STAKEHOLDER INTERVIEW GUIDEs
Form Approved
OMB No: 0935-XXX
Exp. Date XX/XX/20XX
EXTERNAL STAKEHOLDERS
Thank you for speaking with us today. In the email we sent confirming this interview, we provided information on who we are, why we’re here, what topics we’re interested in talking about, and we assured you that your responses will be kept confidential. Do you have any questions before we start the interview? If not, may we begin recording the conversation?
If the respondent did not receive or does not remember the confirmation email or if they have questions about the information provided in the email, review the introduction to the study on next page.
Public
reporting burden for this collection of information is estimated to
average 60 minutes per response, the estimated time to complete the
interview. An agency may not conduct or sponsor, and a person is not
required to respond to, a collection of information unless it
displays a currently valid OMB control number. Send comments
regarding this burden estimate or any other aspects of this
collection of information, including suggestions for reducing this
burden, to: AHRQ Reports Clearance Officer Attn: PRA, Paperwork
Reduction Project (0935-XXXX) AHRQ, 540 Gaither Rd., Rm. 5036,
Rockville MD 20850.
Introduction to Study
We are from the Urban Institute and Mathematica Policy Research, and we are part of the team conducting the cross-state evaluation of the CHIPRA Quality Demonstration. The evaluation is federally funded by the Agency for Healthcare Research and Quality (AHRQ). The Centers for Medicare & Medicaid Services (CMS) provides the grants to states.
We are now conducting our first round of visits to the 18 demonstration states. We are meeting with people who are closely involved in the design, management, and day-to-day operations of each state’s demonstration initiatives, as well as other people who care about how the demonstrations affect children’s care quality in Medicaid and CHIP.
We are particularly interested in your thoughts and insights on several topics, including:
Features of the health care system in [state] that may affect your state’s demonstration plans or its ability to implement them.
The demonstration’s goals and activities and how those activities are interacting with other initiatives in the state.
Your involvement with the demonstration’s activities.
How the demonstration has impacted your organization.
Our interview will take an hour. Your responses will be kept confidential to the extent permitted by law, including AHRQ’s confidentiality statute, 42 USC 299c-3(c). We will share everyone’s comments with members of the evaluation team and we will report to AHRQ and CMS on the general themes that emerge from all of our discussions. Our reports will list the people we spoke to in each state, but we will not attribute specific comments or quotes to named individuals without permission. We would like to record our discussion in case we miss something in our notes and want to go back and listen. But, we do not plan to transcribe the recording.
Do you have any questions before we start? May I begin recording?
I. Introduction/Background
My first questions are for background.
Please tell me what your position is at here at [this organization] and how long you have worked here.
What are your responsibilities in connection with the state’s CHIPRA Quality Demonstration grant? Are you directly involved in some grant categories, but not others? Which ones?
In your own words, what are the state’s major goals for the demonstration?
What improvements to care quality in Medicaid and CHIP does the state want to achieve in the next four years?
What impact on utilization and expenditure does the state hope to achieve?
How does the state hope to impact transparency and consumer choice?
II. State Context
Let’s move on to some contextual questions.
Please describe any features of the Medicaid and CHIP program in [state] that may facilitate or create challenges to the state achieving its goals for the demonstration.
Probe as needed on prior experience implementing similar initiatives, leadership support, Medicaid/CHIP eligibility and enrollment, budgetary issues, managed care prevalence, and provider participation or reimbursement.
How may these features facilitate or create challenges to the state achieving their goals for the demonstration?
Now that we have a better understanding of the baseline context, we would like to discuss recent changes in the state. We understand that [researcher summarizes known information on state-level changes]. Have there been any other major state-level changes since the final operational plan was submitted in December 2010?
Changes in governor, legislature, key agency staff, or changes in their level of support? Changes in the state’s budget outlook?
What impact, if any, are these changes having on the implementation of the demonstration?
Pace? Strategy or approach?
We understand that [researcher summarizes known information on health sector changes.] Have there been any other major changes in the health sector?
Growth or other changes in managed care in Medicaid or CHIP?
Greater interest to cut Medicaid or CHIP costs?
The willingness of private health plans to participate in multi-payer efforts that involve Medicaid or CHIP?
New or changing PCMH efforts in private plans or being advocated by professional associations?
What impact are these changes having on the implementation of the demonstration?
Pace? Strategy or approach?
Any other changes that are outside of, but important to the CHIPRA Quality Demonstration?
What impact are these changes having on the implementation of the demonstration?
Pace? Strategy or approach?
III. Strategies
My next questions are about the CHIPRA Quality Demonstration in [this state].
[Interview: Use the cross-strategy module if respondent has general knowledge, or a category-specific module if respondent has specialized knowledge.]
