Supporting_Statement

The Centers for Medicare & Medicaid Services’ Center for Medicare & Medicaid Innovation (CMMI)
strives to make information available to all. Nevertheless, portions of our files including charts, tables,
and graphics may be difficult to read using assistive technology. Persons with disabilities experiencing
problems accessing portions of any file should contact CMMI through e-mail at
[email protected].

February 2013

Evaluation of the Multi-Payer Advanced
Primary Care Practice Demonstration
Interview Protocols
Office of Management and Budget Clearance
Package and Data Collection Instruments

Prepared for
Suzanne M. Goodwin, PhD
Centers for Medicare & Medicaid Services
Mail Stop WB-06-05
7205 Windsor Boulevard, Room WB-20-13
Baltimore, MD 21244-1850
Prepared by
RTI International
3040 Cornwallis Road
Research Triangle Park, NC 27709

RTI Project Number 0209853.029
CMS Contract No. HHSM-500-2005-00029I
Task 13: Order #HHSM-500-T0013

Supporting Statement for
Evaluation of the Multi-Payer Advanced Primary Care Practice (MAPCP) Demonstration:
Interview Guides

RTI International
February 2013

This project was funded by the Centers for Medicare & Medicaid Services under contract no.
HHSM-500-2005-00029I Task 13: Order #HHSM-500-T0013. The statements contained in this
report are solely those of the authors and do not necessarily reflect the views or policies of the
Centers for Medicare & Medicaid Services. RTI assumes responsibility for the accuracy and
completeness of the information contained in this report.

_________________________________
RTI International is a trade name of Research Triangle Institute.

A.

BACKGROUND

On September 16, 2009, Secretary of Health and Human Services, Kathleen Sebelius, and the
Director of the Office of Health Reform, Nancy-Ann DeParle, announced the establishment of
the Multi-payer Advanced Primary Care Practice (MAPCP) Demonstration, under which
Medicare joined Medicaid and private insurers as a payer participant in state-sponsored
initiatives to promote the principles that characterize advanced primary care, often referred to as
the “patient-centered medical home” (PCMH). CMS selected eight states to participate in this
demonstration: Maine, Vermont, Rhode Island, New York, Pennsylvania, North Carolina,
Michigan, and Minnesota. These states vary on a number of important dimensions, such as
features of their public (Medicaid) and private insurance markets, delivery system, prior
experience with medical home initiatives, and nature of their state-sponsored multi-payer
initiative.
The PCMH care delivery model is a potentially transformative health system innovation,
combining changes in provider payment and primary care structure and care processes.
Evaluations of medical home models have shown mixed results to date, with some studies
showing positive effects and others not showing statistically significant effects. Many findings
to date have been preliminary, have had limited generalizability to multi-payer initiatives and the
Medicare population, and have had some limitations in their study design (e.g., no comparison
group). Although some positive outcomes from the medical home model have been shown to be
significant, critical questions remain unanswered. For example, the impacts of the PCMH
provider payment models and medical home transformation process on health outcomes and the
U.S. health care system, particularly from a cost perspective, are largely unknown (Berenson et
al., 2011; Crabtree et al., 2010; Steiner et al., 2008; Bitton et al., 2010).
CMS is conducting an evaluation of the demonstration to assess the effects of advanced primary
care practice when supported by Medicare, Medicaid, and private health plans. As part of this
evaluation, qualitative and quantitative data will be collected and analyzed to answer research
questions focused on: 1) state initiative features and implementation, including various payment
models; 2) practice characteristics, particularly medical home transformation; and 3) outcomes,
including access to and coordination of care, clinical quality of care and patient safety,
beneficiary experience with care, patterns of utilization, Medicare and Medicaid expenditures,
and budget neutrality.
This OMB application seeks approval to conduct in-person, semi-structured interviews to inform
CMS’s evaluation of the MAPCP Demonstration. These interviews will be conducted with six
types of respondents from each of the eight participating states:

• Physicians and administrators of participating practices and/or health systems
• Individuals representing provider associations
• Individuals representing payer organizations
• Individuals representing Office of Aging staff and patient advocates
1

• Leaders of community health teams and networks
• State officials
These interviews will be conducted by staff of CMS’s evaluation contractor, RTI International,
and RTI’s subcontractors, The Urban Institute and the National Academy for State Health
Policy. They will be conducted at the mid-point and end of the demonstration.
A.1

