Evaluation of Health Care Innovation Awards (HCIA): Primary Care Redesign Programs, Second Annual Report, Volume I: Synthesis Report

Evaluation of Health Care Innovation Awards (HCIA): Primary Care Redesign Programs, Second Annual Report, Volume I: Synthesis Report

Published: Mar 30, 2016
Publisher: Princeton, NJ: Mathematica Policy Research
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Associated Project

HCIA Evaluations: Primary Care Redesign

Time frame: 2013-2017

Prepared for:

U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services

U.S. Department of Health and Human Services, Center for Medicare & Medicaid Innovation

Authors

Lorenzo Moreno

Greg Peterson

Catherine DesRoches

Emily Ehrlich

Lauren Hula

Rachel Shapiro

KeriAnn Wells

Kate Stewart

Frank Yoon

Key Findings

Key Findings:

  • Eleven awardees implemented a care coordination innovation component; 10 used care management; nine focused on care transitions innovations; seven implemented patient-centered care innovations; and six used health information technology innovations.
  • Adaptability of program components to the local context is critical to overcoming implementation challenges and maximizing implementation effectiveness. Staff and stakeholder engagement were central to the success of the implementation process. Finally, impediments to implementation effectiveness were health IT and challenges serving high-risk patient populations.
  • The first round of a clinician survey suggests significant variation in clinician experiences with and attitudes toward the HCIA awards. Despite this variation, a majority of clinicians anticipated the award would have a positive effect on patient care. However, many clinicians experienced the program implementation as burdensome in terms of the amount of time and documentation required.
  • Four awardees had impacts that are substantively important and favorable, but only two awardees had statistically significant impacts in at least one outcome domain. For the rest of the awardees, one had substantively important unfavorable impacts in one domain; three had indeterminate effects in all domains analyzed; and for two no conclusions could be drawn.

The Health Care Innovation Awards (HCIA) initiative is a central part of the Center for Medicare & Medicaid Innovation’s (CMMI) overall objective of finding effective and efficient ways to achieve better quality of care, improved population health, and lower costs. CMMI classified 14 of the 108 HCIA Round 1 awards as primary care redesign (PCR) programs. Together, they represent a broad range of intervention models, target populations, organizational settings, and health care markets. Our evaluation approach examines the PCR programs across four key areas of inquiry: (1) effectiveness of program implementation, (2) workforce development, (3) program effects on clinicians’ behavior, and (4) program effects on patients’ outcomes.

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