Cross-Category
Are you familiar with the state’s goals for the first year of the demonstration since December 2010? If so, how would you describe them?
Please briefly describe the major strategies or approaches the state has been using to accomplish those goals. Whatever you know about is fine.
In your opinion, has the state made progress towards its goals? Why would you say that?
What strategies seem to be working well? What factors seem to be contributing to progress?
Probe as needed on skills and experience of staff, effective planning, high-level support, other external factors
What strategies seem to be working less well? What factors seem to be inhibiting progress?
Probe as needed on skills and experience of staff, effective planning, high-level support, other external factors
How is the state trying to overcome the challenges you’ve described? What approaches is the state using or considering?
Probe for examples.
Quality Measurement Initiatives (Category A)
[NOTE: Use category A module if state has a category A project and respondent has specialized knowledge.]
The next few questions will focus on Category A, collecting and reporting the core set of CHIPRA quality measures.
Please describe how you and your organization have worked with the demonstration project staff to plan and implement activities related to quality measurement.
Probe as needed on involvement in workgroups, provider selection and recruitment, learning collaboratives, development of resources or tools.
[If involved in workgroups] Please describe the pros and cons of working together with other stakeholders on this initiative.
How satisfied are you with the level of involvement your organization had in planning and implementing activities in this area?
[Researcher should briefly summarize goals mentioned previously.] What would you describe as the major goals in this area for the first year of the demonstration?
Please briefly describe the major strategies or approaches the state has been using to accomplish the goals in this area.
What strategies seem to be working well? What factors seem to be contributing to progress?
Probe as needed on data infrastructure, skills and experience of staff, effective planning, high-level support, other external factors
What strategies seem to be working less well? What factors seem to be inhibiting progress?
Probe as needed on data infrastructure, skills and experience of staff, effective planning, high-level support, other external factors
In your view, how comprehensive and clear were the CMS measure specifications?
What areas were most unclear? How could the specifications be improved, if at all?
Is your organization using the measures or planning to use them? How?
Did the state provide your organization with any resources, including training, materials or tools, to help you use the measures? How satisfied are you with these resources?
Did you receive any resources, including training, materials, or tools, in addition to those provided through the demonstration? If so, please describe.
Did you receive reports based on these measures? If so, please describe. How satisfied are you with these reports?
Before the CHIPRA demonstration started in December 2010, what quality measures, including HEDIS and CAHPS measures, if any, did Medicaid and CHIP plans and/or providers in [this state] collect and report on?
Did plans or providers report pediatric focused measures? What measures?
Before the CHIPRA demonstration started in December 2010, did providers receive reports on quality or utilization? If so, please describe.
What information was contained in the reports? How often did they receive the reports? To what extent did quality reports for child-serving providers include pediatric focused measures?
How useful did providers find these reports, to your knowledge?
Were these reports part of formal pay for performance (P4P) incentive programs?
How has the CHIPRA quality demonstration changed the reporting requirements for Medicaid and CHIP plans and/or providers? How has it changed the reports providers receive?
To what extent has it increased the data collection and reporting burden on plans and/or providers? How have plans and/or providers responded to this change?
Do the reports come more frequently? Less frequently? Do they contain different information?
Are there other initiatives related to quality reporting in Medicaid and CHIP in the state that we should know about? If so, please describe.
To what extent do child-serving providers participate in these initiatives? (Providers could be practices, hospitals, school-based health centers, federally qualified health centers, and so forth.)
Is the state integrating data collection and reporting for the core measures with data collection and reporting for this other initiative? If so, how?
Has the CHIPRA demonstration increased or decreased the amount of time, attention, and/or financial resources available to these initiatives? If so, please describe.
How would you compare the impact of the CHIPRA quality demonstration to these initiatives?
Health IT Initiatives (Category B)
[NOTE: Use category B module if state has a category B project and respondent has specialized knowledge.]
The next few questions will focus on Category B, health IT initiatives.
Please describe how you and your organization have worked with the demonstration project staff to plan and implement activities in this area.
Probe as needed on involvement in workgroups, provider selection and recruitment, learning collaboratives, development of resources or tools.
[If involved in workgroups] Please describe the pros and cons of working together with other stakeholders on this initiative.
How satisfied are you with the level of involvement your organization had in planning and implementing activities in this area?
[Researcher should briefly summarize goals mentioned previously.]What would you describe as the major goals in this area for the first year of the demonstration?
Please briefly describe the major strategies or approaches the state has been using to accomplish the goals in this area.
What strategies seem to be working well? What factors seem to be contributing to progress?
Probe as needed on skills and experience of staff, effective planning, high-level support, other external factors
What strategies seem to be working less well? What factors seem to be inhibiting progress?