Need and Legal Basis

The interviews are part of a mixed-methods evaluation strategy for studying the process of, and
barriers and facilitators to, transforming practices into PCMHs and for assessing the effects of
the PCMH model on access, quality, and cost of care. Mixed-methods research is well-suited for
accomplishing the goals of this evaluation, as different methods yield different insights. While
quantitative methods (e.g., Medicare claims data analysis) are well-suited for outcomes or
summative evaluation, qualitative methods (e.g., interviews, focus groups) are necessary for
process or formative evaluation (Patton, 1990 and 1996; Sofaer, 1999). The combination of
these methods can provide a comprehensive understanding of the nature of each state PCMH
initiative, their implementation, the process and degree of practice transformation, and perceived
outcomes for patients, practices, and purchasers (Creswell, 2009). Qualitative methods are
particularly useful for evaluating health policy interventions, providing a more complete
understanding of the interventions themselves and the context in which they are taking place, the
views of different stakeholders, the unexpected outcomes, and the state and program conditions
or factors more likely to be associated with success (Ragin, 1999; Rist, 1994; Sofaer, 1999; Yin,
1999).
For this evaluation, the interviews will provide us with answers to fundamental “what, how, and
why” questions such as:

• How did the state initiatives arise?
• What are their goals?
• How were features of the state initiatives, such as the payment model and other

efforts to support practice transformation (e.g., learning collaboratives), chosen and
implemented?

• How do the state initiatives facilitate transformational activities within the
participating practices?

• Which aspects of the state initiatives have been successful and which have required
retooling?

• What challenges have the states and participants faced in implementing the state
initiatives?

2

• What adjustments did the states and participants make to accommodate Medicare’s
participation in the initiative?

• What anticipated and perceived effects do the state initiatives have on practice
transformation, quality, and efficiency?

The information collected through these interviews is critical to CMS in determining whether the
MAPCP Demonstration model should be expanded under Medicare, and if so, what
modifications and/or supports would be needed to implement similar innovations in other states
and practices in the future.
A.2

Information Users

These interviews will be used by CMS to understand:

• The implementation and evolution of the state initiatives
• The implementation and practice transformation process
• The perceived effects of the state initiative and, over time, identify the features of
state initiatives most responsible for the observed impacts (positive or negative)

This information will help CMS decide whether the MAPCP Demonstration model should be
expanded under Medicare, and if so, what modifications and/or supports would be needed to
implement similar innovations in other states and practices in the future.
The results will also be used by policymakers, payers, healthcare purchasers, primary care
practices, and Medicaid and Medicare beneficiaries in the following ways:

• Local and state governments will have information from key stakeholders about their
perceptions on implementation and the effectiveness of their initiatives as well as
suggestions about potential areas for program improvement

• Payers and healthcare purchasers will have information to help them to know whether
their payment models and program activities (e.g., learning collaboratives, practice
coaches) are effective or whether modifications are warranted

• Primary care practices will have data to inform them about what other practice

changes may be beneficial to enhance the quality and safety of care, efficiency of care
delivery, access to care, and other outcomes

• Patients will directly benefit from any improvements implemented by policymakers,
payers, purchasers, and their primary care practices

This information also will facilitate diffusion and implementation of similar initiatives in other
states, if this demonstration is successful.
3

A.3

Use of Information Technology

The interviews will make minimal use of information technology. Skilled and experienced
interviewers from the evaluation team will lead each discussion and a dedicated note taker will
capture participant responses. Audio recorders will be used as a back-up to assure the
completeness and accuracy of the notes. Data will be managed and analyzed in NVivo, a
powerful and widely used qualitative data analysis software program (QSR International,
Doncaster, Australia; Bazeley, 2007; Richards, 2009; Sorensen, 2008). The research team has
significant experience in managing and analyzing large primary qualitative data sets with this
type of software.
A.4

