View Research by Author - Kelly J. Devers

Kelly J. Devers, PhD, is a Senior Fellow in the Health Policy Center at the Urban Institute. She received her doctorate from Northwestern University and was a Robert Wood Johnson Scholar in Health Policy Research at the University of California, Berkeley and San Francisco. Her main areas of expertise are provider payment and competition, the organization and delivery of care, and their impacts on access, cost, and quality.

Dr. Devers' current research focuses on the implementation of national and state health policy reforms, particularly as they relate to patient-centered medical homes (PCMHs), accountable care organizations (ACOs), and related provider payment changes; hospitals' and medical groups' efforts to improve quality and efficiency through the use of electronic health records (EHRs), process redesign techniques (e.g., Lean/Toyota Production Systems, Six Sigma), and learning collaboratives; and, efforts to improve the quality of cancer care in community hospital based cancer centers.

She currently serves as the Urban Institute's project director for the Agency for Healthcare Research and Quality's (AHRQ) National Evaluation of CHIPRA Quality Demonstrations; the Office of National Coordinator?s (ONC) Global Assessment of HITECH programs; the Center for Medicare and Medicaid Services (CMS) Medicaid EHR Incentive Program Technical Assistance Contract; and, the evaluation of the National Cancer Institute?s (NCI) pilot of a Community Cancer Centers Program (NCCCP), which is testing the concept of a national network to expand cancer research and deliver the latest, most advanced cancer care to more Americans in their home communities.

She has published widely in major journals of health services research and policy, while also acting as a peer reviewer for federal and foundation grants, serving on editorial boards, editing a book and special journal issue, speaking widely, and in 2008-09 advising the presidential transition team.

Prior to joining the Urban Institute, Dr. Devers was an Associate Professor at Virginia Commonwealth University, and before her academic position, she worked at the Center for Studying Health System Change and the Agency for Healthcare Research and Quality.

Publications

This Evaluation Highlight is the first in a series that presents descriptive and analytic findings from the 18-state evaluation of the Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA)'s Quality Demonstration Grants. In this Highlight, we discuss the early accomplishments, challenges, and lessons learned from the following four States pursuing practice-level quality measurement: Maine, Massachusetts, North Carolina, and Pennsylvania. Our analysis is based on work completed by the States during the first two years of their five-year demonstration projects. These two years included a one-year planning period followed by a year of implementation.

The implementation of the Patient Protection and Affordable Care Act will profoundly impact cancer care. Its components will influence multiple levels of the health-care environment including states, communities, health-care organizations, and individuals seeking care. To illustrate these influences, two reforms are considered: 1) accountable care organizations and 2) insurance-based reforms to gather evidence about effectiveness. We discuss these reforms using three facets of multilevel interventions: 1) their intended and unintended consequences, 2) the importance of timing, and 3) their implications for cancer care and research. Successful implementation of multilevel interventions depends on understanding the political setting and goals of health-care reform.

In a March 2012 article in Health Affairs, a team of authors from the Urban Institute and Mathematica Policy Research finds that achieving ambitious goals for the adoption of electronic health records and the nationwide exchange of electronic health information will require overcoming a number of hurdles. First and foremost, providers and patients have to be persuaded of the value of exchanging information and have to be supportive of steps to make it possible. For example, there are broad concerns about the tradeoffs between sharing information electronically and safeguarding the privacy and security of patients’ health care data. A case in point: existing federal law provides for the use of a single identification number for every US patient, but Congress has blocked the use of federal funds to develop this ID system because of privacy concerns.

This report compares ten provider survey tools designed to measure the extent to which a practice is a 'patient-centered medical home' (PCMH). These tools are primarily used for recognition purposes (i.e., to qualify for entry into a payment pilot or demonstration), as opposed to for practice self-improvement, research/evaluation, or quality measurement. Our analysis, Our analysis, conducted for the Centers for Medicare and Medicaid Services, compares these ten tools' operational details (e.g., price, whether a site visit is required) and their content emphases (i.e., the different practice capabilities that the tools emphasize). We conclude by discussing issues for payers to consider when selected a PCMH recognition tool.

This policy paper by Kelly Devers analyzes the trend toward quality improvement (QI) efforts in health care, concluding that while QI alone is no magic bullet, it generally has modest, positive effects. The paper, funded by the Robert Wood Johnson Foundation, reviews the evolution of QI initiatives, the current evidence about whether QI interventions work, QI’s promise for the future, and how to help it find success in health care. The paper offers recommendations for enhancing QI, including by providing incentives for providers to prioritize quality; improving education, training, and technical assistance; investing in health IT; and promoting greater collaboration across organizations.

A number of states have used the flexibility of the Medicaid program to develop innovative payment and delivery systems designed to coordinate and improve quality of care. This brief, based on site visits from Nov. 2009 through March 2010, highlights care coordination and related efforts in five states: Alabama, Oklahoma, Oregon, Pennsylvania and Washington State. Such efforts by states to realign the provider payment and delivery systems are key to improving Medicaid and to successfully implementing coverage expansions under the health reform law.

This status report on the patient-centered medical home covers such topics as: What is a medical home? Where did the concept come from? How are medical homes assessed and paid? Do medical homes actually work? How does the health reform law encourage medical homes? The paper, funded by the Robert Wood Johnson Foundation, concludes that the medical home model has the potential to transform health care delivery, but organizations promoting the model should tread carefully because enthusiasm for the approach may not be borne out in evidence of success. Pilots should be completed and evaluated, and the model should be recalibrated before it is broadly expanded.

This American Journal of Preventive Medicine article presents findings from a cluster randomized controlled trial aimed at determining whether smoking cessation support in practices is enhanced by the use of telephone quitlines. The study found that a systems approach to identifying smokers, advising and assessing readiness to quit, combined with partnership with a quitline, increased delivery of cessation support for primary care patients by 12.5% beyond that accomplished by traditional tobacco-use vital sign screening alone. The increase in cessation was more pronounced with patients aged 35-54 years and with male and more experienced clinicians.

This Health Services Research article describes how administrative and health records (including electronic medical records) can be linked for comparative effectiveness and health services research, using cancer care research to illustrate points. The article notes challenges that may be encountered in the linkage process, and advocates fostering collaboration among institutions, researchers, and public and private components of the health care sector to ensure that data collected for clinical and transactional purposes can benefit the research community and, ultimately, the patient population.

This American Journal of Preventive Medicine article presents findings from a mixed-methods study conducted in 2005 to understand patient perspectives on colorectal cancer screening. Responses to a mailed survey identified fear and the bowel preparation as the most important barriers to screening, while remarks by focus group participants exposed the intricacies of complex barriers -- such as fear, lack of information, time, the role of physicians, and access to care -- as well as barriers that have little documentation in the literature, such as low self-worth, "para-sexual" sensitivities, fatalism, negative past experiences with testing, and skepticism about the financial motivation behind screening recommendations.

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