National Evaluation of the CHIPRA Quality Demonstration Grant Program: Early Observations

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Slide 1

National Evaluation of the Children's Health Insurance Program Reauthorization Act (CHIPRA) Quality Demonstration Grant Program: Early Observations

AHRQ 2012 Annual Conference
Moving Ahead: Leveraging Knowledge and Action to Improve Health Care Quality
Tuesday, September 11, 2012

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The National Evaluation Team

• Mathematica: H. Ireys, L. Foster, C. McLaughlin, A. Christensen, G. Ferry, B. Natzke, others.
• Urban: K. Devers, J. Kenney, I. Hill, R. Burton, S. McMorrow, others.
• AcademyHealth: L. Simpson, V. Thomas.
• AHRQ: C. Brach, S. Farr.
• Centers for Medicare & Medicaid Services (CMS): K. Llanos, E. Hill.

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Today's Presentation

• Overview of the CHIPRA Quality Demonstration Grant Program.
• Goals and methods of the national evaluation.
• Early observations about practice-level reporting of quality measures.

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The CHIPRA Quality Demonstration Program

• Congressionally mandated.
• $100 million dollar program:
  • Large federally-funded efforts specifically focused on improving quality of child health care.
• Five-year grants awarded by CMS to 10 grantees, involving 18 states, Feb. 2010.
• National evaluation overseen by AHRQ, Aug. 2010 – Sept. 2015.

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CHIPRA Quality Demonstration Program (cont'd)

• Focus on five strategies to improve quality:
  • Show how quality measures can be used to improve quality of care for children (Category A).
  • Demonstrate utility of HIT/EHR applications (Category B).
  • Implement provider-based models (Category C).
  • Apply model format for EHRs for children (Category D).
  • Other innovative approaches to improve quality (Category E).

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Demonstration Grantees and States, by Grant Category

* Demonstration Grantees.

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Example of Within Category Variation: States' Activities Related to Quality Measures

• Expand, build on existing data and reporting infrastructure, such as warehouses, linked datasets.
• Apply measures at practice, system, and state levels.
• Develop new measures, beyond core measure set.
• Report performance to various audiences: providers, health plans, families/public, policymakers.
• Link performance on measures to incentives.

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National Evaluation: Goals

• Goals:
  • Identify effective strategies to improve quality of children's health and health care.
  • Disseminate information about what works, why it works, and what's worth replicating.
  • "Tell the stories" of projects, categories, states, grantees.

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National Evaluation: Methods

• Mixed-Methods Design:
  • Quantitative (claims/administrative files) & qualitative (site visits, document review).
  • Descriptive/compare-and-contrast analysis of program implementation.
  • Comparative analysis of trends/outcomes.
  • Impact analyses for selected medical home projects.
  • Multiple levels of analyses: patient, provider, practice, network, regional, state, grantee, groups of grantees.

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Early Observations About Practice-Level Reporting

• Used information from 4 states: Maine, Massachusetts, North Carolina, Pennsylvania.
• Site visits conducted: March – August 2012.
• Results to be published in October issue brief.

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What are States Learning About Practice-Level Reporting?

• Practice-level reporting: Very different from state-level reporting:
  • Technical challenges re: accessing data sources from multiple systems, defining quality measure denominators.
  • Data collection via providers: Managing burden, expectations.
• Two questions particularly important to practices:
  • Can my practice influence these measures?
  • Are these measures useful for our QI efforts?

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Practice-level Reporting: Take Away Messages

• An essential step: Involving physician practices in selecting measures for quality-improvement projects.
• Adapting measures originally designed for state-level: An unexpectedly resource-intensive task.
• States are actively turning to EHRs and HIEs:
  • Barriers: Outdated, undeveloped, or unsophisticated health IT, data infrastructures.

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National Evaluation Web Page

Image: A screenshot National Evaluation of the CHIPRA Quality Demonstration Grant Program Web site is shown.

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Web Page

• https://www.ahrq.gov/chipra/demoeval/.
• Features:
  • 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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Contact Information

For more information or to share your good ideas, contact:

Henry T. Ireys, PhD
Senior Fellow, Mathematica Policy Research
202-554-7536
hireys@mathematica-mpr.com