9 2014 Health Care Organization Staff Interview Guide

Attachment J

2014 Health care organization staff INTERVIEW guide

Form Approved

OMB No:

Exp. Date

CHIPRA QUALITY DEMONSTRATION Evaluation

2014 Interview Guide

HEALTH CARE ORGANIZATION STAFF

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 45 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 (0935-0190) 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 second 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:

1. Your experience implementing your state’s quality demonstration.

2. Changes you made as a result of the demonstration.

3. Efforts to sustain or spread your work after the demonstration.

Our interview will take 45 minutes. 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?

CORE QUESTIONS

I. Introduction/Background

1. What is your role in the [practice/ clinic/ FQHC/ CME/ SBHC], and how long have you worked here?

2. Besides patient care, what other responsibilities (formal or informal) do you have? For example, do you lead a care team or a committee?

3. Please tell me about this [practice/ clinic/ FQHC/ CME/ SBHC]. [Note: ask if practice not visited in 2012; otherwise, rephrase to ask about changes since 2012.]

   • Who owns this [practice/ clinic/ FQHC/ CME/ SBHC] (if it is not privately owned or free-standing)?

   • Are you a single-specialty or multi-specialty group? If single-specialty, what is that specialty (e.g., pediatric, family practice)?

   • About how many clinicians work here?

   • How many pediatric patients overall does your [practice/ clinic/ FQHC/ CME/ SBHC] see? How about Medicaid/CHIPRA?

4. What is the predominant way your [practice/ clinic/ FQHC/ CME/ SBHC] is paid? For example, is it discounted fee-for-service plus some case management fees, or perhaps partial capitation? [Note: ask if practice not visited in 2012; otherwise, rephrase to ask about changes since 2012.]

   • Do you receive any financial incentives from plans for EHR investment or QI projects? Do you participate in any pay-for-performance programs?

• How much of your payment is at risk?

5. Do you use an electronic health record (EHR)? [Note: ask if practice not visited in 2012; otherwise, rephrase to ask about changes since 2012.]

   • What vendor do you use?

   • Are you participating in the Medicaid EHR payment incentive program? Why or why not?

• Did you attest to stage one of Meaningful use? Do you anticipate meeting the requirements for state two or three?

6. What are your responsibilities in connection with the state’s CHIPRA quality demonstration grant?

   • Are you designated as a physician champion or leader? Do you head any particular QI effort or task like measure collection and reporting, health IT optimization, or PDSA cycles on a specific topic?

II. Strategies

Cross-Category

1. In your own words, how would you describe your [practice/ clinic/ FQHC/ CME/ SBHC] goals for the last year of the CHIPRA quality demonstration?

2. For your own [practice/ clinic/ FQHC/ CME/ SBHC] – how would you characterize your progress towards these goals over the last year?

   • What has gone well?

   • What has gone less well?

3. How engaged are other physicians and staff members in this demonstration? What roles have they played in the CHIPRA quality demonstration activities?

4. How has [the state/this learning collaborative] supported your [practice/ clinic/ FQHC/ CME/ SBHC] in making demonstration progress? What have they done well? What has been less helpful or could they do better?

5. What were the costs and benefits to you and your [practice/ clinic/ FQHC/ CME/ SBHC] of continuing to participate in this CHIPRA demonstration?

Provider-Based Initiatives (Category C)

[NOTE: Use category C module if state has a category C project]

1. What are your practice’s specific goals around [patient centered medical homes, youth engagement, expanding CMEs, etc]?

2. How would you characterize your progress towards these goals over the last year?

   • What has gone well?

   • What has gone less well?

3. Could you please elaborate on what specific changes you made to your [practice/ clinic/ FQHC/ CME/ SBHC] over the last year to [insert goal of the demonstration “increase your medical homeness” or “engage youth”? Please focus on changes in structure and service delivery related to the demonstration.

   • Probe on efforts to improve access, care coordination, links to other providers, cultural competence, patient centeredness

   • Did you hire or work with new staff?

   • Did you change care processes?

4. As you made these changes to your [practice/ clinic/ FQHC/ CME/ SBHC], what went relatively well? What challenges have you experienced?

   • How has your approach to demonstration evolved overtime?

5. How are patients and their families responding to the new care delivery model you are implementing (e.g., the medical home model) and the specific changes you are making to your [practice/ clinic/ FQHC/ CME/ SBHC]?

   • Have they noticed changes in how the practice operates?

   • What kind of feedback do you hear from families about these changes?

   • How did you gather this feedback? Probe on family advisory group, surveys, or information provided by state or plans.

Quality Measurement Initiatives (Category A)

[NOTE: Use category A module if state has a category A project.]

1. What are your practice’s specific goals for collecting and reporting measures under the CHIPRA demonstration?

2. How would you characterize your progress towards these goals over the last year?

   • What has gone well?

