Evaluating Provider-Based Models

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

The U.S. Preventive Services Task Force posted today a draft Research Plan on screening for syphilis infection in nonpregnant adolescents and adults. The draft Research Plan is available for review and public comment from June 26 to July 23, 2014. To review the draft Research Plan and submit comments, go to http://www.uspreventiveservicestaskforce.org/tfcomment.htm.The National Evaluation reports provide useful insights into their strategies and lessons learned:

Learn more about provider-based models on this page:

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Importance of Assessing Provider-Based Models for Children

During the last several 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 (Tables 1-3).

Table 1. Type of Provider-Based Model

Activity AK CO* FL* GA ID IL MA* MD* ME* NM NC* OR* SC* UT* VT WV WY
Patient-centered medical home          
School-based health centers                              
Care management entities                            

Table 2. Service Emphasis of Provider-Based Models
Activity AK CO* FL* GA ID IL MA* MD* ME* NM NC* OR* SC* UT* VT WV WY
EPSDT services                        
Services for serious mental health conditions                    
Services for chronic physical health conditions                          

Table 3. Implementation Strategies of Demonstration States
Activity AK CO* FL* GA ID IL MA* MD* ME* NM NC* OR* SC* UT* VT WV WY
Establish Learning collaboratives for practices                  
Use Practice facilitators, coaches, coordinators                          
Provide financial compensation to participating practices                            

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 About the CHIPRA Quality Demonstration

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.

Page last reviewed June 2014
Internet Citation: Evaluating Provider-Based Models. June 2014. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/policymakers/chipra/demoeval/evaluate-model/index.html