How are States and Evaluators Measuring Medical Homeness in the CHIPRA Quality Demonstration Grant Program?

The CHIPRA Quality Demonstration Grant ProgramIn February 2010, the Centers for Medicare & Medicaid Services (CMS) awarded 10 grants, funding 18 States, to improve the quality of health care for children enrolled in Medicaid and the Children’s Health Insurance Program (CHIP). Funded by the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA), the Quality Demonstration Grant Program aims to identify effective, replicable strategies for enhancing quality of health care for children. With funding from CMS, the Agency for Healthcare Research and Quality (AHRQ) is leading the national evaluation of these demonstrations.The 18 demonstration States are implementing 51 projects in five general categories:• Using quality measures to improve child health care.• Applying health information technology (IT) for quality improvement.• Implementing provider-based delivery models.• Investigating a model format for pediatric electronic health records (EHRs).• Assessing the utility of other innovative approaches to enhance quality.The demonstration began on February 22, 2010 and will conclude on February 21, 2015. The national evaluation of the grant program started on August 8, 2010 and will be completed by September 8, 2015. The National Evaluation of theCHIPRA Quality Demonstration Grant ProgramHow are States and evaluators measuring medical homeness in the CHIPRA Quality Demonstration Grant Program? Evaluation Highlight No. 2, May 2013KEY MESSAGESSelecting a tool for assessing medical homeness is critical for implementing and evaluating efforts to enhance medical homes for children. The experiences of the demonstration States provide important lessons for other medical home initiatives. • CHIPRA demonstration States selected different assessment tools based on a variety of factors, including other medical home activities in the State, the target population for the medical home intervention, and properties of the tools themselves.• The MHI-RSF provides a low-burden option for collecting valid and reliable information on medical homeness for child-serving practices.• The MHI-RSF indicates that medical homeness varied across intervention practices in six States at baseline and suggests the opportunity for significant improvement as a result of the demonstrations.• The increased adoption of the MHI-RSF in child-serving practices across medical home demonstrations and evaluations could lead to improved generalizability of findings on the impact of medical homes on costs, quality, and outcomes. . Many State Medicaid and CHIP programs and private health plans are pursuing medical home initiatives in an effort to improve the quality of care for children and adults, but varying conceptual definitions and measurement goals have led to the development of a number of different medical home measurement tools. This Evaluation Highlight examines the measurement of medical homeness in selected CHIPRA Quality Demonstration Grant Program projects. It also describes the development of the Medical Home Index-Revised Short Form (MHI-RSF), an adaptation of the short version of the Medical Home Index (MHI), for use in evaluating the demonstration projects. Using baseline MHI-RSF data, we present preliminary statistics on medical homeness for demonstration practices in six States. Authors: Stacey McMorrow, Anna Christensen, Brenda Natzke, Kelly Devers, and Rebecca Peters Page 2How are States and evaluators measuring medical homeness in the CHIPRA Quality Demonstration Grant Program?Background The patient centered medical home (PCMH) model originated in the pediatric community and has seen renewed popularity in recent efforts to improve quality of care for children.1 The Agency for Healthcare Research and Quality (AHRQ) and several professional societies agree on the general characteristics of a medical home, which include accessible, coordinated, continuous, comprehensive, and patient-centered care.2 However, each concept can be defined differently across diverse clinics, practices, and patient populations, and as a result, many medical home assessment or recognition tools have emerged over time.3 Each tool includes unique questions to capture a given concept and places different emphasis on specific attributes. The use of different tools prevents “apples-to-apples” comparisons across demonstration projects, thus making any evaluation less useful for policymakers and researchers. Nonetheless, measurement of medical homeness—the extent to which a practice exhibits the attributes of a medical home—is critical to: 1. Evaluating whether demonstrations and pilots actually transform clinics and practices into medical homes.2. Understanding whether such transformations affect key health care outcomes such as access, quality, or costs. Twelve States are using CHIPRA Quality Demonstration Grant Program funding to design and implement PCMHs for child-serving practices, including pediatric and family practices and