Smith L, Amico P, Hoerger T, Jacobs S, Payne J, Renaud J, RTI Qualitative Team, RTI Claims Analysis Team, RTI Provider Survey Tea, RTI Awardee Secondary Data Team
Abstract
In an effort to identify and understand the models that could be expanded on a broader scale, the Center for Medicare & Medicaid Innovation (CMMI) contracted with RTI International to evaluate the 24 HCIA Community Resource awardees (HCIA awardees). The evaluation draws upon qualitative and quantitative methods to assess the impact of the awardees’ innovations on three overarching goals of the Affordable Care Act of 2010 (ACA): smarter spending, better care, and healthier people. This executive summary of the third annual report presents the awardees’ progress and impact over the 3-year funding period from 2012 to 2015. We provide an overview of the HCIA awardees, evaluation design, and key findings organized by the specific evaluation questions that we addressed:
Insights Results
Staffing and communication
Targeted communications and education, clear job descriptions and protocols, formal divisions of labor, and liaisons between clinical and nonclinical staff reduced the ambiguity of community health workers’ contributions to patient care
Awardees that effectively integrated community health workers adopted thoughtful recruitment and training practices; offered information and education to providers; and aligned work processes, tools, and technology with community health workers’ responsibilities
To fill key roles with the right people, awardees realized they needed more rigorous interview processes. By fully disclosing to candidates all the positive and negative aspects of the position, both in the job descriptions and in the interviews, awardees envision being able to find and better retain appropriate candidates
By doing non-medical tasks, community health workers gave other staff the time to focus on clinical care and other productive activities
Financial and quality outcomes
Five awardees showed significant reductions in spending
Nine awardees significantly decreased the likelihood of inpatient admissions. Nine awardees had statistically significant reductions in emergency department (ED) visits (p-value < 0.10)—the focus and goal of many awardees. However, successful delivery of the innovation varied among these awardees and across disease conditions
Patients with diabetes in Bay Area Heart Center (BAHC), Eau Claire Cooperative Health Centers (ECCHC), and U-Chicago had improved hemoglobin A1c control
Patients with diabetes in BAHC, Curators, and South County had improved low-density lipoprotein cholesterol (LDL-C) control
Enrollees with hypertension in ECCHC and U-Chicago had improved blood pressure control
Future considerations
After facing turnover that slowed program implementation, some awardees identified a need for redundancy in key roles, including community health workers and health promoters (especially with relevant language skills), analysts, supervisors, and nurse practitioners
To fill key roles with the right people, awardees realized they needed more rigorous interview processes. By fully disclosing to candidates all the positive and negative aspects of the position, both in the job descriptions and in the interviews, awardees envision being able to find and better retain appropriate candidates
To protect against burnout, awardees concentrated on improving working conditions and opportunities. Awardees argued that positions should be marketed as careers and offer opportunities for advancement and competitive salaries. They also had to be mindful of staff needs for self-care and peer support during stressful periods
