Home

Topics

Measuring Results

Evaluation to assess whether states' efforts are succeeding not only in changing primary care practices but also containing costs and improving quality, including patient experience.

Alabama
Alabama is planning to have an outside entity perform CAHPS surveys for a baseline and post-implementation evaluation for measuring progress within each community network pilot. Additionally, the state will perform a pre- and post-financial analysis.
 
Key outcomes of interest for the community network pilots will include improved clinical outcomes, improved patient satisfaction, and Medicaid cost containment. Specific measure that will be used include CAHPS survey results, Emergency Department utilization for asthmatics, Hemoglobin A1C Measures for diabetics, inpatient hospitalization, immunization rates, and average number of office visits. The University of Southern Alabama is assisting with evaluation design.
 
The Alabama Healthcare Improvement and Quality Alliance Workgroup – a public/private effort – is working to collectively establish measures predicated on national standards that can be used to assess progress on all programs throughout the state.
Alaska No known activity at this time.
Arizona No known activity at this time.
Arkansas No known activity at this time.
California
No known activity at this time.
Colorado

Medical Homes for Children Program:

Outcomes of interest for the Medical Homes for Children Program tracked by the Colorado Department of Healthcare Policy and Financing and Colorado Children's Healthcare Access Program include:
  • Ratio of preventive visits to expected (10 visits by age 2, 1 every year after);
  • ED utilization rates;
  • Immunization rates;
  • Parent satisfaction;
  • Use of a preventative developmental screening code; and
  • Provider willingness to take more Medicaid children
Accountable Care Collaborative (ACC) Program:
The primary goals of Colorado’s Accountable Care Collaborative program is to improve health outcomes through a coordinated, client/family-centered system that proactively addresses clients health needs and controlling costs by reducing avoidable, duplicative, variable and inappropriate utilization.
 
HealthTeamWorks Multi-payer Pilot:

The HealthTeamWorks multi-payer pilot evaluation, which is being prepared by the Harvard School of Public Health, will include quality, cost, and patient/provider satisfaction measures.
Connecticut
As part of the incentive and performance improvement payments, Connecticut will track a number of specific pediatric and adult outcome and process measures. These measures include:
 
Adult:
  • Number of diabetics receiving blood pressure screenings and eye exams
  • Inpatient readmissions
  • Emergency department utilization
  • Medication reconciliation for asthmatics
Pediatric:
  • Developmental Screenings
  • Recommended well-care visits
  • Connection to dental services
  • Emergency department utilization
Customized CAHPS PCMH surveys for both the adult and pediatric populations will include questions to evaluate patient experience with medical homes and the Medicaid provider network.
Delaware No known activity at this time.
District of Columbia No known activity at this time.
Florida
No known activity at this time.
Georgia No known activity at this time.
Hawaii No known activity at this time.
Idaho
A proposed Idaho Medical Home Collaborative workgroup will develop common quality, outcome, and cost measures.
Illinois
Illinois Health Connect is taking a four-pronged approach to measurement. They are tracking:
  • Patient experience of care, as assessed by surveys
  • Cost savings, as calculated by actuaries
  • Process and clinical outcomes improvements, especially at the population-level
  • Provider satisfaction
The Illinois Department of Healthcare and Family Services has announced that Illinois Health Connect saved the state approximately $150 million in fiscal year 2009. The state has also seen increases in developmental screenings, mammograms, and regular adolescent check-ups since implementing the program.
 
The Commonwealth Fund has provided $100,000 in funding for the Robert Graham Center to study the impact of Illinois Health Connect and Your Healthcare Plus (a disease management program). The evaluation will draw on claims data from before and after program implementation, as well as data from Medicaid programs in other states. The grant was announced in 2011, and results are expected in early 2012.
Indiana No known activity at this time.
Iowa

IowaCare will draw on clinical information from patient registries and provider records to evaluate progress in several key areas of interest including:

  • Reduction in unjustified variation of utilization and expenditure;
  • Improvement of safety, timeliness, effectiveness, and efficiency;
  • Increased patient participation in decision making;
  • Increased access to evidence-based care in underserved areas; and
  • Medicaid and Medicare cost containment
Kansas No known activity at this time.
Kentucky No known activity at this time.
Louisiana
Beginning in calendar year 2013, Bayou Health networks are required to report clinical and administrative performance data annually.
Required data will include measures from the following sources:
  • Healthcare Effectiveness Data and Information Set (HEDIS);
  • Agency for Healthcare Research and Quality Review (AHRQ);
  • Consumer Assessment of Healthcare Providers and Systems (CAHPS);
  • Children's Health Insurance Program Reauthorization Act (CHIPRA); and
  • Other measures as determined by the Louisiana Department of Health and Hospitals.
For specific measures, please see the networks’ quality companion guide or the appendices for the prepaid and shared savings request for proposals.
Maine
The University of Southern Maine’s Muskie School of Public Service is undertaking an evaluation of Maine’s Patient-Centered Medical Home (PCMH) Pilot. The evaluation is assessing the impact of the PCMH Pilot on clinical outcomes, cost, and patient experience. PCMH Pilot sites are being compared with two control groups: (1) a group of highly capable practices that applied for participation in the Pilot but were not selected, and (2) a group of less capable practices (“usual care”).
 
The Centers for Medicare & Medicaid Services (CMS) is also evaluating the impact of the CSI-RI on outcomes for Medicare and Medicaid patients through a contract with RTI International.  NASHP and the Urban Institute are subcontractors to RTI.
Maryland
SB 855/HB 929 directs the Maryland Health Care Commission (MHCC) to adopt a, “uniform set of health care quality and performance measures that the participating patient centered medical home is to report to the commission and,” health plans.  The legislation directs MHCC to engage a consultant to evaluate the effectiveness of the pilot in “reducing health costs and improving health care outcomes,” and reserves $450,000 for that purpose.
 
The evaluation will draw on multiple data sources including: claims information, condition-specific quality measures, and patient/provider satisfaction surveys. MHCC expects to use a, “pre/post treatment with a quasi-experimental control group of similar practice.” As of August 2011, the evaluation was expected to be more expensive than had originally been estimated.
Massachusetts The University of Massachusetts Medical School’s Department of Commonwealth Medicine will conduct an evaluation of the Patient-Centered Medical Home Initiative (PCMHI).
Michigan
Reporting activity in the Michigan Primary Care Transformation (MiPCT) Project includes:
  • Quarterly narrative and financial reports submitted by each physician organization on progress in achieving MiPCT goals.
  • Semi-annual payer reports.
  • Financial reports
  • Standard audit procedures
Minnesota Minnesota’s Outcomes Measurement Work Group has developed recommendations for the state’s evaluation. The Work Group has proposed to focus on clinical quality (especially care for patients with asthma and vascular conditions), patient access to care and experience of care, and cost (especially rates of hospitalizations, readmissions, emergency department use, and total cost of care).
Mississippi No known activity at this time.
Missouri

ACA Section 2703 Health Home State Plan Amendment – Community Mental Health Centers: MOHealthNet will use claims, a disease registry, a web-based electronic medical record, monthly health home reports, and annual status reports to measure success in eight specific goals specified in their first health home state plan amendment:

  1. Improve health outcomes for persons with mental illness
  2. Reduce substance Abuse
  3. Increase patient empowerment and self-management
  4. Improve coordination of care
  5. Improve preventative care
  6. Improve diabetes care
  7. Improve asthma care
  8. Improve cardiovascular care

Missouri will assess quality improvement and clinical outcome measures at both the practice and aggregate level.
Montana No known activity at this time.
Nebraska
Nebraska is in the process of collecting data for five pilot outcomes of interest, and identified measures for each. These outcomes are:
  • improved health care access
  • improved health outcomes for patients
  • Medicaid cost containment
  • patient satisfaction
  • practice satisfaction
Outcomes will be measured through analysis of claims data, provider records, and surveys.
 
In addition, TransforMED is collecting metrics on the progress of the transformation of the practices through the Patient Experience Assessment Tool (PEAT) and provider/staff surveys.
Nevada No known activity at this time.
New Hampshire No known activity at this time.
New Jersey
According to New Jersey’s Medicaid managed care contract, Medicaid managed care organizations (MCOs) are to evaluate their medical home demonstrations using the following criteria:
  1. "Whether cost savings are achieved and supporting documentation;
  2. Types and rates of health screening;
  3. Health outcome measures including but not limited to:
    • emergency room visit rates;
    • hospitalization rates; and
    • avoidable hospital readmission rates, comparing medical home cohorts;
  4. At a minimum, two clinical measures; and
  5. Satisfaction measures, e.g., CAHPS [Consumer Assessment of Healthcare Providers and Systems] measures.”

