CMS-10477 Staff educator interview protocol and consent

Attachment 5.e. Site Visit Educator Staff Interview Protocol and Consent Form
MEDICAID INCENTIVES FOR PREVENTION OF CHRONIC DISEASES EVALUATION
INTERVIEW GUIDE
Educator Protocol
(Individuals who work directly with participants to educate them about their health condition and to
implement the MIPCD intervention)
Roles may include the following:
• Peer coaches
• Navigators
• Lifestyle coaches
• Health educators
• Hotline counselors
• Certified diabetes educators
• Dietitians
• Program teachers
• Participant motivators
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 and 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?
Finally, we are conducting a second round of stakeholder interviews focused on beneficiaries’
satisfaction with the program so we may contact you for further information.
Are the remaining interview conditions OK with you? Do you have any questions before we begin?

Background
About the Respondent
1. What is your role in [name of state program] and how long have you been in it?
2. What type of interaction do you have with participants (e.g., do you provide ongoing
counseling or teach a class or serve as a resource when participants have questions)?
a. On a typical day, what percentage of your time is spent interacting with participants?
b. How do participants typically contact you (e.g., via telephone, in person, as part of a
group meeting, schedule an appointment)?

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c. How frequent is your contact with each individual participant?
i. How, if at all, does the frequency of participant contact vary?
3. In your position, how often, if at all, do you interact with Medicaid beneficiaries who are
not [name of state program] participants (occasionally, daily, or never)?
a. What type of interaction do you have with these individuals?
b. How do your interactions with [name of state program] participants compare to those
with individuals who are not participating in [name of state program]?
i. To what extent, if at all, are your interactions with these two groups of
individuals similar?
ii. To what extent, if at all, are your interactions with these two groups of
individuals different?
4. In your opinion, are there any ways your interactions with participants could be improved?
a. If so, how could they be improved?
b. In your opinion, how could [name of state program] facilitate this change?
5. [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]?
6. [For partner organization staff only] How long has your [organization] participated in
[name of state program]?
7. What type of training did you and other staff receive as part of [name of state program]?
a. What organization conducted this training?
b. Was this training helpful?
c. In your opinion, how could the training be improved to be more useful? For example,
are there other topics that would be helpful?

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About the Program
8. Some state participants refer to the initiative by a name different from the official program
name. Other than [name of state program], what names do you or participants use when
referring to this program?
a. In your opinion, do you think participants will recognize the program as [name of
state program]?
9. In your opinion, can participants distinguish between [name of state program] and general
health services provided by Medicaid?
a. Do participants recognize that they are in a special Medicaid incentive program?
Implementation Progress
This section of questions focuses on implementation progress within the
[classroom/organization/community] where you are working.
Overall Program
10. In your opinion, what have been the key successes of [name of state program] in your
[classroom/organization/community]?
a. What key factors helped you accomplish this success?
11. What challenges or barriers do you think [name of state program] faces?
a. How has the [name of state program] addressed this challenge(s)?
b. Are there any challenges that still remain?
i. What can be done to address these remaining challenges?
12. Within your [classroom/organization/community], does participation in [name of state
program] vary based on the following characteristics, and if so, please describe.
e. Patient characteristics (age, sex, race)?
f. Native language?
g. Geographic location?
h. Other characteristics?
13. What type of interaction/communication, if any, do you have with participant recruiters such
as outreach coordinators, providers, clinic staff?
a. How often do you interact/communicate with program recruiters?
b. How, if at all, could communication between education and recruitment staff be
improved?

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Recruitment and Retention
In discussing your implementation progress, we would like to ask a few questions about recruitment
and retention. We recognize that you may have a limited role in recruiting participants; however, we
hope to obtain your opinion on the progress of this activity.
14. How is [name of state program] currently recruiting participants to your
[classroom/organization/community]?
a. Please describe how this recruitment strategy(ies) was developed.
b. What staff are responsible for recruiting participants?
15. In your opinion, how successful has [name of state program] been at recruiting participants
to your [classroom/organization/community] over time?
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 populations?
ii. What are the reasons?
16. In your opinion, is there a way that [name of state program] could improve its participant
recruitment to your [classroom/organization/community]?
17. What marketing strategies have been most successful at recruiting participants to your
[classroom/organization/community]?
a. To what extent, if at all, does the effectiveness of these strategies vary across
population groups?
i. What population groups?
18. In your opinion, how successful has [name of state program] been at retaining participants
in your [classroom/organization/community] for the full duration?
a. What factors have contributed to this success?
b. Are there any major retention challenges that exist?
i. How are you or [name of state program] addressing these challenges?
c. Has retention been more effective with certain populations?

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i. What populations?
ii. What are the reasons?
Incentives
19. In your opinion, what role do the incentives play for participants in your
[classroom/organization/community]?
c. Do they assist with recruiting participants to your
[classroom/organization/community]?
d. Do they help motivate and retain participants in your
[classroom/organization/community]?
20. In your opinion, does the incentive motivate beneficiaries to participate and remain in the
program?
a. How could the incentive be improved if at all?
b. If your program provides multiple incentives, are there some incentives that seem to
be more effective than others at motivating participants?
c. Are there incentives that do not seem to motivate participants?
d. If [name of state program] were to stop providing incentives, what impact, if any,
would this change have on motivating participants to participate and remain in the
program?
21. In your opinion, is the incentive appropriate for motivating participants to change their
health behaviors or achieve their health outcomes?
a. How could the incentive be improved if at all?
b. If [name of state program] were to stop providing incentives, what impact, if any,
would this change have on motivating participants to change their health behaviors or
achieve their 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.
22. We understand that [name of state program] is planning to engage [special population listed
here], which we consider to be a special population. How is [name of state program]
recruiting or engaging this special population(s) to participate in your
[classroom/organization/community]?

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a. How do these recruitment techniques differ, if at all, from the techniques [name of
state program] is using to recruit the general population?
23. Based on your experience, how successful are these techniques at engaging [name of
special population(s)] to participate in the [name of state program] implemented by your
[classroom/organization/community]?
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 do you handle participants who speak languages other than English in your
[classroom/organization/community]?
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?
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]. What role, if
any, do you have in this evaluation?
b. How is [name of state program] assessing the impact of your work with participants?
26. What assessments, if any, are you or [name of organization evaluating] conducting with
beneficiaries?
a. Are you assessing beneficiary satisfaction (e.g., with accessibility of the program,
quality of care)?
i.

If so, what types of assessment tools such as questionnaires, focus group
discussion guides are being used to gauge participant satisfaction with [name
of state program]?

27. 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 that have been shared with you?
a. What have you learned so far from this evaluation?
b. Based on these results, have you made any adjustments to your
[curriculum/process/interactions with participants]?
Data Collection
28. What data systems, if any, do you use to collect and track program participation and
retention?

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29. [name of state program] is conducting a study with an experimental group receiving
incentives and comparing them to a control group that may not be receiving incentives. Do
you know which participants are in the experimental group or the control group?
30. If yes: In many experimental studies, interaction between control and experimental groups
can impact study outcomes. To what extent does this interaction currently occur with
participants in your [classroom/organization/community]?
a. Do the two groups interact frequently, occasionally, or not at all?
b. In what context does interaction between control and experimental group participants
occur (for example, sharing information or concepts learned in the classes)?
c. What steps, if any, have been taken to minimize this interaction?
Overall
31. To date, what key implementation lessons have you learned?
a. What advice would you give other [peer coaches/navigators/program
teachers/motivators] participating in a similar type of program?
32. 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?
33. 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?
34. Is there anything else about [name of state program], that we haven’t covered but that would
be important for our team to know?

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