Efforts to Identify Duplication

The evaluation has been designed to comprehensively address the evaluation questions while
minimizing the burden placed on the states, their partners (e.g., state evaluators), demonstration
participants (e.g., practices and community health teams), and Medicare and Medicaid
beneficiaries and special populations.
Interviews are designed to complement other primary and secondary data collection and analysis
(see section A-1 for more details). That is, they will build on and fill information gaps rather
than duplicate information from other sources of data. Interviews will be used only when
primary or secondary data from states or their evaluators cannot be obtained to fully answer the
evaluation research questions.
CMS and its evaluation contractor and subcontractors have taken numerous steps to ensure that
the information to be collected through these interviews are not readily available from existing
sources. We have examined secondary qualitative documents and resources publicly available
and have reviewed the states’ MAPCP applications and other documentation and
communications provided to CMS. In addition, we are seeking to collaborate with the states on
future data collections. Furthermore, since programs vary by state we will be tailoring each
state’s interview protocols to best understand the programs and to minimize the collection of
data. By tailor, we mean either deleting questions that are not relevant given a particular states
initiative, or making slight modifications to the questions to reflect specific or unique elements
of the state’s initiative (e.g., name of the effort, when it began, provider payment method). For
example, some states have operated or participated in medical home initiatives prior to the
MAPCP Demonstration via Medicaid and/or multipayer initiative with commercial health plans,
while others have not. If a state has not previously operated or participated in a Medicaid or
multipayer medical home effort, we will not ask respondents in that state questions related to
prior medical home initiatives. Furthermore, due to unique features of the initiatives being
implemented in four states (Vermont, Michigan, North Carolina, and Pennsylvania), we have
submitted separate protocols for certain state officials and providers in those states. This will
enable us to ask more targeted questions of these respondents and to avoid questions that are not
relevant.
Thus, the information collected through the interviews should not duplicate any other effort and
should not be obtainable from any other source.
4

A.5

Involvement of Small Entities

Some interviews will be conducted with individual physician participants who have elected to
participate in the MAPCP Demonstration. Advocacy and community groups that are involved in
medical home initiatives in some states also may be small entities comprised of fewer than five
staff.
Again, the interviews have been designed to avoid duplication of other efforts and to be of
minimal burden to participants.
A.6

Less Frequent Collection

The interviews will be conducted twice - at the middle and end of the 3-year demonstration.
This frequency allows for the collection of information and feedback at critical points in the
demonstration that are necessary for addressing the evaluation research questions while being
respectful of participants’ time and resources.
A strength of the qualitative data collection plan is its timeliness for obtaining relatively early
insights about implementation, practice transformation, and perceived outcomes, which can be
used to make improvements to and MAPCP Demonstration and, in turn, increase the likelihood
of program success. These early insights also can be used to inform the development of
quantitative data collection instruments.
A.7

Special Circumstances

There will be no special circumstances.
A.8

Federal Register/Consultation Outside the Agency

The 60-day Federal Register Notice was published on May 31, 2012 (77 FR 32118). We
received comments from two commenters. The response to those commenters is attached to this
PRA package.
The first commenter, a state agency, had no recommended changes to CMS's planned
information collection in relation to this evaluation, but voiced strong support for the medical
home model of care and for CMS's efforts to support it through the MAPCP Demonstration and
the Comprehensive Primary Care Initiative. The other commenter, a patient advocacy group,
described specific patient-centered principles, strategies, policies, and practices that they
believe are important features of the medical home model, and recommended considering
addressing these areas in the evaluation of the MAPCP Demonstration. They also urged CMS to
consider incorporating these areas in any expansions of the MAPCP Demonstration. In response
to the second commenters comments, we added a few questions and probes to our interview
protocols where possible and appropriate in an attempt to obtain moore specific responses from
interviewees on topics specified by the second commenter, including access to care, consultation
with patients and families outside of regular business hours, and specific mechanisms that support
transitions across care settings.

5

A.9

Payments/Gifts to Respondents

No remuneration will be offered to the interview participants. We anticipate that interviewees
have sufficient interest in the MAPCP Demonstration that they will be willing to participate
without compensation. To facilitate participation, interviews will be held at the participant’s
location. Telephone will be used only if the person is unavailable during the time we will be in
the state.
A.10

Confidentiality

Personnel to be given access to interviews and/or individual identifiers will be trained on the
significance and protection of confidentiality, particularly as it relates to controlled and protected
access to interview notes and summary files. Further, materials will be sent to potential
interviewees describing the purpose and the voluntary nature of the interviews and will convey
the extent to which respondents and their responses will be kept confidential. We pledge privacy
to the fullest extent possible. We will use a file-naming convention (denoting the state, type of
organization and interviewee’s role) to de-identify the names of individuals and their affiliations
for the interview notes and NVivo 9 database. As previously described on page 3, NVivo 9 is a
computer software package used to analyze qualitative data. The notes and the database will be
stored on a secured server and password-protected computers.
A.11