Probe as needed on skills and experience of staff, effective planning, high-level support, other external factors
Before the CHIPRA demonstration started in December 2010, how would you have characterized the state’s health IT infrastructure?
If you were rating the infrastructure on a scale from 1 (very weak) to 10 (very strong), where would your state have been on the scale?
Uptake of EHRs by child-serving hospitals and physicians?
The health information exchange capacity within the state?
Usefulness of any electronic registries, such as immunization registries?
Before the CHIPRA demonstration started in December 2010, what initiatives were underway to encourage change in these areas? I am thinking of federal initiatives like an HIE cooperative agreement, regional extension centers, and the EHR meaningful use incentive program.
To what extent do child-serving providers participate in these initiatives? (Providers could be practices, hospitals, school-based health centers, federally qualified health centers, and so forth.)
Is the state integrating their CHIPRA demonstration project with these initiatives? If so, how?
Has the CHIPRA demonstration increased or decreased the amount of time, attention, and/or financial resources available to these initiatives? If so, please describe.
How successful are these initiatives? What factors make these initiatives more or less successful?
How is the state’s ability in these areas changing?
To what extent would you say the CHIPRA quality demonstration is stimulating or driving these changes?
[Researcher will add probes if necessary to build on information provided in the state’s FOP.] How would you compare the CHIPRA quality demonstration activities to others, like HITECH dollars, plan incentive programs, or other efforts? (To the extent you can isolate the demonstration from other health IT initiatives.)
Provider-Based Initiatives (Category C)
[NOTE: Use category C module if state has a category C project and respondent has specialized knowledge.]
The next few questions will focus on Category C, provider based models.
Please describe how you and your organization have worked with the demonstration project staff to plan and implement activities in this area.
Probe as needed on involvement in workgroups, provider selection and recruitment, learning collaboratives, development of resources or tools.
[If involved in workgroups] Please describe the pros and cons of working together with other stakeholders on this initiative.
How satisfied are you with the level of involvement your organization had in planning and implementing activities in this area?
[Researcher should briefly summarize goals mentioned previously.]What would you describe as the major goals in this area for the first year of the demonstration?
Please briefly describe the major strategies or approaches the state has been using to accomplish the goals in this area.
What strategies seem to be working well? What factors seem to be contributing to progress?
Probe as needed on skills and experience of staff, effective planning, high-level support, other external factors
What strategies seem to be working less well? What factors seem to be inhibiting progress?
Probe as needed on skills and experience of staff, effective planning, high-level support, other external factors
Before the CHIPRA demonstration started in December 2010, what provider-based initiatives to improve quality of care were underway with [physicians/SBHCs/CMEs]? Please include private or commercial initiatives that you know of.
What was the scope of the project, what types of providers participated and how many?
How successful were these initiatives? What factors made these initiatives more or less successful?
Is the state integrating their CHIPRA demonstration project with these initiatives? If so, how?
Has the CHIPRA demonstration increased or decreased the amount of time, attention, and/or financial resources available to these initiatives? If so, please describe.
How would you compare the impact of the CHIPRA quality demonstration to these initiatives?
In addition to the CHIPRA demonstration, are there other new provider-based initiatives in the state to improve quality of care in [practices/SBHCs/CMEs]? If so, please describe. We’re interested in initiatives planned for the next 5 years or so, even if they haven’t begun yet. Again, please include private initiatives you may know of.
What is the scope of the new project, what types of providers are participating and how many?
Is the state integrating their CHIPRA demonstration project with these initiatives? If so, how?
Has the CHIPRA demonstration increased or decreased the amount of time, attention, and/or financial resources available to these initiatives? If so, please describe.
How would you compare the potential impact of the CHIPRA quality demonstration to these initiatives?
Pediatric Electronic Health Record (Category D)
[NOTE: Use category D module if state has a category D project and respondent has specialized knowledge.]
The next few questions will focus on Category D, testing the model electronic health record. [The state] has completed its 12-month planning phase and is now in the infrastructure development phase. They will receive the EHR format soon.]
Please describe how you and your organization have worked with the demonstration project staff to plan and implement activities in this area.
Probe as needed on involvement in workgroups, provider selection and recruitment, learning collaboratives, development of resources or tools.
[If involved in workgroups] Please describe the pros and cons of working together with other stakeholders on this initiative.
How satisfied are you with the level of involvement your organization had in planning and implementing activities in this area?
[Researcher should briefly summarize goals mentioned previously.]What would you describe as the major goals in this area for the first year of the demonstration?
Please briefly describe the major strategies or approaches the state has been using to accomplish the goals in this area.
What strategies seem to be working well? What factors seem to be contributing to progress?
