Funded by a grant from the Robert Wood Johnson FoundationThinking Ahead – Monitoring the Impactof Health ReformElizabeth L...
Presentation Overview• Why should states develop a monitoringframework (and why should Medicaid beinvolved)?• Steps to dev...
Today3
2015 and Beyond4Everyone will be clamoring for dataand analysis on the impact of healthreform• States will be looking to r...
Objectives for Generating aMonitoring/Evaluation Framework• Encourages agreement on goals,priorities, and how progress wil...
6o National surveys and analyses are a great, especiallywhen cross-state comparisons are important, but…• Each state will ...
Why Should Medicaid Play a Role?7• Medicaid is “where it’s at”– Even if you don’t plan for it, you will likely engage inev...
Why Now?• Define in advance what is important to measure –helps identify successes and problem areas• Establish a baseline...
Evaluation and MonitoringFramework Development Define scope Choose andoperationalize measures Select appropriate dataan...
Defining Scope10• Set focus– Medicaid only, all health reform activities (state and federal?)• Need to keep the number of ...
Choosing Measures• Keep the number of measuresmanageable - prioritize• Choose measures that are directlyrelated to policy ...
Operationalize the Measure• Create a working definition or preferred method forcalculating the measure– e.g., how do you c...
Select Appropriate Data1. Conduct a data scan2. Assess data againsta defined set ofcriteria3. Identify gaps4. Prioritize w...
Setting Benchmarks and Goals (or not)• Possible benchmarks– Change over time– Defined ideal– Other states– National averag...
Stakeholder Engagement• “Stakeholder” can be defined narrowlyor broadly• Stakeholders can be engaged at anypoint in the pr...
California - Approach• Led by the California HealthCare Foundation (work done by SHADAC)• Development of a set of measures...
California - Coverage Measures17Uninsured Public Coverage Employer CoverageDistribution of Insurance CoverageHealth Insura...
California - Affordability &Comprehensiveness of CoverageMeasures18Insurance PremiumsSubsidiesComprehensiveness Financial ...
California - Access to Care Measure19Individuals SystemUse of services Barriers to careHas usualsource of careDid not getn...
Maryland - Approach• Led by the Maryland Health Connection (work done bySHADAC)• Development of a set of measures to monit...
Maryland Approach - Continued• Considerations for measures selection– Drawn from data currently produced by other state ag...
Maryland -Measures22
Too Daunting? Leverage AvailableResources!• Leverage federal funding• Let another agency or division take the lead– Just m...
Sign up to receive our newsletter and updates atwww.shadac.org@shadacContact InformationElizabeth LukanenSenior Research F...
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Namd lukanen

Published on: Mar 3, 2016
Published in: News & Politics      Health & Medicine      
Source: www.slideshare.net