Sensitive Questions

Information collected in the interviews is not of a sensitive nature. Questions are confined to
interviewee experiences, opinions, and perspectives regarding the MAPCP Demonstration.
Some interviewees might have views that are critical of state or federal initiatives or particular
participating organizations (e.g., health plans, health systems or practice, community
organizations). We will handle such insights with sensitivity and confidentiality in mind and
will not share nor attribute the identities of those individuals or their organizations in an
identifiable way in any written or oral communications.
A.12

Burden Estimates (Hours and Wages)

Six types of interviews lasting 30 to 90 minutes will be conducted in two rounds:
1. Physicians and administrators of practices and/or health systems participating in the
MAPCP Demonstration (including North Carolina’s care managers and community based
care networks, Pennsylvania’s physician organizations, and Michigan’s provider
organizations) (length of interview: 30 to 60 minutes)
2. Individuals representing local chapters of physician and clinical professional associations
(length of interview: 60 minutes)
3. Individuals representing payer organizations, including Medicaid (length of interview:
60 minutes)
4. Individuals representing Office of Aging and patient advocates (length of interview: 45
minutes)
5. Individuals representing community health teams and networks, where applicable, as
some states do not include these kind of teams or networks in their initiative (including
6

respondents from Vermont’s Support and Services at Home program) (length of
interview: 45 minutes)
6. State officials (including respondents from North Carolina’s Division of Aging and Adult
Services) (length of interview: 90 minutes)
The estimated length of each interview includes time to review the interview processes and to
obtain verbal informed consent. We will request that each interview be conducted with one
interviewee. However, some organizations may request that additional people participate during
some or all of the interview, given the topics to be discussed. For example, a state official
leading the demonstration may answer some questions, but request that other members of his or
her staff answer others during the interview or separately. However, each interview will be
attended by no more than three individuals. We estimate that half of the interviews will be
conducted with one individual or interviewee (i.e., one interviewer and interviewee), and the
other half of the interviews will be conducted with two or more interviewees, as many times
people will request that several staff from their organization participate. To estimate the cost of
burden, we used an average of two interviewees per interview. Wage calculations are based on
the mean hourly wages as indicated in the “National Compensation Survey: Occupational
Wages in the United States, May 2011,” by the U.S. Department of Labor, Bureau of Labor
Statistics.
The maximum number of respondents (by state and category) that will participate in semistructured interviews during each round is shown in Exhibit 1. A total of 472 respondents will
be interviewed in each round. We will conduct two rounds of interviews during the course of the
demonstration, meaning that we will interview 472 respondents in the eight states at two points
in time (i.e., approximately twelve months apart), for a total of 944 respondents interviewed (472
x 2).
Estimated annual time and wage burden during each round is shown in Exhibit 2. The total
estimated time burden for each round is 478 hours, which is slightly higher than the number of
respondents (472) because some individuals will be interviewed for 45 minutes and others will
be interviewed for one and a half hours. The total estimated time burden for two rounds is 956
hours (478 x 2). The total estimated wage burden for each round of interview is $33,253.62.
The total estimated wage burden for the entire evaluation (2 rounds combined) is $66,507.24.
Exhibit 1.
Maximum number of respondents by interview site and respondent type (472 respondents)
per round

State
Officials
(3)

Total
Respondents

6

4

6

60

6

6

0

6

56

6

6

4

6

60

Individuals
Representing
Physician
Associations

Individuals
Representing
Payer
Organizations

ME

36

2

6

MI

36

2

MN

36

2

State

Individuals
Representing
Office of
Aging and
Patient
Advocates

Individuals
Representing
Community
Health Teams
and Networks (2)

Practice /
Health System
Physicians and
Administrators
(1)

7

Practice /
Health System
Physicians and
Administrators
(1)

Individuals
Representing
Physician
Associations

Individuals
Representing
Payer
Organizations

NY

36

2

6

NC

36

2

6

State

Individuals
Representing
Office of
Aging and
Patient
Advocates

Individuals
Representing
Community
Health Teams
and Networks (2)

State
Officials
(3)

Total
Respondents

6

4

6

60

6

4

6

60

PA

36

2

6

6

0

6

56

RI

36

2

6

6

4

6

60

VT

36

2

6

6

4

6

60

288

16

48

48

24

48

472

Total

(1) Includes North Carolina’s care managers and community based care networks, Michigan’s provider
organizations, and Pennsylvania’s organized delivery systems
(2) Includes Vermont’s Support and Services at Home (SASH) program. MI and PA do not have community health
teams or networks
(3) Includes North Carolina’s Division of Aging and Adult Services

