After the Demonstration: What States Sustained After the End of Federal Grants to Improve Children’s healthcare Quality

Ireys H, Brach C, Anglin K, Devers K, Burton R
Source: Matern Child Health J
Publication Year: 2017
Population Focus: Medicaid beneficiaries
Demographic Group: Child
Intervention Type: Best practices, Service redesign
Study Design: Other Study Design
Type of Literature: White

Under the CHIPRA Quality Demonstration Grant Program, CMS awarded $100 million through 10 grants that 18 state Medicaid agencies implemented between 2010 and 2015. The program’s legislatively-mandated purpose was to evaluate promising ideas for improving the quality of children s healthcare provided through Medicaid and CHIP. As part of the program’s multifaceted evaluation, this study examined the extent to which states sustained key program activities after the demonstration ended.

We identified 115 potentially sustainable elements within states’ CHIPRA demonstrations and analyzed data from grantee reports and key informant interviews to assess sustainment outcomes and key influential factors. We also assessed sustainment of the projects intellectual capital.

56% of potentially sustainable elements were sustained. Sustainment varied by topic area: Elements related to quality measure reporting and practice facilitation were more likely to be sustained than others, such as parent advisors. Broad contextual factors, the state’s Medicaid environment, implementation partners’ resources, and characteristics of the demonstration itself all shaped sustainment outcomes.

Assessing sustainment of key elements of states’ CHIPRA quality demonstration projects provides insight into the fates of the “promising ideas” that the grant program was designed to examine. As a result of the federal government s investment in this grant program, many demonstration states are in a strong position to extend and spread specific strategies for improving the quality of care for children in Medicaid and CHIP. Our findings provide insights for policymakers and providers working to
improve the quality of healthcare for low income children

Insights Results

Overview of model

  • Across all demonstration states, 56% of elements were sustained after the grant period ended; most states found ways to sustain the intellectual capital developed by the grant
  • Elements related to practice facilitation and quality measure reporting were more likely to be sustained than other areas; elements related to family engagement were least likely to be sustained
  • Few states sustained elements that involved providing financial or labor support directly to practices

    Key takeaways/implications

    • Factors influencing sustainment: 1) Leadership and availability of new financial support; 2) States’ investment in infrastructure and institutionalization of procedures developed with grant funds; 3) Early planning for sustainment combined with systematic evidence of a program’s effects from state-based process evaluations; 4) Alignment of program activities; and 5) Stakeholder support
    • For example, demonstration states sustained 77% of quality measurement elements because of factors such as states’ existing measure-related contracts with universities, relatively low costs of institutionalizing procedures first developed with demonstration funds, and anticipation that voluntary reporting of quality measures to CMS would become mandatory
    • Takeaway: As a result of the federal government’s investment, many demonstration states were in a strong position to extend and spread specific strategies for improving the quality of care for publicly-insured children