Probe as needed on skills and experience of staff, effective planning, high-level support, other external factors
What strategies seem to be working less well? What factors seem to be inhibiting progress?
Probe as needed on skills and experience of staff, effective planning, high-level support, other external factors
How familiar are you with the health IT capacity of the providers testing the model EHR format?
[If familiar with health IT capacity] Before the CHIPRA demonstration started in December 2010, how would you have characterized the health IT capacity of the providers testing the model EHR?
IT infrastructure?
Experience implementing and/or using health IT?
[If familiar with health IT capacity] Before the CHIPRA demonstration started in December 2010, what activities were underway with participating providers to improve their health IT capacity?
How successful were these initiatives? What factors made these initiatives more or less successful?
Is the state integrating their CHIPRA demonstration project with these initiatives? If so, how?
Has the CHIPRA demonstration increased or decreased the amount of time, attention, and/or financial resources available to these initiatives? If so, please describe.
[If familiar with health IT capacity] How are the providers’ capacities in these areas changing?
To what extent would you say the CHIPRA quality demonstration is stimulating or driving these changes?
[Researcher will add probes if necessary to build on information provided in the state’s FOP.] How would you compare the CHIPRA quality demonstration activities to others, like HITECH dollars, plan incentive programs, or other efforts? (To the extent you can isolate the demonstration from other health IT initiatives.)
[If NOT familiar with health IT capacity] What activities are underway in [state] to improve the health IT capacity of providers?
Do child-serving providers participate in these initiatives? To what extent? (Providers could be practices, hospitals, school-based health centers, federally qualified health centers, and so forth.)
How successful are these initiatives? What factors made these initiatives more or less successful?
Is the state integrating their CHIPRA demonstration project with these initiatives? If so, how?
Has the CHIPRA demonstration increased or decreased the amount of time, attention, and/or financial resources available to these initiatives? If so, please describe.
How would you compare the CHIPRA quality demonstration activities to these initiatives?
Other Quality Initiatives (Category E)
[NOTE: Use category E module if state has a category E project and respondent has specialized knowledge.]
The next few questions will focus on Category E, other quality initiatives.
Please describe how you and your organization have worked with the demonstration project staff to plan and implement activities in this area.
Probe as needed on involvement in workgroups, provider selection and recruitment, learning collaboratives, development of resources or tools.
[If involved in workgroups] Please describe the pros and cons of working together with other stakeholders on this initiative.
How satisfied are you with the level of involvement your organization had in planning and implementing activities in this area?
[Researcher should briefly summarize goals mentioned previously.]What would you describe as the major goals in this area for the first year of the demonstration?
Please briefly describe the major strategies or approaches the state has been using to accomplish the goals in this area.
What strategies seem to be working well? What factors seem to be contributing to progress?
Probe as needed on skills and experience of staff, effective planning, high-level support, other external factors
What strategies seem to be working less well? What factors seem to be inhibiting progress?
Probe as needed on skills and experience of staff, effective planning, high-level support, other external factors
Before the CHIPRA demonstration started in December 2010, were there other similar initiatives in the state? If so, please describe.
How successful were these initiatives? What factors made these initiatives more or less successful?
How would you compare the impact of the CHIPRA quality demonstration to these initiatives?
Is the state integrating their CHIPRA demonstration project with these initiatives? If so, how?
Has the CHIPRA demonstration increased or decreased the amount of time, attention, and/or financial resources available to these initiatives? If so, please describe.
IV. Stakeholder Involvement
Overall, how satisfied are you with the level of involvement your organization has in planning and implementing the demonstration?
What changes, if any, do you suggest the state make to its strategy for involving stakeholders?
Involve additional stakeholders? Different stakeholders? Engage them in a different manner?
V. Indications of Change
I’d like to talk with you about the impact the demonstration may have on children’s quality of care.
At this point in the demonstration, how optimistic are you that the CHIPRA demonstration will translate into positive impacts on patients’ care? What makes you say that?
Have you seen or heard evidence of achievements so far?
Changes in knowledge and skills? Changes in attitudes and behaviors?
With providers, MCOs, or other groups? Related to quality measurement, health IT, provider-based models?
Has your organization done anything differently to improve children’s care quality as a result of the CHIPRA demonstration?
Probe for examples.
What impact, if any, do you expect the demonstration to have on your organization’s efforts to improve children’s care quality moving forward?
VI. Lessons Learned
Given your state’s experience so far in the demonstration, what insights and advice might you have for other states?
Any overarching or specific lessons you’d like to share are fine.
Is there anything you would suggest the state do differently if they could?
What should other states be aware of in designing and implementing these kinds of quality initiatives?
