Form CMS-10477 Management staff interview protocol and consent

Attachment 5.c. Site Visit Management Interview Protocol and Consent Form
MEDICAID INCENTIVES FOR PREVENTION OF CHRONIC DISEASES
EVALUATION
INTERVIEW GUIDE
State Demonstration Management Protocol
(Individuals who oversee and implement the state’s initiative)
Roles may include the following:
• Principal investigators
• Project managers
• Project administrators
• Project assistants
• Partner organizations
Questions in blue are designed to be probes that will be asked when needed.

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Introduction
Thank you for making time to speak with us today. We are researchers from Research Triangle
Institute International (RTI) and the National Academy for State Health Policy (NASHP),
evaluating the Medicaid Incentives for Prevention of Chronic Diseases demonstration.
In this discussion, we are interested in gathering your perspective on implementation progress
and challenges, program details such as the types of special populations involved or targeted by
your state initiative, your data collection processes, and the project’s evaluation progress. We are
also particularly interested in your perspective on the effectiveness and sustainability of this
initiative on reducing Medicaid and health care costs.
Our evaluation is being funded by the Centers for Medicare & Medicaid Services (CMS). As a
condition of participation, CMS expects state staff and program partners to cooperate with the
evaluation team, but ultimately your decision to participate in this aspect of the study is
voluntary. If you do not wish to participate in this interview or answer specific questions, please
let us know immediately.
We believe there are minimal risks to you from participation, and every effort will be made to
protect your confidentiality. We want to assure you that we will not quote you by name. We will
use some quotes in reports, but quotes will not be attributed to an individual or his or her
organization.
There are no direct benefits to you from participating in this study. But your insights will be used
by federal and state policymakers as well as other Medicaid programs to improve the impact that
incentives have on chronic disease prevention and management among Medicaid beneficiaries
and address the challenges involved in implementing an incentivized health prevention program.
CMS along with RTI’s Institutional Review Board (IRB) have reviewed and approved this
research protocol.
We would like to record our conversation, to ensure that our notes from today are complete.
Do I have your permission to audio record our conversation today? Are the remaining interview
conditions OK with you?
Finally, following our interview, we may e-mail you a few detailed questions related to focus
group discussion, beneficiary satisfaction survey logistics, and administrative costs. Because
these questions may involve reference materials, we thought it would be helpful to share them
via e-mail to provide you with time to review any relevant materials before responding.
Do you have any questions before we begin?
Background
About the Respondent
1. What is your role in [name of state program]?
2. How long have you been in this role?

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3. [For partner organization staff only] How did your [organization] become involved in
[name of state program]?
a. Was your [organization] recruited to participate in [name of state program]?
b. Did your [organization] respond to a solicitation such as an RFP to participate
in [name of state program]?
c. Is your [organization] paid to participate in [name of state program]?
4. [For partner organization staff only] How long has your [organization/clinic]
participated in [name of state program]?
Implementation Progress
Overall
5. We understand that [name of state program] was implemented in [XXX]. Did
implementation occur according to the originally proposed timeline?
a. [If it did not follow the timeline] What are the reasons implementation did not
follow the timeline?
6. What steps did you and other initiative staff take to implement [name of state program]?
a. What stakeholders were involved in the implementation process?
i. What were their roles?
b. What processes were developed to facilitate implementation (e.g., MOUs with
partners or contracting with an incentive vendor to develop an incentive
strategy)?
i. Who developed or participated in these processes?
c. What training, if any, was provided to staff (e.g., Diabetes Prevention
Program training or health instructing training)?
i. In your opinion, was this training effective?
7. What [other] partners, if any, are involved in implementing [name of state program]?
8. What role does each partner play in [name of state program]?
a. Did you establish a formal agreement with your partners outlining the role
they would play in the project?
b. How do you monitor partner progress?
9. To date, how effective has this partnership(s) been at helping [name of state program]
implement?

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10. How would you describe your communication with your partner [organizations]?
a. How often do you communicate with your partners?
i. What means do you use to communicate—e-mail, conference calls, inperson meetings?
b. How, if at all, could communication between you and your partners be
improved?
11. To date, what have been the key successes of the [name of state program]?
a. What factors helped [name of state program] succeed?
b. What stakeholders were involved in each success?
12. What challenges or barriers have you faced in your role within [name of state program]?
a. How have you addressed this challenge(s)?
b. Are there any challenges that remain?
i. In your opinion, what could help [name of state program] overcome
these remaining challenge(s)?
13. What challenges or barriers other than those we’ve discussed already has the [name of
state program] faced implementing this initiative?
a. Did [name of state program] face any challenges:
i. obtaining IRB approval?
ii. recruiting providers?
iii. retaining participants in [name of state program] for the full project
timeframe?
b. How has the [name of state program] addressed this challenge(s)?
c. Are there any challenges that remain?
i. In your opinion, what could help [name of state program] overcome
these remaining challenge(s)?
14. In your opinion, what improvements, if any, could [name of state program] make to
participant retention?

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Recruitment
15. When did participant recruitment begin?
a. Did participant recruitment occur according to the originally proposed
timeline?
i. What are the reasons?
b. In your opinion, will [name of state program] meet its enrollment goals?
c. What challenges has [name of state program] encountered recruiting
participants?
16. What material(s) or method(s) are [name of state program] using to recruit participants
(i.e., flyers, outreach to providers)?
a. Please describe how this recruitment strategy(ies) was developed.
b. How many staff recruit [name of state program] participants?
i. What roles do these staff members have within [name of state
program]?
17. In your opinion, how successful has [name of state program] been at recruiting
participants?
a. What factors have contributed to this success?
b. Are there any major recruitment challenges that exist?
i. How is [name of state program] addressing these challenges?
c. Has recruitment been more effective with certain populations?
i. What are the reasons?
ii. What populations?
18. What method(s) is [name of state program] using to recruit providers or outreach staff?
19. What challenges, if any, has [name of state program] faced recruiting providers or
outreach staff?
a. How has the [name of state program] addressed this challenge(s)?

