Improving Care and Proving It!

Second Annual CMS Quality Conference

The National Evaluation of the CHIPRA Quality Demonstration Grant Program

Presentation to the Demonstration States at the CMS Medicaid and CHIP Quality Conference, Friday, June 15, 2012

  1. National Evaluation of the CHIPRA Quality Demonstration Grant Program: An Update
  2. The National Evaluation Team
  3. Today's Comments
  4. Site Visits: Status
  5. Site Visits: Early Observations
  6. Site Visits: Early Observations (cont.)
  7. Site Visits: Early Observations (cont.)
  8. Claims, Administrative, and Medical Home Data
  9. Comments? Questions?
  10. Web Page Updates
  11. Web Page Mockup
  12. Looking Ahead: Possible Topics for Evaluation Highlights Series
  13. Looking Ahead: Other Possible Activities
  14. Comments? Questions?
  15. National Evaluation Timeline
  16. National Evaluation Timeline (cont.)
  17. Contact Information

Slide 1

National Evaluation of the CHIPRA Quality Demonstration Grant Program: An Update

Second Annual CMS Quality Conference: Improving Care and Proving It!

Baltimore, Maryland
June 15, 2012

The bottom of this slide contains the four logos of the organizations that lead the national evaluation. From left to right, the logos are for the Agency for Healthcare Research and Quality, Mathematica Policy Research, AcademyHealth, and the Urban Institute.

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Slide 2

The National Evaluation Team

  • Mathematica: H. Ireys, L. Foster, C. McLaughlin, C. Trenholm, A. Christensen, G. Anglin,
    B. Natzke, F. Yoon, and others
  • Urban: K. Devers, J. Kenny, I. Hill, R. Burton, S. McMorrow, and others
  • AcademyHealth: L. Simpson, V. Thomas
  • AHRQ: C. Brach, S. Farr
  • CMS: K. Llanos, B. Dailey

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Slide 3

Today’s Comments

  • Updates on data collection: site visits, claims, and administrative data
  • Website updates
  • Looking ahead

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Slide 4

Site Visits: Status

  • Goal of initial site visits: gather information about early implementation experiences
  • Much assistance from state project staff has yielded a smooth scheduling process, willing respondents
  • 2012 visit schedule to 18 states, by month
    • March: 1 state
    • April : 4
    • May: 4
    • June: 4
    • July: 5

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Slide 5

Site Visits: Early Observations

  • Multiple interpretations of “demonstration”
    • Concept development: “medical home in frontier environment”
    • Pilot study: start local, expand statewide after grant
    • Showing how to do it, or how to do it better: improving results of earlier efforts to build statewide infrastructure for electronic sharing of data
    • Building the evidence base: gathering and analyzing information to inform future programs and policies

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Slide 6

Site Visits: Early Observations

  • Key factors affecting early implementation
    • Policy, program context: leadership changes, budget/spending/hiring constraints
    • Previous work: what these projects are building on
    • Related, ongoing projects: many interactions with other efforts
    • What states are doing now to sustain the project later
    • Role of multistate partnerships

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Slide 7

Site Visits: Early Observations (cont.)

  • Quality measures: reporting “up” to CMS is very different from reporting “down” to practices
  • HIT projects: numerous delays related to multiple agendas, initiatives, and technical problems; obstacles often beyond the control of CHIPRA project teams
  • Many different strategies for provider-based models: behavioral health integration, improved patient compliance around well child care, better care coordination, tighter relationships between primary care physicians and patients, and others

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Slide 8

Claims, Administrative, and Medical Home Data

  • Working with seven Category C states (IL, MA, ME, NC, OR, SC, WV) and one Category B state (PA)
  • Major efforts by states to provide files
  • Essential to assess outcomes, impacts of state efforts to assist future planning and sustainability
  • Analyses to address key questions; for example:
    • What are the characteristics of participating practices across states?
    • Is the medical home level associated with service use?

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Slide 9

Comments? Questions?


