Texas Medicaid 1115 Waiver Evaluation

The Healthcare Transformation and Quality Improvement Program (Program) aims to improve access to health care, increase quality of care, and reduce costs of care by expanding Medicaid Managed Care, revising the Uncompensated Care (UC) system, and creating a Delivery System Reform Incentive Pool (DSRIP). Given the geographic vastness of the State of Texas, as well as the diversity of the populations in different areas of the state, the Texas Health and Human Services Commission (HHSC) elected to implement the UC and DSRIP portions of the Program by facilitating the creation of 20 Regional Healthcare Partnerships (RHPs). The RHPs serve as a mechanism to plan, implement, and track DSRIP projects. In many cases, the counties and subsequent agencies and providers comprising these RHPs have worked together previously in varying capacities; however, as the RHP regions do not reflect exact boundaries of other service region designations, new stakeholders were likely introduced as well.

Through the RHPs, the Program seeks to create collaborative environments for providers to achieve improved system performance. In the Program, Upper Payment Limit (UPL) funds have been replaced with a UC pool, and hospitals must now participate in RHPs to access those funds. Hospitals and other participating providers may also earn DSRIP for collaborative projects designed to improve system performance in various specific ways approved by HHSC and the Centers for Medicare & Medicaid Services (CMS). Such DSRIP activity is expected to improve access to preventive care; improve quality, health, and cost outcomes for the populations served by specific projects; and improve regional health and human service delivery capacity through enhanced collaboration.

To evaluate the Program, we will assess the following questions. Below these questions are reordered from that in the CMS-approved evaluation plan to a sequence that we believe reflects the Program’s implicit theory of change, from system restructuring to delivery innovation to improved health and cost outcomes:

What are stakeholders’ experiences and perceptions about the implementation and effectiveness of the Program, and what are their recommendations for improving it in the future? (Evaluation Goals 10 & 11; STC 69.a.v)

  1. Did the Program increase collaboration among entities that comprised the RHPs? (Evaluation Goal 9; STC 68.a.iv)
  2. Did DSRIP projects improve value (cost, quality, health outcomes)? (Evaluation Goals 6,7 & 8; STC 68 a.iii)
  3. Did participation in DSRIP projects change the trajectory of UC, the other part of the former UPL pool? (5; STC 68.a.iv)

Official 1115 Waiver Website
Some interesting data visualization on the Wavier from the Texas Tribune

TAMHSC School of Public Health, Health Policy and Management

University of Texas School of Public Health, Management, Policy and Community Health

University of Louisville, School of Public Health

  • Faculty & Staff
    • Monica Wendel (PI)
    • Liza Creel (co-PI)

Collaborators: TX HHSC Strategic Decision Support (SDS) Members

  • Sarah Roper-Coleman
  • Tenaya Sunbury
  • Angie Cummings
  • Amy Hess

Project CV

Presented in chronological order
Last updated: June 30, 2015

Refereed Presentations:

