DRAFT:
State Innovation Model Priority Decision Framework
Community Health Worker Initiative (January 31, 2014)
Selected
Innovation or
Intervention
What is This?
Can We Do This?
Reach
Should We Do This?
Can We Sustain Doing
This?
Consistent
Implementa-tion
Adoption
ASSESS
Implementation
Yes.
Continue.
Does it Matter to
SIM?
NO. STOP
Maintenance
Sustainability
Impact
Adapted from Re-AIM Guidelines for developing, selecting and evaluating programs/interventions
1
Effectiveness
Process of Filtering: Rate our Level of Confidence related to:
Quantify the
WHAT, WHO,
WHERE




WHAT IS THIS?
High Cost-who are the High utilizers? Where are they?
Geography—gaps in service?
Populations—highest priority? Will the intervention address the needs of more
than one high priority sub-populations? Can the program reach those most in
need and those most often left out?
Conditions—will the intervention be the most likely to arrive at the outcomes we
want (better health, cost containment, improved experience of care)
CAN WE DO THIS?
YES
ADOPTION








Are there concerns about organizations/settings “taking up” or “fully embracing” the
planned innovation/intervention?
Are there early adopters or identified champions to the innovation/intervention?
Is there sufficient capacity and willingness among settings and organizations to adopt as
a test and after testing?
Is there confidence that the innovation/intervention will effectively reach those
organizations and settings who serve members of the target population with the highest
needs?
Is there a willingness to work with the identified target population(s)?
Is there a system in place to identify and overcome barriers that arise?
Is the implementation approach feasible for the identified organizations/settings (i.e.,
resources required, costs, expertise, time, etc.)?
Can the innovation/intervention be adopted by low-resource settings and the typical
staff who work with high-risk populations?
Solo “No” is a yes with acknowledgement that “taking up” will need to be embraced by
all partners in the healthcare system for post-testing stage. All other guiding questions
matched terms/expectations spelled out in RFP or plans for implementation and
monitoring of CHW Pilots.
Total
2
NO
X
X
X
X
X
X
X
X
7
1
REACH
YES


X
X


Is target population(s) adequately defined?
Are there barriers to reaching key segments of the target population (race/ethnicity,
gender, age, socio-economic, etc.)?
Will the innovation/intervention reach those most in need, most likely to benefit, and
most often left out?
Will innovation/program likely reach a substantial proportion (representative cross
section) of identified target population(s)?
All guiding questions match terms/expectations spelled out in RFP/monitoring process
for defining target population, connecting with those most in need, and capacity
/resources for reaching representative sample. Shared trait of CHW model and
community connections intentionally minimizes barriers.
Total
NO
X
X
4
0
EFFICACY-EFFECTIVENESS
YES
NO

X





Is there clarity on the outcomes that are anticipated to result from the
innovation/intervention?
Is innovation/intervention evidence supported or is it new (untested)?
Is there buy-in among stakeholders regarding the value and effectiveness of the
innovation/intervention?
Is there agreement among stakeholders on defining and measuring success?
Is the innovation/intervention likely to influence one or more SIM outcomes and
produce robust effects across multiple priority populations?
Does implementation have any adverse or unintended consequences, and if so, are they
minimal?
X
X
X
X
X
Yes responses match performance measures (outcomes) spelled out in RFP/monitoring 4
process. Stakeholder group convened for CHW Project share recognition of value and
effectiveness to inform development of infrastructure in Maine. Evidence base
including. ICER/CEPAC report is reference point for RFP as it relates to pilot
interventions. Unclear at this point whether intervention will produce robust effects
across multiple populations as pilots have not been selected . Total
YES
IMPLEMENTATION

Are there established implementation or practice guidelines associated with
innovation/intervention?
3
X
2
NO