VII. Plans for the Coming Year
Please describe how you and your organization will work with the demonstration team to plan or implement demonstration-related activities in the coming year.
Probe as needed on involvement in workgroups, provider selection and recruitment, learning collaboratives, development of resources or tools.
What factors do you see as most critical for the state’s success over the next year?
VIII. Wrap Up
You have answered all my questions. Is there anything I didn’t ask that you’d like to tell me about?
Thank you very much for making time to speak with us.
MEDICAID MANAGED CARE ORGANIZATION INTERVIEW GUIDE
Form
Approved OMB
No: 0935-XXX Exp.
Date XX/XX/20XX
MEDICAID MANAGED CARE ORGANIZATION /
PRIVATE HEALTH INSURANCE PLAN
Thank you for speaking with us today. In the email we sent confirming this interview, we provided information on who we are, why we’re here, what topics we’re interested in talking about, and we assured you that your responses will be kept confidential. Do you have any questions before we start the interview? If not, may we begin recording the conversation?
If the respondent did not receive or does not remember the confirmation email or if they have questions about the information provided in the email, review the introduction to the study on next page.
Public
reporting burden for this collection of information is estimated to
average 60 minutes per response, the estimated time to complete the
interview. An agency may not conduct or sponsor, and a person is not
required to respond to, a collection of information unless it
displays a currently valid OMB control number. Send comments
regarding this burden estimate or any other aspects of this
collection of information, including suggestions for reducing this
burden, to: AHRQ Reports Clearance Officer Attn: PRA, Paperwork
Reduction Project (0935-XXXX) AHRQ, 540 Gaither Rd., Rm. 5036,
Rockville MD 20850.
Introduction to Study
We are from the Urban Institute and Mathematica Policy Research, and we are part of the team conducting the cross-state evaluation of the CHIPRA Quality Demonstrations. The evaluation is federally funded by the Agency for Healthcare Research and Quality (AHRQ). The Centers for Medicare & Medicaid Services (CMS) provides the demonstration grants to the states.
We are now conducting our first round of visits to the 18 demonstration states. We are meeting with people who are closely involved in the design, management, and day-to-day operations of each state’s demonstration initiatives, as well as other people who care about how the demonstrations affect children’s care quality in Medicaid and CHIP.
We are particularly interested in your thoughts and insights on several topics, including:
Your experience to date implementing your state’s quality demonstration;
Evidence to date that your strategies may be having the desired effect; and
Key issues for the coming year.
Our interview will take an hour. Your responses will be kept confidential to the extent permitted by law, including AHRQ’s confidentiality statute, 42 USC 299c-3(c). We will share everyone’s comments with members of the evaluation team and we will report to AHRQ and CMS on the general themes that emerge from all our discussions. Our reports will list the people we spoke to in each state, but we will not attribute specific comments or quotes to named individuals without permission. We would like to record our discussion in case we miss something in our notes and want to go back and listen. But we do not plan to transcribe the recording.
Do you have any questions before we start? May I begin recording?
CORE QUESTIONS
I. Introduction/Background
Please tell me what your position is here at [this organization] and how long you have worked here.
What are your responsibilities in connection with the state’s CHIPRA quality demonstration grant? Are providers in your network actively participating in demonstration activities?
What specific activities has your plan engaged in related to this CHIPRA quality demonstration to date?
What interested your plan in participating in this CHIPRA quality demonstration?
What kind of time and resources has your organization dedicated to or invested in this initiative? Please briefly describe.
Based on your experience to date, what are the strengths of participating in this initiative? Conversely, what do you see as the major challenges?
In your own words, describe the goals (over the entire 4-5 year period) of this CHIPRA quality demonstration.
What did the state, and participating health plans like yours, hope to achieve in the first year of the project (since December 2010)?
II. Plan Context
[Interviewer: Use this section only if network providers are actively involved in the demonstration.]
Prior to this CHIPRA quality demonstration, what major strategies had your plan used to attempt to improve quality for children enrolled in your Medicaid/CHIP plans?
Did you use any predictive or risk modeling to target kids at risk for poor quality, as well as high costs?
Did you employ case managers to work with providers to coordinate care for high risk children?
Did you pursue any other initiatives to directly bolster provider capacity, such as making available quality improvement expertise?
Prior to the CHIPRA quality demonstration, what pediatric quality measure data did your plan provide to the state, employers, or providers? For example, do you provide HEDIS, patient experience or CAHPS data, or other quality measures?
How much do employers and other purchasers rely on that measure data?
For plans, is there any “carrot” or reward associated with high quality scores or conversely any “stick” or penalty for poor quality scores?
Prior to the CHIPRA quality demonstration, what kinds of information did you provide to child-serving providers (including practices, FQHCs, SBHCs, and hospitals)?
