2010 Study of the Older Americans Act Provider Network

AOA’S NATIONAL STUDY OF THE PROVIDER NETWORK
AAA INTERVIEW GUIDE
November, 2009

As you know, Westat is conducting a study of the provider network in your state. We would like to interview you about how services are provided in your area, the characteristics of the providers that deliver services to your clients, and the broader community context in which services are delivered.

The interview, which should last 45-60 minutes, will be tape recorded to ensure accuracy of the information. Please be assured that no one will have access to these data except Westat researchers who have taken a pledge of confidentiality. Furthermore, results will be reported in aggregated form and in a way that will not enable statements to be linked to identifiable individuals.

Are there any other questions before we begin? I am now going to turn on the tape recorder, Okay?

A. The AAA’s Approach to the Provision of Services

Thank you for completing the pre-site visit questionnaire. The first few questions are about your general approach to service delivery and wherever possible, I want to use your responses from the pre-site visit questionnaire as a starting point for our discussion.

1. Can you describe your AAA’s overall philosophy of providing services? What would you say drives that philosophy? (Probe on key features and drivers as needed, e.g. state and local policies, needs assessments.) Do you have a written mission statement—if so, can you say a little about it and when, how and by whom it was developed?

2. Now I’d like to ask specifically about how you would characterize your AAA’s approach to working with service providers. (First let respondent articulate, then probe as needed for clarification/elaboration.) In particular, I’d like to know more about how you view the roles and responsibilities of the AAA in relation to service providers as well the ways in which you may work together to achieve common goals.

3. Next I’d like to turn to your approach to delivery of services. How would you describe your overall approach to service delivery? (Only ask if not covered in Q1.) OR

1. Based on what you said earlier, this seems to be your approach to service delivery (briefly summarize). Did I get the gist of what you said? (Ask respondent to elaborate, clarify, with respect to intensity and mix of services.)

2. [If not already addressed] What role, if any, does consumer-directed care play in your overall approach? What factors influence the development of a service package for any given individual and how does case management typically fit into the picture?

3. [If not already addressed] What are your thoughts about short-term versus long-term provision of services?

4. Has any part of your overall approach to service provision (as discussed above) changed in an important way in the last 5 years? If so, please say more about the nature of the change and the factors contributing to any such change(s).

B. Contextual Factors that Influence the Provision of Services

1. In the pre-site visit questionnaire, you noted that the AAA is situated in an (urban, rural, suburban, or a combination of areas). Could you say more about this, especially about recent changes or other geographic or demographic characteristics that in your view are distinctive to your service area?

2. Overall, how would you say these demographic and geographic characteristics impact the provision of services? How has this changed, if at all, in the past 5 years?

3. Apart from these geographic and demographic characteristics, are there any other factors that influence how the AAA provides services? (e.g., municipal or county governmental structure, political culture.) If so, please explain.

C. AAA as a Direct Service Provider

1. In the pre-site visit questionnaire, you noted that the AAA provides [NAME OF SERVICES] to your clients. We want to know more about the factors that contributed to the AAA becoming a provider of these services. (If not explicitly noted, probe on political situation, lack of other available services.)

2. For the services that the AAA directly provides, please briefly describe: a) the service, b) the clientele, c) the location where the service is provided, and d) any in-kind resources that are leveraged (e.g., free rent on space for service, materials, staff time, etc.) to help provide the service.

3. We are also interested in learning about AAAs that provide services to other organizations. What services, if any, does the AAA provide to other organizations and how did this arrangement evolve?

D. AAA Relationships with Service Providers

In this section I’ll pose a series of questions about your AAA’s relationships with the organizations and individuals that provide services to your clients.

1. Now I’d like to ask about the type(s) of mechanisms – including contracts, cooperative agreements, or other arrangements–you employ in working with your service providers. (Probe on variations; which most used/why; how different mechanisms developed over time.) Can you show me an example of the vendor package you normally use? Overall, how well would you say these mechanisms work?

2. Which major funding sources are used to pay providers? How do you determine how resources are allocated? (Probe on any inconsistencies/anomalies in billing—e.g., different rates for same service from different providers.)