Reports are to be made to the Division of Medical Assistance and Health Service (DMAHS) annually.
New Mexico
New Mexico Medicaid plans to adopt a common set of performance measures for quality improvement, possibly drawing from NCQA and Electronic Health Record Meaningful Use requirements. Also, utilization measures and cost data will be included in the performance reporting and feedback process to practices and plans. The state is exploring methods to aggregate performance data to identify pockets of care disparities and high avoidable costs.
 

Initial quality measures have included monitoring diabetic and asthmatic patients. Annual reviews of PCMH pilots include implementation of a scorecard with cost, quality and satisfaction measures. New Mexico is also monitoring emergency department and inpatient utilization.
New York
Adirondack Medical Home Demonstration: The four major goals of the Adirondack Medical home demonstration are to:
  • improve quality and outcomes
  • lower overall health care costs
  • improve access; and
  • create a new clinically integrated model that can be replicated in other parts of the state.
Statewide Patient-centered Medical Home Program:
Chapter 58 of the Laws of 2009 requires the state health commissioner to report on the Statewide Patient-centered Medical Home Program’s impact on quality, cost, and outcomes to the legislature and governor by December 31, 2012.
 
In addition, Chapter 59 of the Laws of 2011 requires the state health commissioner to prepare a similar annual report for the effects of regional multi-payer medical home initiatives on Medicaid, Family Health Plus, and Child Health Plus enrollees.
North Carolina
Treo Solutions, Inc. has reported that Community Care of North Carolina has saved over $1.5 billion between 2007 and 2009. Mercer, Inc. prepared studies that found annual savings ranging from $154-194 million between 2006 and 2009.
 
CCNC has also reported that enrollee’s diabetes, asthma, and heart disease HEDIS measures rank in the top 10% nationally (compared to commercial managed care plans).
 
Practice assessments are completed by local Community Care Program Office using: 
  • Medicaid claims data;
  • Pharmacy claims data – web-based pharmacy home program;
  • Case identification reports – risk stratification;
  • Gaps in care analysis reports;
  • Customized queries; and
  • Baseline measures, ongoing monitoring, and trend analysis.
Furthermore, an informatics center can provide feedback reports at the individual, practice, network and state levels. However, certain data (including substance abuse and HIV data) cannot be included in individual reports.
 
The Brookings Institution will be evaluating the public-private “First in Health” program’s impact on both quality and cost of care.
North Dakota No known activity at this time.
Ohio

The patient-centered medical home (PCMH) education advisory group selected a number of practice and curriculum metrics. The selected metrics fall into six categories:

  1. Core clinical outcome metrics;
  2. Enhanced clinical outcome metrics;
  3. Patient, staff, and student satisfaction survey outcomes;
  4. Access to care metrics;
  5. Practice operations/financials metrics; and
  6. Curriculum/training metrics

For specific measures selected, please see pages 7-8 of the advisory group’s final work product report.
Oklahoma
The Oklahoma Health Care Authority (OHCA) uses HEDIS measures to evaluate performance.
 
The SFY2010 Performance and Quality Report describes that the OHCA Quality Assurance and Improvement Department uses standardized audit tools to conducts on-site reviews of contracted SoonerCare Choice providers.
 
Following the redesign of SoonerCare Choice, the number of patients contacting the Oklahoma Health Care Authority (OHCA) for same/next day access issues in a year decreased from 1670 in 2008 to 13 in 2009 to 4 in 2010.
 
The program has demonstrated a $29 decrease in per capita member costs (per patient/per year) from 2008-2010 while increasing evidence-based primary care services (including breast and cervical cancer screening).
 
A 2009 pediatric health survey showed an increase of more than 18 percent of patients between 2007 and 2009 who “always [received] treatment quickly.” A 2010 adult health survey found a similar increase of 8 percent for adults between 2008 and 2010.
Oregon
Chapter 595 of the 2009 Oregon Laws requires practices receiving Patient-Centered Primary Care Home (PCPCH) reimbursement to report quality measures specified by OHPR. Proposed PCPCH measures vary by tier, and can be found in Appendices C and D of the Standards Advisory Committee’s final report.
 