What kind of quality data do you share with providers?
What kind of utilization and cost data do you share with providers?
How are quality and cost or utilization data shared?
What kind of report format do you use?
How often is the information provided?
Is this information available to enrollees or the wider public?
To what extent, if at all, do you provide real-time data? (For example, information on an enrollee that was just hospitalized somewhere in the network or perhaps even out of the provider network?)
Do providers generally say they find this information useful? Why or why not?
Prior to the CHIPRA quality demonstration, please describe briefly any major health IT initiatives your plan had underway?
Any initiatives involving upgrading your enrollment or claims processing capability?
Any initiatives offering support for providers to implement electronic health record (EHRs) or to more rapidly exchange information between EHRs?
Any e- prescribing initiatives?
How about a web-portal to allow patients to schedule appointments or access their personal health records (PHRs)?
Were there any other health IT-related initiatives underway before this demonstration began?
Prior to this CHIPRA quality demonstration, please describe any initiatives your plan was involved in related to changing the way care is delivered – such as by offering financial incentives to providers that adopt the patient-centered medical home model, expanding or enhancing school-based health centers or using care management entities, or sponsoring learning collaboratives for providers.
[If unclear whether children involved]: To what extent have these initiatives included child-serving providers and children?
[If unclear what conditions targeted]: Have they focused on all conditions, or beneficiaries with particular conditions (e.g., chronic, behavioral, special needs?)
Prior to this CHIPRA quality demonstration, has your plan had any type of pay-for-performance (P4P) program that involved pediatric providers? If so, please describe the program and when it began.
Are there any other major initiatives that your plan is implementing that focus on similar quality improvement goals as those in your state’s CHIPRA quality demonstration grant? For example, related to Health Information Exchange (HIE)? Others?
III. Strategies
Cross-Category
[Interview: Use the cross-strategy module if respondent has general knowledge, or a category-specific module if respondent has specialized knowledge.]
Please describe in your own words the overall goals for year one of the CHIPRA quality demonstration in your state.
From your perspective, what are the major strategies or approaches the state is using to achieve these goals?
In addition to what you’ve said, last we heard the state’s plans were to [summarize key components of interventions state is implementing and/or show them the logic model]. From your perspective, is that still accurate? Are we missing any activities or should anything be removed?
In general, what is the role of Medicaid MCOs and/or private health plans in the state’s CHIPRA quality demonstration?
What are the major new tasks or changes that Medicaid MCOs and/or private health plans need to make to help achieve these goals?
How is implementation of the CHIPRA demonstration going for your [MCO / plan]?
What has gone well?
What has gone less well?
What would you do differently, if anything?
Overall, how is the CHIPRA quality demonstration going in your state?
What has gone well?
What has gone less well?
What might the state do differently, if anything?
[If not yet discussed]: What payment changes has the state and/or your plan made to support the activities in this demonstration, if any?
[Prompt, if needed]: Any changes in payment to MCO or plans?
[Prompt, if needed]: Any changes in payment to providers?
[If payment changes made]: Are these reimbursement changes adequate to stimulate the kind of change desired? In general, do you think health insurance plans would get a positive return on their investment if they changed the way they pay providers to encourage them to engage in the activities that are part of this demonstration (e.g., increasing providers’ their “medical homeness”)?
If not now, do you anticipate this changing in the future?
What are the costs and benefits to your plan of [engaging in new quality measure reporting / implementing new health IT tools or systems / facilitating care delivery changes / facilitating the testing of the model pediatric EHR] as part of this CHIPRA demonstration?
Do you think the burden or “cons” are greater or less than what you initially anticipated?
Are there any quality improvement initiatives your plan used to participate in that you are no longer able to participate in because of your CHIPRA quality demonstration activities?
Moving ahead, how confident are you in your plan’s ability to implement the desired changes?
What will facilitate making these changes?
What barriers do you think might make it harder to make these changes?
What kinds of technical assistance has the state provided? How helpful has it been? How might it be improved?
What kinds of technical assistance have you received in addition to the assistance provided through this demonstration? How helpful has it been?
[If applicable for this state]: What benefits do you see from implementing multiple projects at once under this CHIPRA grant?
How will implementing one project help another project?
Conversely, have there been any unanticipated "costs" or negative impacts of implementing these multiple projects at once?
[Prompt]: For example, are there too much projects going on at once to do all of them well?
[Prompt]: Are problems in one area making it difficult to make progress in another?
How does your state's Medicaid program monitor implementation progress under this demonstration?
How is your own plan monitoring its progress?
How about plans generally?
Quality Measurement Initiatives (Category A)
[NOTE: Use category A module if state has a category A project and respondent has specialized knowledge.]
