HCIA Evaluations: Primary Care Redesign

In July 2012, the Center for Medicare & Medicaid Innovation (CMMI), an operational unit within the Centers for Medicare & Medicaid Services (CMS) created by the Patient Protection and Affordable Care Act, awarded cooperative agreements to 107 programs proposing innovative ways to improve the quality and lower the cost of care for Medicare, Medicaid, and Children’s Health Insurance Program enrollees. One focus area of these innovations—primary care redesign—seeks to increase and improve the performance of the primary care workforce through enhanced training and education, and to rethink the roles and functions of different types of health care workers. Some of the programs seek to integrate behavioral health into primary care.

CMMI contracted with Mathematica to evaluate the 14 primary care redesign programs, which operate at different levels (that is, physician practices, hospitals, or health systems). The evaluation team assessed improvements in the coordination, efficiency, and quality of patient care. In addition, the evaluation had secondary goals of understanding the development, implementation, and reach of programs; explaining the relationships between program and beneficiary characteristics, delivery systems change, and observed outcomes; describing workforce development and staff training programs; describing providers’ experiences in the programs; and estimating the impact of programs on quality of health care, use of services, and costs.

The evaluation consisted of a mixed-methods approach including implementation analysis informed by telephone interviews with program administrators and in-person discussions with frontline staff; assessment of the perceptions of primary care providers of the program’s impact on the quality, timeliness, and other aspects of the care they provide to patients through two rounds of a web-based primary care clinician survey and metrics from the program about whether specific anticipated changes occurred; and an impact analysis of Medicare and Medicaid claims-based core outcome measures. These three evaluation components have been specifically adapted to each program’s unique characteristics.