Nine States’ Use of Learning Collaboratives to Improve Children’s Healthcare Quality in Medicaid and CHIP

Devers K, Foster L, Brach C
Publication Year: 2013
Patient Need Addressed: Care Coordination/Management
Population Focus: Medicaid beneficiaries
Demographic Group: Child
Intervention Type: Education
Study Design: Other Study Design
Type of Literature: White

We examine quality improvement (QI) collaboratives underway in 9 states participating in the Children’s Health Insurance Program Reauthorization Act (CHIPRA) Quality Demonstration Grant Program. A total of 147 diverse, child-serving practices were participating in the collaboratives. We conducted 256 semi structured interviews with key stakeholders from March to August 2012—2 years into the 5-year demonstration projects—and analyzed states’ grant applications, operating plans, and progress reports. The collaboratives have multiple complex aims. In addition to developing patient-centered medical home (PCMH) capability, some states use collaboratives to familiarize practices with CMS’s Initial Core Set of Children’s healthcare Quality Measures, practice-level quality measurement, and improving QI knowledge and skills. The duration of the collaboratives is longer than other well-known collaborative models. Collaboratives also vary in their methods for targeting areas for improvement and strategies for motivating practice recruitment and engagement. States also vary with respect to the other strategies they use to support QI and PCMH development. All states supplement the collaboratives with practice facilitation; the majority utilized practice-level parent engagement, but only 4 used workforce augmentation (i.e., providing care coordinators and QI specialists). Practice staff highly valued aspects of the collaboratives and supplemental strategies, including the opportunity to work with experts and other child-serving practices; states’ efforts to provide stipends and align demonstration efforts with other professional requirements or programs; receipt of relevant, customized QI materials; opportunities to learn how care coordinators or QI specialists might work in their practice without the risk of hiring them; and satisfaction from learning more about quality measures, QI concepts and techniques, critical medical home components, and how to identify PCMH capacity and performance gaps. However, practice staff also reported a variety of challenges, including difficulty learning from other practices that have very different preexisting QI and PCMH capacity and patient populations, or that are working on different topic areas and measures; a sometimes overwhelming amount of materials and ideas covered during in-person meetings; difficulty keeping up with Webinars, calls, and Web sites/blogs; and trouble motivating and sharing information with other practice staff not attending collaborative activities. As the demonstration projects continue, states and the national evaluation team will learn more about how best to use collaboratives and complementary strategies to support child-serving practices in QI and PCMH development. States will also search for ways to sustain and spread these activities after the demonstration ends, if they prove effective.

Insights Results

Overview of model

  • Evaluation results come from interviews with 256 staff involved with implementing the demonstration grant and the state’s quality improvement (QI) activities, clinical and administrative staff at participating practices and representatives of child advocacy organizations/ child-serving state agencies

    Key takeaways/implications

    • Themes of Children’s Health Insurance Program Reauthorizations Act of 2009 (CHIPRA) learning collaboratives: 1) All collaboratives aimed to improve practice standing as a PCMH; 2) Many attempted to familiarize practices with CMS’s initial Core Set of Children’s healthcare Quality Measures for Medicaid and CHIP; 3) Commonly used webinars, blog posts, semi-annual in-person meetings; and 4) Focused on setting clear and measurable targets
    • Perceived strengths of collaboratives: 1) Opportunities to work with experts and other child serving practices; 2) States’ efforts to provide stipends and align demonstration efforts with other professional requirements; 3) Receipt of relevant QI materials; and 4) Opportunities to learn about care coordination, PCMH elements and quality improvement techniques
    • Perceived challenges: 1) Difficulty learning from other practices with dissimilar QI and PCMH capacity and patient populations; 2) Sometimes overwhelming amounts of materials given during in-person meetings and webinars; and 3) Difficulty keeping up with webinars/blogs/calls given time demands, practices report that even with stipends and workforce augmentation, full participation in in QI collaboratives can be taxing
    • These findings suggest that state Medicaid and CHIP agencies should partner with other payers and change agents to continue QI strategies (e.g., enter into multiplayer collaboratives, engage with the ACA’s Primary Care Extension Program)