Are the implementation procedures replicable across settings?
Can the innovation/intervention be delivered consistently during and after testing?
Can it be implemented consistently across different organizations programs and staff?
Are there sufficient resources to support consistent and effective implementation?
Are there any unintended consequences that may result from implementation?
Can we achieve a balance of flexibility and fidelity as data informs possible midcourse
corrections?
Is there an established infrastructure for data collection to monitor and document the
innovation/intervention implementation and outcomes?
Are there threats to consistent implementation and if so, are there plans to deal with it?
X
X
X
X
X
X
X
X
X
X
Well established practice guidelines and procedures to inform the intervention. Consistency 5
post-testing is dependent on resources. Organizational readiness and commitment to
implement CHW model with fidelity will be evaluated through RFP process. Resourcing for
CHW Pilots was based upon existing programming elsewhere. Evaluation plan, monthly
calls, site visits, mechanisms in place to inform midcourse corrections. ME-CDC lacks
infrastructure for data collection. Data and evaluation capacity of prospective pilots will be
assessed through RFP process. For Threats see above.
Total (2 Maybes)
2
CAN WE SUSTAIN DOING THIS?
CONSISTENT IMPLEMENTATION
YES

Is there confidence that the innovation/intervention can be maintained after the initial
testing period is complete?
Are there threats to maintaining consistent implementation and if so, are there plans to
deal with it?
Can the innovation/intervention be readily integrated into the regular practice of the
delivery organization(s)?
X
Focus on building infrastructure through the pilots is intended to support post-test
period. Monitoring process inclusive of minimizing threats to consistent
implementation. Screening for organizational readiness and commitment will be
accomplished during RFP review .
Total
3
0
YES
NO


MAINTENANCE/SUSTAINABILITY
4
NO
X
X



Are their solid plans for innovation/intervention sustainability? Can the level of
stakeholder buy-in be reflected in real financial and social capital for sustaining the
intervention?
Does the innovation/intervention include strategies to enhance long-term
improvements (i.e., follow-up contact, community resources, mechanisms for ongoing
feedback and support?
Is there a high likelihood of the innovation/intervention being sustained without
additional resources and leadership, etc.?
Is there a high likelihood of innovation/implementation becoming regular practice for
delivery organizations?
X
Buy-In exists through the high level of engagement amongst stakeholder group. Clearly,
national buy-in is well-established, less certain here in Maine. Shared learning and
project monitoring will be part of improvement process. Project will need to establish
feedback loop for grantees and stakeholder members. Purpose of pilots is to prove the
value proposition that CHWs can help achieve the triple aim, and that they are a cost
effective use of resources (i.e. can deliver better value than other potential uses of the
same resources) . If achieved that will lead to broader adoption, integration, etc.
Long term adoption of CHW model is contingent on adoption of payment reform and
willingness of payers.
Total (2 Maybes)
X
X
X
X
X
2
0
IMPACT
YES
NO

X



Is there a high likelihood that the innovation/implementation will produce long-lasting
effects /benefits to population members and participating organizations?
Is there confidence that the innovation/intervention will move the bar on health care
reform?
Is there a high likelihood that the innovation/ intervention will produce sustained
change in one or more of the SIM outcomes?
o Reduce the total cost of care per member per year in Maine to the national
average?
o Improve the health of Maine’s population in at least four categories of disease
prevalence (including diabetes, mental health, obesity, and tobacco use)?
o Improve patient experience scores for targeted practices by 2% from the
5
X
X
X
o
baseline 2012 survey?
Increase the number of practices reporting patient experience information from
50% to 66%?
YES
2
Pilots are focused on capacity building and their effects are intended to be long lasting for
participating organizations & others . Combination of ACA/CMS Rule Change and regional
and national activity efforts all focused on raising bar for CHWs in terms of recognition and
reimbursement. Maybe is reflection of stage of pilots, the SIM outcomes are integrated in
the RFP.
TOTAL( Maybe 1)
Grand Total (Maybes=5) 27
6
NO
0
5