Evaluating Provider-Based Models

Seventeen demonstration States are evaluating provider-based models to improve the delivery of children’s health care.



In February 2010, the Centers for Medicare & Medicaid Services (CMS) awarded grants to 10 States under a 5-year, $100 million effort to improve health care quality and delivery systems for children enrolled in Medicaid and the Children's Health Insurance Program (CHIP). The five grant categories encompass projects that:

  1. Show how a core set of children's quality measures can be used to improve quality of care for children (Category A).
  2. Promote the use of health information technology to enhance service quality and care coordination (Category B).
  3. Implement new or more comprehensive provider-based models of service delivery (Category C).
  4. Demonstrate the impact of a model electronic health record format for children (Category D).
  5. Test an approach to quality improvement of a State's own design (Category E).

This page summarizes projects that States are implementing under the third category (Category C), "new or comprehensive provider-based models of service delivery," and highlights some of the key questions addressed by the national evaluation.

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Importance of Assessing Provider-Based Models for Children

During the last 5 years, public and private health insurance plans have developed numerous approaches for encouraging providers to adopt certain practices and procedures designed to improve quality of care for their patients. These provider-based models usually focus on ensuring that services are patient-centered, comprehensive, coordinated, accessible, and supported by the appropriate use of health information technology, staff training, and payment reform. Although these models have proliferated in Medicaid and commercial health plans throughout the States, few of them focus specifically on health services for children. The CHIPRA Quality Demonstration Grant Program provides a singular opportunity to identify effective child- and family-focused provider-based models of care.

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Demonstration Project Activities

Seventeen States are implementing demonstrations of provider-based models. Of these States, 12 are implementing variations on the patient-centered medical home (PCMH) model—an approach to care that is characterized by partnerships among the family, the child's doctors, and community institutions.1 Three States are focusing on care management entities (CMEs), which are organizations that oversee and coordinate services for children with serious behavioral health needs. Two States are working to improve services provided through school-based health centers. These demonstrations are based on different combinations of activities, depending on the State (Table 1). 

Table 1. Selected Characteristics of States' Projects to Assess Provider-Based Models

Type of Model
Patient-centered medical homeXXXXXXXXXXXX     
School-based health centers            XX   
Care management entities              XXX
Service Emphasis
EPSDT services  X    X    XXX  
Services for serious mental health conditions  X   X     XXXXX
Services for chronic physical health conditionsX X XX           
Implementation Strategies
Establish Learning collaboratives for practices  XXXXXX XXX     
Use Practice facilitators, coaches, coordinators  XXXX  X        
Provide financial compensation to participating practices   X  XX         

Source: Information gathered from the demonstration States in 2011 through telephone calls and project documents.
Note: *denotes grantee.

1 The PCMH model is defined further at www.pcmh.ahrq.gov. States are using different PCMH models. For a description of the model promoted by the U.S. Department of Health and Human Services’ Maternal and Child Health Bureau, see http://mchb.hrsa.gov/programs/medicalhome/index.html. See the model used in the Patient-Centered Primary Care Collaborative.

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Evaluating these Projects

The national evaluation of the CHIPRA quality demonstrations will provide new insights into strategies for improving outcomes of children who receive care in pediatric and family practices, community and school health centers, and mental health service systems. Specifically, the national evaluation will analyze both qualitative and quantitative data. Qualitative data will be collected through review of project documents, interviews with project staff and key stakeholders during site visits to demonstration States, and focus groups with parents. Quantitative analyses will involve data submitted by selected States on service use and characteristics of participating practices. Analyses will be based on comparison group designs, when available, and will focus on determining the impact of selected PCMH projects on children's quality of care. These analyses will address a wide range of questions, such as:

  • What resources were essential to successfully implement an innovative provider-based model of care?
  • Did the medical home projects that the States implemented change the extent to which practices adopted key components of the medical home model?
  • To what extent did these provider-based models improve care coordination for children with special health care needs?
  • What were the impacts of these provider-based models on children's health care quality?

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Learn More

To learn more about the individual projects in this grant category, use the following links: Alaska, Colorado, Florida, Georgia, Idaho, Illinois, Maine, Maryland, Massachusetts, New Mexico, North Carolina, Oregon, South Carolina, Utah, Vermont, West Virginia, Wyoming.

This page summarizes projects that States are implementing under the third category (Category C), evaluating the ability of provider-based models to improve quality of children's health care. To learn about the other grant categories, please use the left navigational bar, organized by 5 areas of focus.

To learn more about the evaluation of these demonstrations, send an email to CHIPRADemoEval@ahrq.hhs.gov.

Please note: This Web site uses the term "national evaluation" to distinguish this evaluation of the entire demonstration program from evaluations commissioned or undertaken by grantees. The word "national" should not be interpreted to mean that findings are representative of the United States as a whole.

Current as of June 2013
Internet Citation: Evaluating Provider-Based Models. June 2013. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/policymakers/chipra/demoeval/evaluate-model/index.html