• Federal funds (OAA,USDA, DOT, Medicare, Medicaid, Medicaid waiver)

• State funds

• Local government funds

• Foundations (specify)

• United Way

• In-kind contributions

• Participant contributions

• Other (specify)

3. Your response to the pre-site visit questionnaire indicates that you work with [INSERT NUMBER PRIOR TO THE SITE VISIT] providers of various types. Please choose a few examples of major types of provider organizations and tell me about their organizational structure:

• An individual service provider (e.g., 1 person)

• A stand-alone provider agency

• An umbrella organization that provides a service

• Some other type of organization (specify)

4. Earlier we talked a bit about the AAA’s overall approach to working with service providers. Now, can you elaborate more specifically on how providers contribute to achieving AAA program goals? [USE INFORMATION FROM ANSWERS TO PRIOR QUESTIONS AND PRE SITE-VISIT QUESTIONNAIRE AS APPLICABLE] For providers that you described in the previous question, please give an interesting example of how that provider is contributing/has contributed to achieving AAA program goals in one or more of the following areas. If it makes sense to do so, please build on the examples you just gave or choose additional providers to describe how they work with the AAA (or independently in achieving program goals):

• Fundraising

• Outreach

• Targeting

• Program development

(If not addressed, probe on factors contributing to each provider’s role, degree of independence/
collaboration, how responsibilities are shared.)

5. Your pre-site visit questionnaire indicates that your AAA does offer a consumer-directed care option. [DRAW ON PRIOR ANSWERS AND SITE-VISIT QUESTIONNAIRE AS APPLICABLE] Can you tell me more about how this works and what contributed to the initiation of this option for your clients? What have been the facilitators as well as the barriers to its implementation? How has having this option affected your relationships with service providers?

6. Earlier you noted that [FILL IN ANSWERS FROM ABOVE] are the most common mechanisms you use for working with service providers. As the final question in this section, I’d like to ask about the continuity and duration of the AAA’s arrangements with your service providers. (First let respondent speak to this subject. Then, if needed, probe on: average length of arrangements, newest and oldest, AAA’s role.)

What are the main reasons why you need to change service providers? How do you go about doing so? If you’ve had to terminate a relationship with a provider in the past 3 years, please say more about the circumstances surrounding this.

E. Provider Databases, MIS Systems, Billing, and Monitoring

I’d like to ask about how you track provider and client service data.

1. How do you maintain information about your service providers? (Probe on format – electronic, paper records.) Is there a central location where the information is stored? If the information is not in a central location, is it decentralized? (Probe on how it is decentralized.)

2. What information about providers is collected and maintained? (Probe: contact information, point of contact, type of contract or grant, service provided, staff certifications, assurances, geographic coverage, monitoring data…) Who maintains the information on providers? (Probe: contracts office, program staff, …) How frequently is it updated?

3. Can you briefly describe how you track information about providers in terms of the delivery of services? (Electronic versus paper records, software packages (COTS or commercial), where data reside.) Which data elements are tracked for each provider, each client? (Probe on cost/billing data) How was it decided which specific items would be tracked? How interlinked are your MIS systems with those of the providers? (Probe on how communicate with providers about service requests, payments, tracking.)

(If not addressed in the response to question 1, ask the following question.)

4. Briefly describe the payment system that the AAA uses for providers (fee-for-service/rate, capitated, unit-based, etc.). To what extent does the payment system and/or amount vary by funder? What is the frequency for billing? (Weekly, monthly, per occurrence of service.) If consumer direction is offered, how is this tracked and paid?

5. Briefly describe the system used to monitor service providers and evaluate their performance (Probe: client assessments of service quality, complaint mechanisms, site visits, document reviews, performance targets…). How do you determine that clients receive the appropriate service and unit of service?

6. How does your agency contact providers and clients during a manmade or natural emergency, such as a snowstorm, hurricane, or earthquake that may make it difficult for providers to deliver services or for clients to access services? (Probe: If not mentioned in the answer, is there a formal plan for emergency communications?) Has your agency had an emergency in which the plan was used? If, yes how did it work? Were any changes made based this experience?

F. Final Questions

This is the last section of the interview. I have two questions for you.

1. If there is one thing you could change about your relationship with the service providers in your area, what would you change?

2. Is there anything else that you would like to tell me about how you work with providers?

Thank you so much for taking your time to speak with us today. Is there anything else you’d like to add to help us better understand your provision of services?

Thanks, again, for all your help.