National Evaluation, Healthy Communities Access Program

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National Evaluation, Healthy Communities Access
Program

• Charles Daly
• Amisha Pandya
• Division of Clinical Quality
• Data Branch/BPHC/HRSA

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Key Points

• Opportunity to demonstrate
• that funding community coalitions is a sound
  alternative to a silo funding approach
• the importance of effective services integration
  and coordination to the health care safety net
• Success depends in large part on your voluntary
  cooperation in providing information
• An exceptional evaluation team is working on very
  short timelines to help you tell your story

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Background

• National evaluation of HCAP required by P.L.
  107-251
• Report to Congress Sept. 2005
• Final report Sept. 2006
• Report to describe success of funded projects in
• Improving effectiveness, efficiency, and
  coordination of services for uninsured and
  underserved
• Providing better quality health care
• At lower cost than in the absence of projects

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Development

• Coordinated with program and grantees in
  developing evaluation design
• Evaluators meetings in June and Dec. 2003
• Progress described in All Grantees meeting
  January 2004
• Highly structured approach
• HCAP objectives
• Reported grantee activities
• Performance measures, outputs and outcomes
• Tools used by grantees
• Information used to design hypothesis and
  questions in scope of work

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Evaluation Design - HCAP Objectives

• Coordination/collaboration
• Effectiveness e.g., integrated services
  activities to improve access
• Efficiency e.g., services expansion
• Quality e.g., disease management, provider and
  patient satisfaction

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Evaluation Design - HCAP Objectives

• Potential cost savings from health system
  improvements
• Sustainability
• - Leveraging funds
• - Financial/in-kind support (partners,
• outside sources)
• Increase public awareness of safety net

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Design hypotheses and questions
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Design hypotheses and questions
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The Study

• Major features of the evaluation
• - two phases
• - multi-faceted (quantitative and
• qualitative)
• - minimizes new primary data collection,
  sensitive to grantee reporting burden
• - recognizes diversity of grantee
• characteristics

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Evaluation Design Key Considerations

• Keep major objectives at forefront
• Unique mechanism to fund consortia
• Integrate information from all sources
• Focus on uninsured/underserved
• Enrollment in public health insurance, plans
• Improved access to care

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Evaluation Design Key Considerations

• Capture all major results
• e.g., changes in legislation, regulation
  improved patient outcomes
• Demonstrate systems, quality of care
  accomplishments and savings

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Implementation

• Related activities
• Data validation and editing (JSI)
• National evaluation (NORC)
• Moving on fast track to meet timelines
• JSI contacted grantees in October to include
  accurate data
• NORC evaluation instruments to be fielded
  starting in January, 2005

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Multi-faceted Approach to Data

• Data sources
• - 6 month reports ( all cohorts 9/00 through
  9/03 grantees --- legacy reports revised reports
  for recent grantees)
• - applications and baseline data
• - closeout reports
• - provider and project directors survey, leader
  discussions, focus groups, case studies
• - administrative safety net data (e.g. HCUP,
• ambulatory sensitive conditions, ER use)

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What we hope to learn from data collection

• Survey of Providers
• Members perspectives on--
• Role in consortium
• Changes in service delivery as part of consortium
• Long run impact on community
• Project Director Survey
• Views on program structure and funding
• Assessment of effectiveness of collaborative
  approach
• Usefulness of funding the safety net
  infrastructure
• Potential changes/improvements

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Focus of data collection, cont.

• Discussions with Consortia Leaders
• What are key factors in success and major
  obstacles?
• Expand on content from surveys
• Evolution of consortium, role of prior funds
• Role of organizational structure
• Keys to sustainability
• Focus on lessons learned in specific activity
  areas
• Select consortia based on key activities
• Individually tailored protocol

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Evaluation Design Goals, measures, data
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Contractor Contacts with HCAP Grantees

• Data validation and editing
• Provider survey
• To all provider types for all consortia
• Mail survey with telephone follow up
• Project Director questions
• Web-based
• Key informant Discussions
• Client focus groups

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Timelines

• Activity Planned dates
• Discussions with 25-30 consortia
• leaders 1/15/05 - 4/29/05
• 3-5 client focus groups 2/2/05 - 4/29/05
• Project Director questions 5/03/05 -
  5/28/05
• Safety net provider
• survey 5/03/05 8/26/05
• Due Dates
• Phase 1 Report to Congress Sept. 16, 2005
• National evaluation report Aug. 25, 2006

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Timelines Key Items

• OMB Approval required for provider survey
• Provider survey fielded after approval
• Congressional report due date
• Flexibility to complete the evaluation

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NORC Our Evaluation Contractor

• Principal Investigator
• Claudia Schur, Ph.D
• 7500 Old Georgetown Road, Suite 620
• Bethesda, MD 20814
• 301-951-5072 (voice)
• 301-951-5082 (fax)
• schur-claudia_at_norc.org
• Team Resources
• Survey Research (CODA)
• Safety Net Studies (NYU/Rutgers)
• Dissemination (Project Hope)

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Bureau Staff Contacts

• Charles Daly CDaly2_at_hrsa.gov
• 301-594-5110
• Amisha Pandya APandya_at_hrsa.gov
• 301-594-3724
• Diana Koorkanian-Sauders
• DDerKoorkanian_at_hrsa.gov
• 301-594-4113
• Sheri Downing-Futrell
• SDowningFutrell_at_hrsa.gov
• 301-594-4468