Appendix A. Additional Detail on Round 2 and 3 Interviews
Round Two. The second round
of interviews sought a better understanding of (1) the location of the
Collaborative lead and other participating staff within each organization; (2)
how top leadership viewed the Collaborative in the context of broader
organizational goals and any differences in views across units of the firm; (3)
the firm context with respect to gathering self-reported data on race and
ethnicity and using it to assess racial and ethnic disparities among members;
(4) the experience of firms participating with RAND in geocoding and surname
analysis; and (5) additional feedback on firms' experience with the
Collaborative to date.
We conducted 54 round two interviews with 60 people—an average
of about 6 interviews per firm and at least 5 interviews with each firm except
one that limited its participation to a group interview with the three staff
members most closely involved with the Collaborative.1 Most firms were
extremely helpful in supporting our interview requests. We were able to
interview many of the staff specified in the protocol along with a few others
(fewer than 5 of the 54) recommended by staff because of their perceived
relevance.2
While we succeeded in interviewing many of the staff types called for in the
evaluation plan, we were more consistently able to interview those most closely
involved in the Collaborative than others. In addition, the executives
interviewed were more likely to represent the clinical side of the organization
than health plan administration. This means that while we gained insight into
marketing, legal, and information technology (IT) issues, we were often not
able to interview staff specifically responsible for these functions.3 In about half
the firms, we succeeded in gaining access to the most senior executives,
including the CEO of a national firm and several medical or operations
directors. In the other half, we were told that executives viewed the staff we
were interviewing (who were senior) as capable of adequately conveying their
concerns. Though disappointing, the responses seem understandable given the
demands on executives' time.
In addition to telephone interviews, we planned to collect two
other types of data in round two. To provide feedback on communications within
the network, we asked each of the nine participating firms and six support
organizations/sponsors to complete a structured worksheet that elicited
feedback on both the Collaborative overall and the contribution of diverse
organizations. We planned to complement this with a request that firms
complete a data capabilities worksheet to provide better insight into baseline
and current capabilities in collecting self-reported racial and ethnic data for
members. However, we dropped this component because of the potential burden
and conflict with competing pressures on firms in the Collaborative,4 along with our growing
recognition that most firms had only collected race and ethnicity for a very
small proportion of their commercial members. (Firms can get limited racial
and ethnic data for Medicare and Medicaid members directly from those
purchasers.) Instead, we captured general insights into the topics covered by
that worksheet as part of the interviews we conducted.
Round Three. The third round of interviews sought a
better understanding of (1) how top leadership viewed the firm's commitment to
disparities and their overall perspectives of the Collaborative; (2) the
specific pilot initiatives carried out by the firms to address racial and
ethnic disparities among their members; and (3) the experiences and
perspectives of firm staff working with GMMB to address communications issues
related to the work of the Collaborative. The more limited scope of inquiry
in round 3—and the recognition that firms were hesitant to spend substantial
time responding to questions—led to fewer interviews in round 3 than round 2.
In this round, we conducted 23 interviews with 26 people; one
firm opted not to participate.5
We conducted an average of approximately three interviews per participating
firm.6
We interviewed the lead contacts from all eight firms participating in the
round 3 interviews. To learn about the pilot activities, we interviewed
additional staff involved in the pilot initiatives from five of the firms; the
other three firms either had no clear pilot activity or the lead contact said
that they could provide the information we needed about it. In addition, we
interviewed firm staff involved in the Collaborative's communications work at
seven of the eight firms.7
Although we wanted to re-interview the same senior executives we talked with in
round two, we were able to do so in only about half the firms. The others
typically believed that their senior executives had provided their views
earlier so talking to them again when they had many demands on their time was
not a priority.
1. Of the other eight firms, we conducted five interviews with two firms, six
interviews with one firm, seven interviews with three firms, and eight
interviews with two firms. With one exception, we conducted fewer interviews
with national firms than local/regional firms, although the overall level of
cooperation among all of these firms was high.
2. Typically, staff had responsibility for diversity issues within the firm, often
related to the firm's workforce objectives. As discussed in Chapter III, the
interviews illustrated that, beyond their care delivery function, the firms
involved in the Collaborative are major employers and, as such, have an
interest in the diversity of their workforce and their ability to contribute
towards broader community goals related to diversity.
3. Among the nine firms, we were able to interview the marketing designee in three
firms and the legal designee in three firms. IT interviews typically took
place with staff involved in geocoding and surname analysis. We were less
successful in talking to staff with overall responsibility for IT within the
firm. Gaps in marketing and IT interviews appear to reflect competing demands
on these staff. Gaps in legal interviews reflect the difficulty of persuading
firms to identify staff appropriate to respond to the legal issues related to
disparities.
4. CHCS, for example, had just asked firms to respond to a survey on their capacity
to provide common HEDIS measures.
5. Firms felt it was burdensome to respond to multiple requests for interviews,
particularly after round 2 when substantially more interviews were requested.
Also contributing to this feeling, firms typically did not distinguish between
requests from the evaluation team and those from support organizations.
6. Of the other eight firms, we conducted one interview with one firm, two
interviews with one firm, three interviews with four firms, and four interviews
with two firms.
7. Five of the firms utilized staff from their communications/public relations
divisions as the primary communications contact for the Collaborative. For one
firm, the communications contact was also the staff member managing the
day-to-day work related to the firms' disparities initiatives. We also found
that one firm was in the process of hiring a new communications staff member
(the former communications contact for the Collaborative left the firm a few
months prior to our round three interviews), but the lead contact for that firm
was moderately involved in the communications work and was able to speak to the
firm's communications activities and perspectives.
Return to Contents
Proceed to Next Section
540 Gaither Road Rockville, MD 20850