Exhibit 2.
Estimated respondent hourly and wage burden by respondent type (478 burden hours for
an estimated $33,253.62 wage burden) per round

Respondent Type

Number of
Respondents

Length of
Interview
(hrs)

Total Burden
Hours

Mean
Hourly
Wage Rate*

Total Wage
Burden

Practice / Health System Physicians
and Administrators 1

288

1

288

$85.26

$24,554.88

Individuals Representing Physician
Associations 1

16

1

16

$85.26

$1,364.16

Individuals Representing Payer
Organizations 2

48

1

48

$51.64

$2,478.72

Individuals Representing Office of
Aging and Patient Advocates 3

48

0.75

36

$21.07

$758.52

Individuals Representing
Community Health Teams and
Networks 3

24

0.75

18

$21.07

$379.26

State Officials 4

48

1.5

72

$51.64

$3,718.08

478

—

$33,253.62

Total

472

*Based upon the mean hourly wages, “National Compensation Survey: Occupational Wages in the United States,
May 2011,” U.S. Department of Labor, Bureau of Labor Statistics.
http://www.bls.gov/oes/current/oes_nat.htm#b29-0000
1
Family and general practitioners
2
Civilian workers
3
Community and social service occupations
4
Management occupations

8

A.13

Capital Costs

There are neither capital or startup costs, nor are there any operation and maintenance costs to
the interview participants.
A.14

Costs to Federal Government

Total costs associated with two rounds of interviews are estimated to be $2,210,364 for
recruitment, interview facilitation, travel, meeting notes and analysis. The annualized costs are
approximately $1,105,182 for each round of interviews; the two rounds will occur over a twoyear period. These costs are funded through an existing CMS contract with RTI.
Federal FTE costs are expected to be negligible. The Project Officer (GS 14-5, annual salary
$119,238) for the CMS contract with RTI may be required to spend 0.2% of her time each year
on the administration of this interviews ($238 of annual salary).
A.15

Changes to Burden

There are no changes to the burden. In response comments, we added a few questions and probes
to our interview protocols where possible and appropriate in an attempt to obtain moore specific
responses from interviewees on topics specified, including access to care, consultation with
patients and families outside of regular business hours, and specific mechanisms that support
transitions across care settings.
A.16

Publication/Tabulation Dates

The semi-structured interview data, which does not constrain the interviewee’s answers to fixed
response categories as in a structured interview or survey, will be analyzed using wellestablished, rigorous qualitative methods and non-statistical techniques. For example, we could
analyze all interviewee responses to questions on particular topics such implementation
experience and lessons learned to identify common patterns and themes across all states. We
also could compare and contrast the responses from interviewees in different states or responses
of policymakers and program leaders to those of participating physicians and practice staff or
health plans. The latter approach would help us to understand the diverse perspectives on the
same program. Finally, the perspectives of interviewees can be compared to secondary
qualitative or quantitative data that is descriptive in nature (Bradley et al., 2007; Devers, 1999;
Miles & Huberman, 1994).
These qualitative results will be reported in three reports. The Second Annual Report will be
completed in March 2014. The Third Annual Report will be completed in March 2015. The
Final Report will be completed in January 2016. Additionally, the RTI/Urban/NASHP team
plans to develop peer-reviewed publications and conference presentations that will be reviewed
and approved by CMS prior to submission.
A.17

Expiration Date

The OMB expiration date will be displayed on all disseminated data collection materials.
9

SUPPORTING STATEMENT – PART B
Collections of Information Employing Statistical Methods
This information collection does not employ statistical methods.