The next few questions will focus on efforts in your state to collect and report on the core set of CHIPRA quality measures.
In your own words, please describe the year one quality measurement goals.
What quality measures is your plan being asked to collect and report on as part of this CHIPRA-funded demonstration?
How often are you collecting measure data from providers and reporting it to the state?
What changes, if any, are being made to data infrastructure or reporting systems to facilitate reporting these new measures?
Have these measures been added to previously-required measures, or have they replaced some measures or displaced other quality measurement activities?
Have you integrated data collection for these new measures with other quality measure data collection activities? If so, how?
How is measure data collection and reporting going?
What has been your experience to date collecting data to support these new measures?
Which measures [have been / do you anticipate being] relatively easy to collect and report on?
How difficult or burdensome are they?
How useful are they in your view?
To date, which measures have you been unable to collect and report on?
What specific obstacles have you encountered in collecting and reporting on these measures?
What might help you overcome these obstacles?
Has the state provided with you with any technical assistance to help with reporting on these new quality measures?
How helpful has this assistance been? In what way could it be improved?
[If applicable]: From talking to other plans participating in this demonstration, do you think your plan’s experience with reporting these measures has been similar or different from other plan’s experiences?
Are data from provider EHR systems being used to populate the new CHIPRA quality measures being submitted by providers to [your plan / the state’s Medicaid program]?
If so, please describe your experience in using EHRs to collect and report quality measure data.
What do you see as the pros and cons of using EHRs to collect the data?
Please briefly describe how you collect and report quality measure data from providers that lack an EHR.
What do you see as the pros and cons of this method?
What information will [the state’s Medicaid program / your plan] be providing enrollees/patients under the project being implemented as part of this CHIPRA demonstration grant?
How is your plan and associated provider network using new CHIPRA quality measure data, if at all at this stage?
What are your plans for using them in the future?
As far as you know, how are other [plans and] intervention providers using new CHIPRA quality measure data, it at all at this stage?
Health IT Initiatives (Category B)
[NOTE: Use category B module if state has a category B project and the respondent has specialized knowledge.]
The next few questions will focus on health IT initiatives.
In your own words, please describe the year one Health IT goals of this CHIPRA quality demonstration.
What hardware or software is your [MCO / plan] supporting as part of this CHIPRA quality demonstration, if any?
What functionality does this new software possess? (What does it do?)
What systems are being electronically connected? Is information being reported from one system to another, or is two-way exchange of information happening?
How much will it cost your plan to make these data infrastructure changes?
At what stage is your Medicaid [MCO / plan] in facilitating the implementation of these new health IT tools?
What has gone well?
What has gone less well? Probe as needed on technical difficulties, privacy and security concerns, work flow issues, and cost overruns.
What has the state done to address these problems?
What changes are being made to the state’s health IT networks, systems, or programs as part of this CHIPRA grant?
How far along is the state in making these changes?
What has gone well?
What has gone less well?
What have been the barriers to, or facilitators of, making these changes?
What has the state done to address these problems? Are the desired end-users now using the new health IT systems routinely?
If not, what issues do you view as most important to improving use of the new system?
Based on your experience to date, how easy or hard have providers found it to use [the new health IT tool or system]?
Do you see any early evidence that providers are changing the way they deliver care as a result of using these new health IT tools? If so, please briefly describe.
What entity is using [the new health IT tool or system] to aggregate and analyze the data collected through [it/them]?
With whom are these data or analyses shared?
How is [the new health IT tool or system] changing the roles and responsibilities of clinicians and provider staff, if at all?
Are the data accurate and complete enough to use them for their intended purpose?
How has the [the new health IT tool or system] affected providers’ care quality?
How has the [the new health IT tool or system] affected providers’ efficiency?
What have been patients’ and families’ reactions to plans and and/or providers’ use of [the new health IT tool or system]?
Provider-Based Initiatives (Category C)
[NOTE: Use category C module if state has a category C project and the respondent has specialized knowledge.]
The next few questions will focus on the [medical home/care management entity/school-based health center] component of the CHIPRA demonstration grant.
In your own words, please describe the year one goals of the CHIPRA grant category associated with provider-based care delivery system changes.
What specific delivery system changes does your state and plan hope to make?
[If state is pursuing a medical home initiative under Category C]: How has the state decided to define the medical home model being implemented under this CHIPRA demonstration grant?
What do you see as the strengths of this definition?
What do you see as the weaknesses of this definition?
To what extent is the definition aligned with your own definition of this concept?
[If state is pursuing a medical home initiative under Category C]: How has the state decided to assess or measure providers’ medical home capabilities?
What tool or survey are they using?