Under the upcoming Integrated and Coordinated Health Care Delivery System, CCOs will be required to report uniform quality measures for PCPCHs to OHA.
 
PCPCH efforts will be included in a statewide scorecard to measure success for the Action Plan for Health across the OHA lines of coverage as well as statewide.
Pennsylvania
The Commonwealth Fund is paying for researchers at RAND and Harvard School of Public Health to conduct an evaluation of Phase I of the Chronic Care Initiative (CCI). The Centers for Medicare & Medicaid Services (CMS) is evaluating the impact of the Phase II CCI on outcomes for Medicare patients through a contract with RTI International. NASHP and the Urban Institute are subcontractors to RTI. Final evaluation results are not yet available, but the state has seen promising improvements in process measures as determined by Pennsylvania’s Improving Performance in Practice (IPIP) program.
Rhode Island
The Commonwealth Fund is paying for researchers at the Harvard School of Public Health to conduct an evaluation of the Chronic Care Sustainability Initiative (CSI-RI). The Centers for Medicare & Medicaid Services (CMS) is also evaluating the impact of the CSI-RI on outcomes for Medicare patients through a contract with RTI International. NASHP and the Urban Institute are subcontractors to RTI. Final evaluation results are not yet available, but the state has seen promising improvements in process measures.
South Carolina
The South Carolina Department of Health and Human Services requires participating medical home networks to work with the department to establish outcome measures relevant to the program.
 
Furthermore, an external quality review organization conducts an annual quality assurance evaluation for each medical home network. This process includes:
  • a quality of care study that includes data on prenatal and newborn care, childhood immunizations, asthma, emergency room utilization, and Early and Periodic Screening Diagnosis & Treatment (EPSDT) examinations;
  • a service access study focusing on emergency room service and utilization; appointment availability and scheduling, referrals, follow up care provided, and the timeliness of services;
  • a medical record survey to ensure compliance with medical record uniformity of format, legibility and documentation; and
  • an administrative survey of administrative policies and procedures.
South Dakota No known activity at this time.
Tennessee No known activity at this time.
Texas No known activity at this time.
Utah

Utah’s Children’s Health Insurance Program Reauthorization (CHIPRA) proposal included funding for an independent evaluation. Utah anticipates that the evaluation will focus on:         

  • Access
  • Utilization
  • Costs
  • Quality
  • Outcomes
  • Patient and family experience
Project leaders anticipate drawing on Utah’s all-payer claims database to use other practices as controls.
Vermont
The 2009 Blueprint for Health Annual Report describes the Blueprint’s evaluation infrastructure as including:
  • a centralized web based registry;
  • a multi-payer claims data base;
  • annual chart reviews;
  • routine independent scoring of practices based on NCQA PPC-PCMH standards;
  • analyses using data from public health registries on population indicators; and
  • an informatics and analytics platform with a web based reporting dashboard.
The 2010 Blueprint for Health Annual Report provides early, mixed results for the three pilot communities on a number of cost and quality metrics.
Virginia No known activity at this time.
Washington
The Washington State Patient Centered Medical Home (PCMH) Multipayer Reimbursement Pilot has planned for the University of Washington School of Public Health to conduct a comprehensive evaluation of their project. The evaluation will focus on the impact of the payment method on utilization, cost, outcomes, and experience. The evaluation team will draw on qualitative data (experience surveys, key informant interviews) and quantitative data (claims data, clinical quality measures). The evaluation will continue for a year after the pilot ends, in order to study changes following the conclusion of the program. Further information is available on pages 34-35 here.
 
The PCMH Collaborative has released a preliminary summary of evaluation results for participating practices. The summary provides information on:
  • Increased practice capabilities over time, as measured by the Medical Home Index
  • Mixed changes in clinical outcomes, such as the portion of diabetic patients with record of an eye exam
  • Improvements in provider satisfaction over time
West Virginia
The Medical Home Performance Incentive Pilot has focused on the following outcomes:
  • Clinical process measures
  • Clinical outcome measures
  • Utilization
  • Cost
  • Alignment with Meaningful Use
Wisconsin
Medicaid Managed Care High Risk Pregnancy Medical Home Pilot: Participating practices are required to measure quality of performance using:
  • Prenatal and Postpartum Care HEDIS
  • Frequency of Ongoing Prenatal Care HEDIS
  • CAHPS or other comparable member satisfaction survey
Wyoming No known activity at this time.