   • What has gone less well?

3. What quality measures did your [practice/ clinic/ FQHC/ CME/ SBHC] collect and report on as part of this CHIPRA-funded demonstration? [Share a list of the measures collected under CHIPRA with the practice.]

   • How has your approach to quality measurement evolved overtime?

• What has gone well? What measures were relatively easy to collect?

• What has gone less well? What measures were difficult to collect?

4. [If facility has an EHR]: Are you extracting any of the CHIPRA quality demonstration measures from your EHR?

   • Please describe your experience in using EHRs to collect and report the CHIPRA quality measures.

   • Did you have to make any changes to your EHR?

   • What do you see as the pros and cons of using EHRs to collect and report the quality measure data?

5. [If no EHR]: Please briefly describe how you collect and report CHIPRA quality demonstration measures without an EHR.

6. How is your [practice/ clinic/ FQHC/ CME/ SBHC] using CHIPRA quality measure data that you collect?

• Is the data useful to your practice? Is it accurate and complete?

• Are you receiving CHIPRA feedback reports from the state or CMS? Are feedback reports useful and easy to read?

1. Do patients or families receive quality measure reports? If so, how are they using the measure reports?

   • Are they aware of how you “score” on different quality measures?

   • What kind of feedback do you hear from families about quality measure reports?

   • How did you gather this feedback? Probe on family advisory group, surveys, or information provided by state or plans.

B. Health IT Initiatives (Category B)

[NOTE: Use category B module if state has a category B project. When possible, refer to health IT by name to distinguish CHIPRA health IT activities from other health IT initiatives.]

1. What are your practice’s specific goals around [name of CHIPRA health IT system or program]?

2. How would you characterize your progress towards these goals over the last year?

   • What has gone well?

   • What has gone less well?

3. Did you implement [name of CHIPRA health IT system or program]?

• What helped you implement the system?

• What were the barriers to implementation?

4. Are providers at your [practice/clinic/FQHC/CME/SBHC] using the new health IT tools and/or systems routinely?

   • If not, what issues do you view as most important to increasing the use of the new tools/system?

5. How is using these new health IT tools changing the way your practice provides care?

• How is the model format changing quality, safety, practice efficiency, or work roles?

• What features of [the new health IT tool or system] work best to improve clinical care?

• Are the data in [the new health IT tool or system] accurate and complete enough to use them for their intended purpose?

6. What have been patients’ and families’ reactions to your [practice/ clinic/ FQHC/ CME/ SBHC]’s use of the new health IT tool or system?

   • How did you gather this feedback? Probe on family advisory group, surveys, or information provided by state or plans.

7. [If there is a patient-facing component] How are patients using the new health IT?

   • What kind of feedback do you hear from families about this [tool / system]?

D. Pediatric Model Format (Category D)

[NOTE: Skip these questions if the state is not testing the model EHR format with practices.]

1. How easy or difficult was implementation of the new pediatric model format for your practice?

   • What components of the model format did you implement?

   • What helped you implement the format? Probe on assistance provided by the state.

   • What barriers did you encounter? Probe on problems with vendors, interoperability, change in work flows, cost.

2. How satisfied are you with the model format?

• How satisfied are you with the usability and functionality of the new system?

• How well does the format interface with other technology in your practice?

3. Are providers at your practice using the new format routinely?

   • If not, what issues do you view as most important to increasing use?

4. How is using the model format changing your practice?

• How is the model format changing quality, safety, practice efficiency, or work roles?

• What features of the model EHR work best?

• What features of the model EHR are frustrating or difficult to use? Did you experience any unanticipated outcomes from using the model format?

5. What have been patients’ and families’ responded to the new format?

   • Favorably, unfavorably, neutral or not aware?

   • Are parents involved in testing?

   • What kind of feedback are they giving on the demonstration? How did you gather this feedback?

   • How did you gather this feedback? Probe on family advisory group, surveys, or information provided by state or plans.

III. Provider Context

1. Besides CHIPRA, what new major initiatives did your [practice/ clinic/ FQHC/ CME/ SBHC] join in the last year related to quality measures, using health IT, or medical homes? (These could be efforts led by the state, Medicaid MCOs, private payers or plans, professional associations, or some other group.)

2. To what extent are specialists or hospitals you refer to getting EHR capacity? Can you exchange data with these providers directly or through a health information exchange?

IV. Demonstration Impact and Sustainability

1. Now, we would like to discuss how the CHIPRA demonstration impacted you, your practice, and your patients.

   • How has your work under the CHIPRA demonstration impacted you?

• More or less satisfied with your job? Problems with burnout?

• What aspects of the CHIPRA demonstration contributed to this outcome?

• How has your work under the CHIPRA demonstration impacted your [practice/SBHC/CME]?

