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MA DSRIP TA ACO/CP Final Annual Report Form

Thank you for completing your MA DSRIP TA Project final 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. ACO/CP Name: *This question is required.

2. TA Project Title *This question is required.

3. Please identify the person in your ACO or CP who is directly accountable for the progress and successful completion of the requested TA. *This question is required.

Name
Title
Organization
Email
Phone Number

4. TA Vendor who is providing this TA: *This question is required.

5. Please identify the TA Card year to which this TA project corresponds. *This question is required.

6. Have you achieved the TA Project milestones outlined for this reporting period (July 1-December 31)? *This question is required.

Why have you not met the TA Project milestones for this reporting period (July 1-December 31)? Please answer in as little or as much detail as you deem necessary. *This question is required.

7. Are you on budget for this reporting period (July 1-December 31)? *This question is required.

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.

8. How would you rate your experience with your TA Vendor during this reporting period (July 1-December 31)?

9. Optional: Please provide any additional information to explain your response.

10. What are the identified competency areas that this project was intended to strengthen? In what ways did the project succeed in strengthening these competency areas? If one or more of the competency areas were not strengthened, please explain. (Max 2-3 sentences)

11. Were there any unexpected benefits associated with pursuing this project? Did the experience of working on this project shift your thinking related to your broader ACO or CP efforts? If so, please explain.

12. Optional: Please provide any recommendations that you have to improve the TA Program.

13. Would a conversation with MassHealth and Abt (the Managing Vendor) be helpful at this time?