10

REFERENCES
Bazeley, P. (2007). Qualitative data analysis with NVivo (2nd ed.). Sage Publications Ltd.
Berenson, R.A., Devers, K.J., & Burton, R.A. (2011). “Will the Patient Centered Medical Home
Transform the Delivery of Health Care.” Robert Wood Johnson Foundation and Urban
Institute Issue Paper, August, http://www.urban.org/publications/412373.html.
Bitton, A., Martin, C., & Landon, B.E. (2010). A nationwide survey of patient centered medical
home demonstration projects. Journal of General Internal Medicine, 25(6), 584–592.
Bradley, E.H., Curry, L.A., & Devers, K.J. (2007). Qualitative data analysis for health services
research: Developing taxonomy, themes, and theory. Health Services Research, 42(4),
1758-1772.
Crabtree, B.F., Nutting, P.A., et al. (2010). Summary of the National Demonstration Project and
recommendations for the patient-centered medical home. Annals of Family Medicine,
8(Suppl. 1), S80–S90.
Creswell, J.W. (2009). Research design: Qualitative, quantitative, and mixed methods
approaches (3rd ed.). Thousand Oaks, CA: Sage.
Devers, K.J. (1999). How will we know good qualitative research when we see it? Health
Services Research, 34(5, part 2), 1153–1188.
Miles, M.A. & Huberman, A.M. (1994). Qualitative data analysis: An expanded source book
(2nd ed.). Thousand Oaks, CA: Sage
Patton, M.Q. (1990). Qualitative evaluation and research methods (2nd ed.). Thousand Oaks,
CA: Sage.
Patton, M.Q. (1996). Utilization-focused evaluation (3rd ed.). Thousand Oaks, CA: Sage.
Ragin, C.C. (1999). Using qualitative comparative analysis to study causal complexity. Health
Services Research, 34(5 Pt 2), 1225-1239.
Richards, L. (2009). Handling qualitative data (2nd ed.). Thousand Oaks, CA: Sage.
Rist, R.C. (1994). Influencing the policy process with qualitative research. In N. Denzin & Y.
Lincoln (Eds.) Handbook of Qualitative Research (pp. 545-557). Thousand Oaks, CA:
Sage Publications, Inc.
Sofaer, S. (1999). Qualitative methods: What are they and why use them? Health Services
Research, 34(5, part 2), 1101–1118.
Sorensen, A. (2008). Use of QSR NVivo 7 qualitative analysis software for mixed methods
research. Journal of Mixed Methods Research, 2(1), 106–110.
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Steiner, B.D., Denham, A.C., et al. (2008). Community Care of North Carolina: Improving care
through community health networks. Annals of Family Medicine, 6(4), 361–367.
Yin, R.K. (1999). Enhancing the Quality of Case Studies in Health Services Research, Health
Services Research, 34(5 Pt 2), 1209-1224.

12

ATTACHMENT A
30-DAY FEDERAL REGISTER NOTICE

A-1

ATTACHMENT B
ADVANCE LETTERS

B-1

E-mail Recruitment Letter
Dear [DR./MS./MR.] [LAST NAME]:
I am writing to ask for your help with an important study of the “medical home” model of
advanced primary care. RTI International (RTI), a not-for-profit research organization, and their
collaborating partner organizations, the Urban Institute and the National Academy for State
Health Policy (NASHP), has been contracted by the Centers for Medicare & Medicaid Services
(CMS) to conduct an evaluation of the Multi-payer Advanced Primary Care Practice (MAPCP)
Demonstration, which includes the [NAME OF RESPONDENT’S STATE PCMH INITIATIVE]
in which you participate. Part of the evaluation includes conducting in-person interviews with
employees of physician practices participating in the MAPCP Demonstration, and key
individuals representing physician associations, payer organizations, Office of Aging staff and
patient advocates, community health teams and networks, and state officials.
We are interested in speaking with you to find out how implementation of this demonstration has
been progressing, and what changes, if any, you are beginning to see as a result of participating
in this demonstration.
In a few days, a representative from RTI or the Urban Institute will contact you to request your
participation in an in-person interview, which will be held sometime in the [Spring / Summer /
Fall / Winter]. The interview will last no longer than [45 minutes / one hour / 90 minutes], and
will take place at a location of your choosing.
Please be assured that your participation is completely voluntary and that all perspectives you
provide during the interview will be kept confidential to the extent provided under law. Refusal
to participate will not affect your practice or organization in any way. Neither you nor your
[practice/organization] will be individually identified in our analyses or reports submitted to
CMS. This study has been reviewed and approved by RTI’s Institutional Review Board.
If you have questions about this study in general, please call or e-mail me at (202) 728-1968 or
toll-free at 1-800-334-8571, extension 2-1968, or [email protected]. If you have any questions
about your rights as an interview respondent, you may call RTI's Office of Research Protection
toll-free at 1-866-214-2043.
Your help is extremely important to the evaluation of this demonstration, and we thank you for
considering this request.
Sincerely,

Nancy McCall, RN, PhD
RTI Project Director
MAPCP Demonstration Evaluation
B-2

ATTACHMENT C
INTERVIEW PROTOCOLS

C-1