  • Roper-Coleman S. & Sunbury, T. Summary of the Texas Healthcare Transformation and Quality Improvement Program: a section 1115(a) waiver demonstration. American Evaluation Association, Washington, DC, Oct 16-19, 2013. (Oral)
  • Sunbury, T. & Roper-Coleman, S. Evaluation Design and Analytic Methodology of Texas’ 1115 Medicaid Demonstration Waiver Evaluation: Expanding Medicaid Managed Care Statewide. American Evaluation Association, Washington, DC, Oct 16-19, 2013. (Oral)
  • Wendel M.L. Designing an evaluation for the delivery system reform incentive program supported by Texas’ 1115 Medicaid demonstration waiver. American Evaluation Association, Washington, DC, Oct 16-19, 2013. (Oral)
  • Sunbury T., Kum H., Ghaffari A., & Gregory S. Building an efficient hybrid human machine system for ongoing record linkage. Academy Health Annual Research Meeting, San Diego, CA, Jun 8-10, 2014. (Poster)
  • Cummings, A., Sunbury, T., & Roper-Coleman, S. Using quality measures to monitor and evaluate the impact of pharmacy carve-in implemented through an 1115(a) demonstration waiver: The Texas healthcare transformation and quality improvement program. American Public Health Association, New Orleans, LA, Nov 15-19, 2014. (Poster)
  • Roper-Coleman S., Wendel, M., Wells, R., Sunbury, T., & Cummings, A. A pragmatic approach to guide the design of a mixed methods evaluation of a Medicaid 1115(a) waiver: The Texas healthcare transformation and quality improvement program. American Public Health Association, New Orleans, LA, Nov 15-19, 2014. (Oral)
  • Sunbury, T., Roper-Coleman, S. & Cummings, A. Applying health service utilization models to the Texas Healthcare Transformation and Quality Improvement Program: Advancing theory-based evaluation. American Public Health Association, New Orleans, LA, Nov 15-19, 2014. (Round table)
  • Sunbury, T., Roper-Coleman, S. & Cummings, A. Texas Healthcare Transformation and Quality Improvement Program: Impacts of Medicaid policy change on quality of care for aged and disabled population. American Public Health Association, New Orleans, LA, Nov 15-19, 2014. (Oral)
  • Ghaffari, A. Wells, R., Armstrong, T., Creel, L., Kum, HC, Brossart, D., Roper-Coleman, S., Sunbury, T. Applying relational coordination to inter-agency teamwork and patient experiences with providers. Oral presentation at Organizational Theory in Health Care Conference, Richmond, VA, May 27-29, 2015 (Ghaffari presenting – doctoral students).
  • Wendel M, Creel L, McMaughan D, Roper-Coleman S, Cummings, A. Transforming the health care system: implementation strengths and challenges in Texas’ Healthcare Transformation and Quality Improvement Program 1115(a) Medicaid Waiver. Academy Health 2015 Annual Research Meeting, Minneapolis, MN, Jun 11-16, 2015. (Poster)
  • Wendel M, Creel L, Wells R, Gregory S, Roper-Coleman S, Cummings, A. Using network analysis to understand regional differences in collaboration resulting from the Texas 1115(a) Medicaid Waiver. Academy Health 2015 Annual Research Meeting, Minneapolis, MN, Jun 11-16, 2015. (Poster)
  • Tamayo L, Kum HC, Wells R, Du Y, Roper-Coleman S, Sunbury T. Health Status and Health Experience Among Adult, Hispanic, Frequent ED Users. AcademyHealth 2015 Annual Research Meeting, Minneapolis, MN, Jun 11-16, 2015. (Poster)
  • Ghaffari, A. Wells, R., Armstrong, T., Creel, L., Kum, HC, Brossart, D., Roper-Coleman, S., Sunbury, T. Applying relational coordination to inter-agency teamwork and patient experiences with providers. Poster Presentation at 2015 AcademyHealth Annual Research Meeting: Minneapolis, MN.
  • Wendel, M., Creel, L. Wells, R., Roper-Coleman, S., Sunbury, T.  Using network analysis to measure changes in local collaboration resulting from implementation of the Texas Healthcare Transformation and Quality Improvement Program. APHA Annual Meeting and Exposition, Chicago, IL, Oct 31 – Nov 4, 2015. (Oral, Wendel/Creel presenting)
  • Wendel, M., Creel, L., McMaughan, Roper-Coleman, S., Cummings, A. Stakeholder Perceptions of Strengths and Challenges in Texas’ Healthcare Transformation and Quality Improvement Program. APHA Annual Meeting and Exposition, Chicago, IL, Oct 31 – Nov 4, 2015. (Oral, Wendel/Creel presenting)

Non-refereed Local Presentations:

  • Wendel M.L., Wells R., & Gregory S. Intervention II evaluation design. Presentation to the 2013 Evaluation Work Group, Austin, TX, Sept 9, 2013.
  • Wells R. Evaluation of regional healthcare partnerships within the healthcare transformation and quality improvement program. Presentation to the HHSC Executive Waiver Advisory Committee, Austin, TX, Jul 11, 2013.
  • Roper-Coleman, S. Evaluating the delivery system reform incentive program supported by Texas’ 1115 Medicaid demonstration waiver, Presentation to Regional Health Partnership 15 representatives, El Paso, TX, Jan 22, 2014
  • Wells R. Evaluating the delivery system reform incentive program supported by Texas’ 1115 Medicaid demonstration waiver, Presentation to Regional Health Partnership 15 representatives, El Paso, TX, Jan 22, 2014.
  • Roper-Coleman S, & Wells R. Evaluating the 1115(a) demonstration waiver – healthcare transformation quality improvement program. Presentation to the Texas Diabetes Council, Apr 24, 2014.
  • Wendel M, Creel L. Evaluation of the Texas Healthcare Transformation and Quality Improvement Program: 1115(a) Medicaid Demonstration Waiver. Presentation at the Statewide Learning Collaborative Summit, Sept 10, 2014.