National Evaluation of the 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

 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  CMS: K. Llanos, E. Hill The National Evaluation Team 2

 Overview of the CHIPRA Quality Demonstration Grant Program  Goals and methods of the national evaluation  Early observations about practice-level reporting of quality measures Today’s Presentation 3

 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  National evaluation overseen by AHRQ, Aug – Sept The CHIPRA Quality Demonstration Program 4

CHIPRA Quality Demonstration Program (cont’d) 5  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)

StatesABCDE Oregon* Alaska West Virginia Maryland* Georgia Wyoming Utah* Idaho Florida* Illinois Maine*, Vermont Colorado* New Mexico Massachusetts* South Carolina* Pennsylvania* North Carolina* Demonstration Grantees* and States, by Grant Category 6

 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 Example of Within Category Variation: States’ Activities Related to Quality Measures 7

 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 National Evaluation: Goals 8

 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 National Evaluation: Methods 9

 Used information from 4 states: Maine, Massachusetts, North Carolina, Pennsylvania  Site visits conducted: March – August 2012  Results to be published in October issue brief Early Observations About Practice-Level Reporting 10

 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? What are States Learning About Practice-Level Reporting? 11

 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 Practice-level Reporting: Take Away Messages 12

13 National Evaluation Web Page

  Features – Clickable map of the demonstration states – State-at-a-Glance descriptions – Category descriptions – More about the national evaluation – Reports & Resources: Findings, issue briefs Web Page 14

For more information or to share your good ideas, contact: Henry T. Ireys, PhD Senior Fellow, Mathematica Policy Research Contact Information 15