Transcripts - Namd lukanen

  • 1. Funded by a grant from the Robert Wood Johnson FoundationThinking Ahead – Monitoring the Impactof Health ReformElizabeth Lukanen, MPHSHADAC, University of MinnesotaNational Association of Medicaid Directors (NAMD)Spring MeetingDenver, ColoradoMay 21, 2013
  • 2. Presentation Overview• Why should states develop a monitoringframework (and why should Medicaid beinvolved)?• Steps to develop a monitoring or evaluationframework• State examples2
  • 3. Today3
  • 4. 2015 and Beyond4Everyone will be clamoring for dataand analysis on the impact of healthreform• States will be looking to report on “earlywins”• Policymakers and operational staff willneed information to make ongoingimplementation decisions• Heated debate is likely to continue and both sides will belooking for information on the impact• The media will be looking for ANY story• The public and key stakeholders will want a progressreport
  • 5. Objectives for Generating aMonitoring/Evaluation Framework• Encourages agreement on goals,priorities, and how progress will bemeasured• Defines how each component ofreform (e.g., Medicaid, exchange)contributes to those goals• Establishes program/agencycollaboration to focus on the “bigpicture”• Avoids duplication of data collectionand provides consistency inmeasurement5• Provides opportunity to select lead agency or individual accountable formonitoring efforts• Prepares state staff to respond to future questions from policymakers
  • 6. 6o National surveys and analyses are a great, especiallywhen cross-state comparisons are important, but…• Each state will be unique in how it implements the ACA• State-led efforts will track progress toward statepriorities• States often have richer data to examine questions in-depthWhy Should Monitoring Efforts be State-Led?Why not just rely onnational studies or 50-state analyses fromother sources?
  • 7. Why Should Medicaid Play a Role?7• Medicaid is “where it’s at”– Even if you don’t plan for it, you will likely engage inevaluation/monitoring work• Many key evaluation measures will rely onMedicaid data– Assure consistency in reporting– Avoid duplication of data collection and analysis– Reduce analyst burden• Define what it means to be successful• Contribute to and be aware of themessaging regarding impact of reform
  • 8. Why Now?• Define in advance what is important to measure –helps identify successes and problem areas• Establish a baseline prior to reform implementation• Identify gaps in available data and ways to fill thegaps– Take advantage of opportunities to “build in” to new datasystems• Stay ahead of “story”8Why can’t I focus onimplementation now and dealwith evaluation later?
  • 9. Evaluation and MonitoringFramework Development Define scope Choose andoperationalize measures Select appropriate dataand identify data gaps Setting benchmarks andgoals (or not) Stakeholder engagement9
  • 10. Defining Scope10• Set focus– Medicaid only, all health reform activities (state and federal?)• Need to keep the number of topic areas manageable– Access, cost, public health, impact on providers• What are you trying to achieve?– High Medicaid participation rates; good enrollee experience,reduced uninsurance; low rate of coverage gaps• What issues are policymakers most concerned about?– Churn, continuity of coverage, provider capacity to care for newlyuninsured;• Who is the audience?
  • 11. Choosing Measures• Keep the number of measuresmanageable - prioritize• Choose measures that are directlyrelated to policy goals and levers• Think about near-/medium-/long-termimpacts and include some measures foreach• Include some measures that might be“early success signs” or “early warningsigns”• Consider feasibility - existing data vs.possibility of collecting new data11
  • 12. Operationalize the Measure• Create a working definition or preferred method forcalculating the measure– e.g., how do you calculate churn?• Defining the “universe”– e.g., population-wide? exchangevs. total market?• Specify the level of detail you want to capture– e.g., disenrollment or disenrollment by reason12
  • 13. Select Appropriate Data1. Conduct a data scan2. Assess data againsta defined set ofcriteria3. Identify gaps4. Prioritize ways offilling gaps13
  • 14. Setting Benchmarks and Goals (or not)• Possible benchmarks– Change over time– Defined ideal– Other states– National average• The most useful goals are– Realistic– Specific– Connected to specific actions/strategies and policy priorities• Decisions will influence choices about data sources• Consensus around goals and benchmarks can bechallenging14
  • 15. Stakeholder Engagement• “Stakeholder” can be defined narrowlyor broadly• Stakeholders can be engaged at anypoint in the process• Best to present stakeholders withsomething to react to• Need clear boundaries on scope andpurpose15
  • 16. California - Approach• Led by the California HealthCare Foundation (work done by SHADAC)• Development of a set of measures to monitor over time• Geared toward public• Focused on the ACA but limited to 3 topic areas:1. Health insurance coverage (section on public coverage)2. Affordability and comprehensive of coverage3. Access to care• Considerations for measures selection– Measures that reflect major goals and provisions of the ACA– Outcomes rather than implementation process– Relevant/meaningful to policymakers– Interest in measures available at a sub-state level– Data availability• Stakeholders engaged after draft list of measures was developedhttp://www.shadac.org/publications/framework-tracking-impacts-affordable-care-act-in-california16
  • 17. California - Coverage Measures17Uninsured Public Coverage Employer CoverageDistribution of Insurance CoverageHealth InsuranceExchangePoint in timeEnrollment as Share ofNongroup MarketEmployer participationEmployees in firmsthat offer% EligibleEnrollment trendEmployers payingpenaltyParticipation rateChurningUninsured for a yearor longerUninsured at somepoint in past yearReasons foruninsuranceExempt from mandatePaying penaltyEmployers offeringFamilies with ESIoffer% EnrolledAll familymembers enrolled
  • 18. California - Affordability &Comprehensiveness of CoverageMeasures18Insurance PremiumsSubsidiesComprehensiveness Financial Burden% of families with highcost burden“Affordable” premiumas % of incomeEmployer coverageTotal premiumEmployee shareSingleFamilyNongroup coveragePer enrolleeEnrollment by benefitlevelESINongroupDeductiblesESI: single, familyNongroup: single,familySingleFamily# receiving premiumand cost sharingsubsidies in exchangeAverage value ofsubsidies
  • 19. California - Access to Care Measure19Individuals SystemUse of services Barriers to careHas usualsource of careDid not getnecessary care(& reasons)Preventable/avoidable ER visitsSafety netVolume and type ofservices providedby safety net clinicsUncompensatedcareType of placefor usual sourceof care% of physiciansparticipating inpublic programsDifficulty findingprovider thatacceptsinsurance typeDifficulty findingprovider to takenew patientsNot able to gettimelyappointmentAny doctor visitin past yearPreventive carevisit in past yearCounty indigentcare volume andcostAmbulatory caresensitive hospitaladmissionsEmergency roomvisit rate% of physiciansaccepting newpatients, by payer
  • 20. Maryland - Approach• Led by the Maryland Health Connection (work done bySHADAC)• Development of a set of measures to monitor over time• Geared toward policy makers and the public• Focused on the exchange and limited to 5 coremeasurement categories:– Affordability– Access (includes seamless and non-seamless coveragetransitions)– Consumer Satisfaction– Stability– Health Equity20
  • 21. Maryland Approach - Continued• Considerations for measures selection– Drawn from data currently produced by other state agencies, datacurrently collected or analyzed by other state agencies orgenerated through exchange– Highly prioritized, no more than 10 measures in each category• Exchange board developed measurement categories andgave feedback throughout the selection of measures• Public comment period after draft list of measures wasdevelopedhttp://marylandhbe.com/wp-content/uploads/2012/12/Performance-Management.pdf21
  • 22. Maryland -Measures22
  • 23. Too Daunting? Leverage AvailableResources!• Leverage federal funding• Let another agency or division take the lead– Just make sure to stay engaged• Consider outside partners to consult on or lead theseefforts– State universities– Evaluation consultants– Local foundations• No need to remake the whee1– Look at monitoring/evaluation schemes developed by other states(ask your NAMD collogues!)– Utilize data you current collect and use for other purposes (e.g.,operations, reporting)23
  • 24. Sign up to receive our newsletter and updates atwww.shadac.org@shadacContact InformationElizabeth LukanenSenior Research Fellowelukanen@umn.edu612.626.1537

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