MA DSRIP TA Vendor Quarterly Report Form

Thank you for completing your MA DSRIP Project quarterly report form. Please note that TA Project progress is assessed according to the Scope of Work (SOW) and budget approved by Abt Associates and MassHealth prior to the start of project work. Copies of these documents are on file with Abt/MassHealth; we will reference them as we review your report.

1. TA Vendor name: *This question is required.

2. Task order number: *This question is required.

3. TA project title: *This question is required.

4. Please identify the person at your organization who is directly accountable for the progress and successful completion of this TA project. *This question is required.

Name

Title

Organization

Email Address

Phone Number

6. Please identify the quarter to which this report applies (“this reporting quarter”). *This question is required.

7. Please describe in two to three sentences the TA that you provided to this ACO/CP during this reporting quarter. *This question is required.

10. What could be improved? *This question is required.

11. Why were the TA project milestones not met? Please answer in as little or as much detail as you deem necessary. *This question is required.

12. What is the reason for the variance from the anticipated budget? Please answer in as little or as much detail as you deem necessary. *This question is required.

13. Why do you anticipate that you will not achieve the TA project milestones outlined for the next reporting quarter? Please answer in as little or as much detail as you deem necessary. *This question is required.

14. Please provide any additional information to explain your answer.

15. Please provide a short list of your TA achievements – the outputs for the TA project. Include quantitative results, where possible (i.e., 50 Community Health Workers received cultural competency training). *This question is required.

15. Please note any known outcomes for the ACO or CP you worked with, based on the TA you provided. This could be knowledge they acquired, actions they took, changes they made, or other outcomes related to this TA project.
*This question is required.

15. Please share any additional experiences working with the ACO or CP. For example, any key learnings or insights about ACO or CP priorities, challenges, or anything else that could help inform future MA DSRIP TA Program activities.
*This question is required.

Thank you!