2012 STAKEHOLDER INTERVIEW GUIDEs
Form Approved
OMB No: 0935-0190
Exp. Date 02/28/2015
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.
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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.
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Leslie Foster |
| File Modified | 0000-00-00 |
| File Created | 2021-01-28 |