What do you see as the strengths of this instrument?
What do you see as the weaknesses of this instrument?
To what extent are the items measured by this instrument aligned with your plans’ initiatives and provider assessment tools, if any?
What changes to how care is delivered have providers made under this demonstration so far, if any?
From your perspective, has there been any resistance or pushback from providers to adopting new models of delivering care? If so, in what areas? What have been their concerns?
To what extent have enrollees or their families been made aware of the care delivery model [being implemented/ enhancements] under this demonstration, if at all?
How were they made aware of this?
How are their responsibilities in this new care delivery model described, if at all?
What have been patients’ and families’ reactions to the changes providers have made to date?
Do you have any early evidence on how these care delivery system models are working? If so, please describe.
Clinical quality of care measures?
Patient/family experience survey data?
Utilization—ED?
[If plan is involved in other initiatives related to changing the way care is delivered (Q II.8)] How does the CHIPRA provider-based care delivery initiative interact with the other initiatives your plan is involved in to change the way care is delivered?
How coordinated are these activities? Has the CHIRPA demonstration increased or decreased the amount of time, attention, and/or financial resources available to these initiatives? If so, please describe.
How would you compare the impact of the CHIPRA quality demonstration to these initiatives?
E. Other Quality Improvement Activities (Category E)
[NOTE: Use category E module if state has a category E project and the respondent has specialized knowledge.]
The next few questions will focus on [describe the state-specific Category E activity being pursued in the state, if applicable].
Could you describe for us what your involvement has been in [the state-specific Category E activity]?
What specific activities will your [MCO / plan] be engaged in as part of this activity?
What activities have you completed as part of this initiative so far?
What technical assistance have you received or provided, if any?
What will you be focusing on next?
IV. Lessons Learned
What do you think have been the biggest lessons you have learned, so far, from your involvement in the CHIPRA quality demonstration?
[Prompt, if needed]: Given your early experience, what insights and advice might you have for other [MCOs / plans] implementing similar types of activities?
At this point in the project, how optimistic are you that the changes that are being made will translate into positive impacts on patients’ care? Please explain.
V. Plans for the Coming Year
What are the goals of the CHIPRA quality demonstration in the coming year?
What are your [MCO’s / plan’s] plans for the coming year related to this demonstration?
What are your plans in relation to other programs, such as encouraging the adoption and meaningful use of health IT and the exchange of electronic health information?
As you continue to implement projects under the CHIPRA demonstration in the coming year, what do you see as the most critical factors that will determine your success…
[If applicable]: in collecting and reporting the new pediatric quality measures?
[If applicable]: in facilitating the use of [the new health IT tools or systems]?
[If applicable]: in facilitating changes to the way providers deliver care (such as by increasing their “medical homeness”)?
VI. Wrap Up
You have answered all my questions. Is there anything I didn’t ask that you’d like to tell me about?
Thank you very much for making time to speak with us.
SUPPLEMENTAL QUESTIONS
Interviewer: Select the most relevant questions as time permits.
How would you characterize your [Medicaid managed care plan/private insurance plan] and products?
[If information not already available]: What is your market position? How much of the [Medicaid MCO / private insurance] market do you have in the [state / region where the CHIPRA quality demo is taking place]? Who are your major competitors?
[For Private Plans]: What is your predominant type of product? (e.g., HMO, PPO, other?)
[For Medicaid MCOs and Private Plans]: Do you also cover behavioral health or is that carved out or under the purview of another plan? If another plan, which one(s)? How do you work with them, if at all?
Please tell us briefly about your provider network. For example, how many providers—primary care, specialists, hospitals—do you contract with?
From your perspective, what are the strengths of your network for children?
From your perspective, what aspects of your network for children need to be strengthened?
What kind of payment methods do you typically use with providers serving children? (For example, is it discounted fee-for-service, in some cases additional case management fees, or perhaps partial capitation?)
What are the characteristics of the Medicaid/CHIP patients or pediatric population that you generally serve? Do you serve a high or low proportion of children with special health care needs?
From your perspective, what are their major unmet needs?
What are the challenges of working with this population?
Please briefly describe the enrollment data you receive from the state and/or share with providers. We’re particularly interested in how timely and accurate it is.
Please briefly describe the claims or encounter data you share with the state. We’re particularly interested in how timely, comprehensive, and accurate the data are that you give to the state.
[If helpful]: Do you provide “shadow claims” for capitated Medicaid MCO beneficiaries?
[If helpful]: Do you provide or facilitate data exchange with other state databases, like immunization or disease registries?
What is the time lag between when you have the data and when it’s provided to the state?
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Leslie Foster |
| File Modified | 0000-00-00 |
| File Created | 2021-01-31 |