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Incentives
20. In your opinion, what role do the incentives play in [name of state program]?
a. Do they assist [name of state program] in recruiting participants?
b. Do they help motivate and retain participants in [name of state program] to
attend program activities?
c. Do they help motivate participants to change their behavior or achieve health
outcomes?
Special Populations
As part of the Affordable Care Act, the MIPCD national demonstration is required to focus on
the extent to which special populations (such as adults with disabilities, children with special
health care needs) are able to participate in the demonstration. This section focuses on special
populations the state may engage in its program.
21. We understand that [name of state program] is planning to engage [special population
listed here], which we consider to be a special population. How have [name of state
program]’s plans to target this special population(s) changed since you’ve implemented
[name of state program]?
a. Why did these plans change?
22. How is [name of state program] recruiting or engaging this special population(s) to
participate in the initiative?
a. How do these recruitment techniques differ, if at all, from the techniques
[name of state program] is using to recruit the general Medicaid population?
23. In your opinion, how successful are these techniques at engaging [name of special
population(s)] to participate in [name of state program]?
a. What challenges has [name of state program] faced recruiting [name of
special population(s)]?
b. What changes, if any, is the [name of state program] planning to implement to
overcome these challenges?
24. How does [name of state program] handle participants who speak languages other than
English?
a. Are program services provided in other languages or are translators or
translation lines (such as the ATT translation phone line) available to assist
participants?

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State Grant Evaluation Progress
25. We understand that [name of organization] is in charge of [name of state program]
evaluation and that they are planning to conduct [name of the evaluation type]. How is
the evaluation progressing?
a. Is it proceeding according to the originally proposed timeline?
i. If not, why?
ii. If so, have there been any changes made in the evaluation plan?
b. Have you faced any challenges implementing a research study while
implementing the program?
26. The MIPCD grant program is designed to test the effectiveness of providing incentives
directly to Medicaid beneficiaries of all ages to try to change their health risks and
outcomes by adopting healthy behaviors. Are there any results to date?
a. What has [name of state program] learned so far from this evaluation?
27. How has [name of state program] used these results, if at all?
a. Are there any adjustments [name of state program] plans to make in response
to these results?
b. Based on these results, are you planning any adjustments to the evaluation
plans?
Data Collection
28. We are aware that the [name of state program] has implemented [list the data tracking
systems] to track data on participation, incentive disbursement, behavior change, and
health outcomes. Are there other tracking systems the program uses to collect data?
29. How are these systems working?
a. Are they providing you with the data you need for the evaluation?
b. Do they allow you to adequately monitor and track participants?
i. What could be improved with these systems to help you better monitor
and track participants?
c. Can you describe any system challenges you or other staff have encountered
collecting and tracking data?
30. What are the limitations of the data collection and tracking for [name of state program]?
a. Tell us about any difficulties you have collecting MDS data elements.

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i. Are you able to collect all of the MDS data elements on a quarterly
basis?
31. You indicated that you were planning to include [not include] individuals who are
enrolled in both Medicaid and Medicare, dual eligibles. How are these participants
identified within [name of state program]’s system?
32. As you know with nearly all experimental studies, interaction between control and
experimental groups can impact the outcome. To what extent does this occur with
participants in [name of state program]?
a. In what context does interaction between control and experimental group
participants occur (for example, sharing information or concepts learned in the
classes)?
b. What steps, if any, have been taken to minimize this interaction?
33. To what extent are you monitoring administrative costs?
a. How do your actual administrative costs compare to projected spending in
your proposal?
b. Are your administrative costs staying within the FOA (Funding Opportunity
Announcement) limit of 15 percent of demonstration expenses?
If not, ask:
i. Did you negotiate a higher limit with CMS?
ii. What was that limit?
c. What are the challenges of staying within the administrative cap?
d. What steps are you taking or would you take if you see that you are exceeding
the administrative cap?
e. Has remaining within the administrative cap had an effect on the program’s
structure or incentives?
34. What types of in-kind resources, if any, is the program receiving from the state or other
partner organizations? By in-kind resources, we are referring to labor, supplies or other
resources provided to the program that are not reflected in the costs covered in the grant.
a. What type of in-kind resources?
b. For each resource type, what are the estimated amounts?

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Overall
35. CMS funding for [name of state program] ends in 2016. Are there plans for your program
to continue beyond 2016?
a. If so, how will it fund the incentives? And the program?
b. If not, are there other initiatives the state will implement to address chronic
disease prevention?
36. To date, what key implementation lessons have you learned?
a. What advice would you give other states that are interested in implementing a
similar program?
37. What changes to [name of state program], if any, do you plan to implement before
beneficiary participation ends in December 2015?
a. Why have you or your staff decided to make these changes?
38. In thinking about the various challenges you’ve shared, in your opinion, are there any
challenges that would/could have benefited from state peer-to-peer learning or technical
assistance?
39. Is there anything else about [name of state program] that we haven’t covered but that would
be important for our team to know?
40. Over the next 2 years, RTI will be conducting focus group discussions and fielding a
beneficiary satisfaction survey. We would like to work with [name of state program] to
identify focus group discussion locations and coordinate the sampling for our beneficiary
satisfaction survey. What staff should we work with to coordinate these aspects of our
evaluation?

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