Key Lessons from the National Evaluation of the CHIPRA Quality Demonstration Grant Program

Using Federal grants to build intellectual capital at the State level

Program objectives

The demonstration allowed State staff and their partners to gain substantial experience, knowledge, and partnerships related to QI for children in Medicaid and CHIP—a resource we refer to as “intellectual capital.” Although the CMS solicitation did not identify this outcome as a specific objective of the grant program, all 18 demonstration States developed this resource in some fashion.

State strategies

Specifically, the demonstration grants allowed States to build intellectual capital through one or more mechanisms, such as:

  • Contracting with State universities or medical schools to develop and implement the demonstration projects, often expanding the scope of work specifications of existing contracts.
  • Supporting State staff directly to develop the partnerships, inter-agency agreements, and subcontracts necessary to enhance a State’s capacity to report quality measures and implement QI activities.
  • Developing new administrative entities in or closely aligned with the Medicaid agency that have specific responsibilities and authority to implement QI activities for children enrolled in Medicaid and CHIP.   

Lessons learned

Because of the demonstration, States had an opportunity to enhance their technical and administrative experience with QI initiatives for children. Analysis of information from stakeholder interviews indicates that States benefitted from this opportunity in a variety of ways:

  • Having dedicated staff and resources for a 5-year period allowed most demonstration States to think about sustaining long-term strategies for improving children’s health beyond the immediate task of implementing demonstration activities. Over half of the programmatic elements that had been implemented by the end of demonstration’s 5th year had been or were likely to be sustained.
  • In several States, the experience and resources developed to improve quality of care for children were subsequently applied to adult populations.
  • Some States contributed substantial in-kind resources to support demonstration activities and, in doing so, worked to raise awareness about child health issues across their administrative agencies and across the State. The intellectual capital derived from the demonstration helped ensure that children and children’s health issues would be a part of broader conversations about health care payment reform and quality measurement and reporting.

In Idaho a new entity—the Idaho Health and Wellness Collaborative for Children (IHAWCC) —was developed to capitalize on intellectual capacity created during the demonstration. This new pediatric improvement partnership is a coalition of clinicians and stakeholders—including representatives from the State's Medicaid program—that is invested in using measurement-based efforts to improve the quality of children's health care. IHAWCC will use what was learned during the demonstration to continue offering learning collaboratives to enhance the QI capacity of clinicians and health care quality.

In South Carolina, demonstration staff will work with other State staff to transition PCMH responsibilities to a new unit in the State’s Medicaid agency (the Pediatric Quality Unit). Although this unit’s specific responsibilities are still being finalized, after the no-cost extension its staff will coordinate PCMH development and monitoring activities, as well as support QI learning collaboratives and related initiatives begun during the demonstration.

Page last reviewed September 2015
Page originally created September 2015
Internet Citation: Using Federal grants to build intellectual capital at the State level. Content last reviewed September 2015. Agency for Healthcare Research and Quality, Rockville, MD.
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