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Slide 10

Web Page Updates

  • Estimated operational date: end of June
  • Three clusters of text and graphics
    • Home page: high-level overview of the program and evaluation
    • Clickable map of the demonstration states
      • State-at-a-Glance descriptions
      • Category descriptions
      • More about the national evaluation
      • Reports & Resources: findings, issue briefs

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Slide 11

Web Page Mockup

Slide 11: Web Page Mockup

This slide contains a graphic mockup of the homepage of the national evaluation site, which will be hosted on the Agency for Healthcare Research and Quality’s (AHRQ’s) web site. The top of the mockup shows the AHRQ web site banner and tool bar. Below that is the logo and title of the National Evaluation of the CHIPRA Quality Demonstration Grant Program. The left sidebar includes the following navigational buttons, from top to bottom: (1) Learn about the Demonstration States, (2) Using the Core Set of Children’s Quality Measures, (3) Enhancing Health IT Infrastructures, (4) Promoting Provider-Based Models, (5) Developing a Model Pediatric EHR Format, (6) Other Strategies for Quality Improvement, (7) Reports & Resources, (8) More About the Evaluation, and (9) Contact the Evaluation Team. The center of the mockup has three photos at the top: (1) two female physicians in lab coats caring for a young male patient, (2) two smiling parents running playfully outside with their young son and daughter, and (3) three people in black suits walking up the steps of the U.S. Supreme Court building in Washington, DC. Below the pictures is the title “The National Evaluation of the CHIPRA Quality Demonstration Grant Program.” Below that is some “dummy” text that shows how the content will look on the page once it goes live. The right sidebar includes the following navigational buttons: (1) What’s new, (2) More about the CHIPRA Quality Demonstration Grants from the CMS web site, and (3) Subscribe to email updates about the Evaluation.

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Slide 12

Looking Ahead: Possible Topics for Evaluation Highlights Series

  • What are states learning about practice-level reporting of quality measures? (August 2012)
  • What are the characteristics of practices participating in medical home projects, and who are the children they serve?
  • Are higher levels of “medical homeness” associated with more primary care visits and fewer emergency department visits?
  • Learning collaboratives and practice coaches: what works? What doesn’t?
  • What strategies are states using to integrate behavioral and physical health services?

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Slide 13

Looking Ahead: Other Possible Activities

  • Opportunities for states to contribute materials, reports to web page
  • Evaluation-focused calls with state evaluation teams
  • Other ways to disseminate findings to demonstration states?
  • In 2013 and beyond: replication guides, Profiles of Promising Practices, AHRQ Innovations, journal articles
  • Other dissemination strategies: reading and resource lists, conferences, group consultations

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Slide 14

Comments? Questions?


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Slide 15

National Evaluation Timeline

  • Year 1 (Aug 2010–Jul 2011)
    • Learn about state projects
    • Finalize evaluation design report
    • Develop data collection protocols, submit OMB materials, gain IRB approvals
  • Year 2 (Aug 2011–Aug 2012)
    • Receive OMB/IRB approvals, negotiate DUAs
    • Collect baseline, initial implementation data: quantitative, qualitative
    • Plan dissemination strategies with key stakeholders
    • Publish first issue brief

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Slide 16

National Evaluation Timeline (cont.)

  • Year 3 (Aug 2012–Jul 2013)
    • Analyze baseline data, report findings
    • Plan cross-sectional physician survey
    • Seek OMB approval for follow-up data collection
  • Year 4 (Aug 2013–Jul 2014)
    • Implement physician survey
    • Collect follow-up data
  • Year 5 (Aug 2014–Sep 2015)
    • Analyze follow-up data, report findings
    • Create replication guides for states

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Slide 17

Contact Information

For more information or to share your ideas, contact:
Henry T. Ireys, Ph.D.
Senior Fellow, Mathematica Policy Research

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Page last reviewed August 2012
Page originally created September 2012
Internet Citation: Improving Care and Proving It!. Content last reviewed August 2012. Agency for Healthcare Research and Quality, Rockville, MD.