1. RTI International RTI International is a trade name of Research Triangle Institute. www.rti.org MAPCP PCMH-CAHPS Surveys September 10, 2014 Presented by Kevin Smith

2. RTI International 2 Objective  To determine how experiences reported by beneficiaries in MAPCP demonstration practices compare to national averages in 6 key domains

3. RTI International 3 CAHPS Survey Design  Sample frame: Random sample of beneficiaries assigned to MAPCP demonstration practices who had had made at least one visit in previous quarter  Practice name inserted in first survey question  Medicare beneficiaries only  Mail surveys: initial and follow-up 3 weeks later  Initial mailing = 1,463 beneficiaries per state  Target = 512 completed surveys per MAPCP state  Surveys conducted in April and May 2014

4. RTI International 4 CAHPS Survey Design  Rhode Island exception : * Administered PCMH-CAHPS to all practices in March * Obtained completed surveys for all 65+ beneficiaries

5. RTI International 5 PCMH-CAHPS – 12-month version 6 Multi-item Composites: 1)Access to care (5 items) 2)Communication with Providers (6 items) 3)Office Staff Interactions (2 items) 4)Comprehensive Orientation (3 yes/no items) 5)Self-management Support (2 yes/no items) 6)Shared decision-making (3 items)

6. RTI International 6 Composite Score Analysis  All composites converted to 0-100 scores (higher scores more favorable) Two weighting adjustments: Response propensity Case-mix (age, education, health status) Computed mean score and SE for each composite Compared MAPCP means to two PCMH-CAHPS standards: 1. CAHPS Database (320 practices reported to Westat) 2. MA Health Quality Partners Study (MHQP; 1,790 patients)

7. RTI International 7 Response Rates  Response rates were very similar across states  Beneficiaries least likely to complete surveys: age < 65 years and Medicaid eligibles StateResponse Rate (%) # Completed ME46.2643 MI42.6599 MN43.3602 NC45.3634 NY44.6630 PA41.6584 RI46.1544 VT44.3627

8. RTI International 8 Access to Care Composite

9. RTI International 9 Communication with Providers Composite

10. RTI International 10 Shared Decision-Making Composite

11. RTI International 11 Self-Management Support Composite

12. RTI International 12 Comprehensive Orientation Composite

13. RTI International 13 Office Staff Composite

14. RTI International 14 Summary  Response rates higher than projected  Many MAPCP composite scores fell between MHQP and CAHPS Database standards  MAPCP state scores were generally comparable to the composites from the CAHPS Database:  17 scores significantly lower  18 scores no significant difference  13 scores significantly higher  Best comparative performance for: Self-Management Support and Comprehensive Orientation  Worst comparative performance for: Access to Care and Shared Decision-Making