applications : Geographic Spread

• AZ -1
• CA—5
• FL- 1
• IN—1
• MA—1
• MD—1
• ME—1
• MI—3
• MN—2
• MO—2
• NC—2
• NH—1
• NY—2
• OH—1
• OK—2
• PA -1
• SC—1
• TX—2
• UT—1
• VA—1
• VT—1
• WA—1
• WI—2
• National—2

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Applicant Presentations

• RFA 10-012
  • Wally Smith, M.D., Virginia Commonwealth
  • Rebecca Malouin, Ph.D., Michigan State
• RFA 10-013
  • Ms. Weslie Kary, M.A, Integrated Health Assoc.
• RFA 10-014
  • Steven Crystal, M.D.

Slide 13

Questions and Comments?

For more information:

• Michael Harrison
  Michael.Harrison@ahrq.hhs.gov
• Dina Moss
  Dina.Moss@AHRQ.hhs.gov