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State Health Access Reform Evaluation: Buidling the Evidence for Reform

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Presentation by Lynn Blewett at the AcademyHealth Annual Research Meeting, Jun 7 2008.

Presentation by Lynn Blewett at the AcademyHealth Annual Research Meeting, Jun 7 2008.

Published in: Health & Medicine, Technology
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  • 1. State Health Access Reform Evaluation: Building the Evidence for Reform AcademyHealth State Health Research and Policy Interest Group Meeting Washington, DC Saturday, June 7, 2008 Lynn A. Blewett, Ph.D. SHADAC/SHARE University of Minnesota
  • 2. Overview of Presentation
    • Overview of SHARE
    • Key dimensions of Health Reform
    • Grantee and Reform Topic Overview
    • Data used by Grantees
    • Concluding Comments
  • 3. State Health Access Reform Evaluation (SHARE)
    • RWJF National Program Office
    • Co-located with the State Health Access Data Assistance Center
      • Providing technical assistance
      • Link to states and state analysts
    • $5+ million in grant-funding
  • 4. SHARE Objectives
    • Support and coordinate evaluations of state reform
      • To establish a body of evidence to inform state and national policy makers
      • To identify and address gaps in research on state health reform activities from a state policy perspective
    • Disseminate findings
      • Meaningful and user-friendly for state and national policy makers, state agencies, and researchers alike
    • Create a research and practice community to facilitate
    evidenced-based reform
  • 5. SHARE Process and Timeline 2007 2008 SHARE worked with a Technical Advisory Group to develop a conceptual framework to guide the research focus 2009 AUGUST : Call for Proposals Received 62 proposals - 26 applicant teams were invited to submit full proposals DECEMBER: 26 full proposals submitted. Proposal Advisory Group reviews full proposals MARCH : 15 studies recommended to RWJF for funding APRIL : Award disbursement begins to 15 grantees Evidenced-Based Reform 2010 Synthesis of
  • 6. Framework for Reform
    • Public Sector
    • Initiatives
    Employer-Based Initiatives Insurance Reform Tax credits HIFA expansion waivers SCHIP premium assistance Small employer purchasing pools
  • 7. Key Dimensions of Reform
    • Increase access and coverage plus demonstrating that reform initiative has:
    • Affordability
    • Sustainability
    • Efficient and Effective Administration
  • 8. Key Assumption
    • The best policy is made on
    • informed decision-making
    • Made based on best available data and analysis
    • Decision maker is knowledgeable, interested and has reliable information at hand
    • Science and methods are sound
    • Thoughtful discussion of alternatives
    • Public is informed
  • 9. SHARE Awards
    • 15 Awards totaling $5.4 million
    • Funding began in April and May of 2008
    • Projects range between 12 and 24 months
    • 7 multi-state studies; 8 single states studies
    • Studies cover a wide range of topics and states
  • 10. States Being Examined
  • 11. Single/Multi State Studies ( 27 States ) New Mexico New York Oklahoma Pennsylvania Rhode Island South Dakota Texas Utah Vermont Washington Colorado Delaware Idaho Illinois Indiana Maine Maryland Massachusetts Missouri Kentucky New Jersey California Massachusetts New Mexico Rhode Island Wisconsin Vermont Multi-state Studies Single-state Studies
  • 12. Reform Topics Being Studied Insurance Market Initiatives (5) SCHIP Reform (1) Comprehensive Reform (3) Medicaid Reform (6)
  • 13. SHARE Grantee Institutions
    • Johns Hopkins Bloomberg School of Public Health
    • Wake Forest University
    • Brown University
    • University of Wisconsin
    • New Mexico Human Services Department
    • USC Department of Family Medicine
    • Mathematica Policy Research
    • UCLA
    • University of Southern Maine
    • University of New England
    • Urban Institute
    • Rutgers University
  • 14. Levels of Measurement
    • Population-based
      • Data collected from sample of target population
      • Survey data, focus groups
    • Program-based
      • Data collected from program recipients, clients, or participants
      • Administrative data
  • 15. Program Evaluation Data
    • Quantitative Data
      • Surveys, secondary data
      • Measures activities carried out
      • Use to assess extent of program utilization, behavior change, or cost per unit of change
    • Qualitative Data
      • Interviews, focus groups, observations, document review
      • Use to understand attitudes, beliefs, reactions, to assess quality, to explain perceptions
  • 16. National Data Sets: Limitations
    • Limited state sample in national surveys
      • constrains number of states that can be analyzed
      • limits number and type of sub-populations that can be analyzed
    • Most cross-sectional ( no time series )
    • In some cases new state specific weights need to be generated to do state-level analysis (e.g. IHIS)
    • Medicaid undercount adjustments
    • State-specific program names can result in inconsistent reporting
  • 17. Federal Survey Data Used by SHARE Grantees
    • With State-Representative Sample
      • 1. Behavioral Risk Factor Surveillance System Survey
      • 2. Medical Expenditure Panel Survey - IC
      • 3. Current Population Survey
    • Not State-Representative but some states with large enough sample
      • 4. Medical Expenditure Panel Survey - HC
      • 5. National Health Interview Survey
  • 18. State-Specific Data: Used by SHARE Grantees
    • State Household Survey Data
      • Washington, New Jersey, California, Massachusetts
    • State-specific claims data
    • State public program enrollment/administrative data
    • Insurers' annual financial reports
    • Rich source of information to examine sub-populations and identify state specific trends
  • 19. Challenges with State Data
    • Acquisition can be challenging and time consuming
    • Administrative data was not collected for the purpose of evaluation
    • State surveys
      • Documentation can be limited
      • Often not conducted regularly over time
      • State survey instruments and collection methods change over time
  • 20. Concluding Comments
    • Goal: to develop a research community committed to evaluating and documenting successful health reform
      • State Health Research and Policy Interest Group
    • Plan to connect researchers to states and states to research
      • Great Research Conversations Monthly Series
      • Outcome Reports on Research Findings
      • Special Issue Journal
      • Participation in state meetings and conferences
    Let us know your ideas!
  • 21. State Health Reform If States are the Laboratories….. Where are the lab reports?
  • 22. Contact Information www.shadac.org www.statereformevaluation.org University of Minnesota School of Public Health Division of Health Policy and Management 2221 University Avenue, Suite 345 Minneapolis Minnesota 55414 (612) 624-4802 Principal Investigator: Lynn A. Blewett, Ph.D. (blewe001@umn.edu) SHARE Deputy Director: Elizabeth Lukanen, M.P.H (elukanen@umn.edu)

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