• Probe on changes to care team, ability to qualify for recognitions (e.g., pay-for-performance incentives or PCMH certification), practice efficiency

• What aspects of the CHIPRA demonstration contributed to this outcome?

• How has your work under the CHIPRA demosntration resulted in positive impacts for your patients?

• Probe on improved care coordination, management of conditions, access, quality, patient safety, fewer visits to specialists, reduced use of EDs, fewer

• Do you have evidence that the quality of care improved?

• What aspects of the CHIPRA demonstration contributed to this outcome?

2. What are your plans for sustaining these changes after the grant period ends?

   • What will help you sustain your efforts?

   • What activities will be difficult to sustain? Why?

3. What are your plans for spreading or expanding your work under CHIPRA?

   • What will help you to spread your activities? Probe on payment reform, additional education, engagement of patients.

4. How does the implementation of health reform present opportunities or challenges for continuing this type of work?

   • What will help you to spread your activities? Probe on payment reform, additional education, engagement of patients.

IV. Lessons Learned

1. What are the key issues to consider moving forward?

2. Given your experience to date, what insights or advice you might have for other [practices/ clinics/ FQHCs/ CMEs/ SBHCs] implementing similar types of activities?

3. Should a demonstration like CHIPRA be repeated or extended? Why or why not?

   • What are the possible dangers or risks? Any negative unintended consequences?

Thank you very much for making time to speak with us.

SUPPLEMENTAL QUESTIONS

Interviewer: Select the most relevant questions as time permits.

Learning Collaboratives (also applicable to other discrete strategies)

1. In the last year, did you participate in [name of the learning collaborative in this state] activities?

   • If so, which ones?

     • Have you participated in in-person meeting(s)? Conference calls? Webinars? Email conversations? Have you read any documents produced by them?

   • How did participation in the learning collaborative impact the incentives you received or your ability to continue participating in the demonstration?

2. As part of these [name of state's learning collaborative] activities, what topics were presented or discussed in the last year?

3. What are your thoughts on the usefulness of the [name of state's learning collaborative]?

   • What do you feel are its strengths?

   • What do you feel are its weaknesses?

   • How could it be improved?

4. What are your thoughts on the usefulness of CHIPRA practice coaches and facilitators?

5. What are your thoughts on the usefulness of medical home coordinators or other staff embedded in the practice?

6. In the last year, what other new learning collaboratives or professional development activities did you participate in? What entities sponsor these activities (e.g., the state Medicaid program or MCO(s), the local AAP chapter, HRSA, a local research or quality improvement network)?

OTHER

1. In the last year, have there been any major changes in your local market, region, or state that will affect your ability to implement the CHIPRA quality demonstration? If so, briefly describe them.

   • Probe on mandatory enrollment of kids in MCOs, mental health carve outs, mergers and acquisitions, changes as a result of health reform.

1. Has the state provided you with any technical assistance to help with reporting on these new quality measures? If so, please describe.

   • How helpful has this assistance been? In what way could it be improved?

2. How useful is technical assistance provided to help you collect and report on quality measures under this demonstration?

   • Who is providing this assistance?

3. Have you received any technical assistance in addition to the help received through this demonstration? If so, please describe.

• Who is providing this assistance? How is it funded?

• How helpful has this assistance been?

4. From talking to other [practices/ clinics/ FQHCs/ CMEs/ SBHCs] participating in this demonstration, do you think your [practice’s/ clinic’s/ FQHC’s/ CME’s/ SBHC’s] experience with collecting and reporting these measures has been similar or different from other [practice/ clinic/ FQHC/ CME/ SBHC]'s experiences? How so?

5. How integrated are reporting for these new measures with other quality measure reporting activities?

1. Under the CHIPRA demonstration, have you received any technical assistance to help with implementing and using new health IT tools? If so, please describe.

• How helpful has this assistance been? In what way could it be improved?

2. Have you received any technical assistance in addition to the help received through this demonstration? If so, please describe.

• Who is providing this assistance? How is it funded?

• How helpful has this assistance been?

3. In your [practice/ clinic/ FQHC/ CME/ SBHC], who enters data into the [name of any new health IT tool(s) being implemented under the CHIPRA grant]?

4. How are these health IT tools helping with the pediatric quality measure reporting?

1. Has the state provided you with any technical assistance to help you [insert goal of state’s category C project]? If so, please describe.

• How helpful has this assistance been? In what way could it be improved?

2. Have you received any technical assistance in addition to the help received through this demonstration? If so, please describe.

• Who is providing this assistance? How is it funded?

• How helpful has this assistance been?

2. Could you describe for us what your involvement has been in [the state-specific Category E activity] over the last year?

• What activities have you completed as part of this initiative?

  • Have you encountered any difficulties associated with implementing these activities? What were they? How did you get around these difficulties?

• [If applicable]: What technical assistance have you received related to this activity, and from whom?