This document summarizes a presentation on developing a framework for monitoring the impact of health reform. It discusses why states should develop such a framework and have Medicaid involved. Key points include using the framework to track progress on goals, define each program's contributions, and avoid duplicative data collection. The presentation provides examples from California and Maryland and outlines steps to develop a framework, including defining scope, choosing measures, identifying data sources, and engaging stakeholders. It emphasizes establishing the framework early to monitor baseline trends and impacts over time.
How to Assess and Continuously Improve Maturity of Health Information Systems...MEASURE Evaluation
This document describes a new toolkit for assessing and continuously improving health information systems (HIS) to achieve better health outcomes. The toolkit includes:
1) A five-stage scale to measure the maturity of six HIS components, from emerging to optimized.
2) An assessment tool that maps the current and desired future stages to guide improvement planning. It is administered through key informant interviews and a stakeholder workshop.
3) The goal is to help countries strengthen their HIS through a collaborative, participatory process focused on setting priorities and tracking progress over time.
This document discusses evaluation methods for health informatics projects. It defines evaluation and evaluation research, and describes formative and summative evaluation approaches. Formative evaluation occurs during a project to provide feedback, while summative evaluation assesses effectiveness at the end. Both qualitative and quantitative methods can be used to collect data to evaluate projects. Logic models are developed to identify inputs, activities, outputs and desired outcomes. Evaluation questions are then used to guide data collection and assessment of key aspects of the project.
Want to better understand what's driving value-based clinical and financial transformation? And, what you need to do to start planning for implementation?
Monitoring Scale-up of Health Practices and InterventionsMEASURE Evaluation
This guide provides information to help monitor the scale-up of health practices and interventions. It introduces the guide and its objectives, which are to provide background on monitoring scale-up initiatives. The guide includes a rationale for monitoring scale-up, a readiness assessment, 10 considerations for monitoring scale-up such as defining objectives and selecting indicators, and appendices with case studies and frameworks for scaling up health interventions. The goal is to create a practical resource that can help effectively monitor and evaluate the scale-up process.
WayPoint Healthcare Advisors is a deeply experienced solutions provider anchored by strategy and focused on cost, growth, patient experience, and clinical process improvement. We translate strategy into action.
Our experts are hands-on, directly involved in
every step from planning to implementation –
until the transformation is complete.
The document discusses how digitizing healthcare can transform the industry by moving from standalone systems to integrated systems that provide real-time access to data. It notes healthcare is moving from paper-based systems with data silos to integrated electronic systems that can improve quality of care through features like alerts and collaboration. The document also discusses how capturing unstructured data from sources like clinical notes using technologies like natural language processing can provide insights to help monitor metrics, identify conditions, and support research.
Achieving population health management through more coordinated care is becoming essential as healthcare organizations move away from fee-for-service models and begin operating in the new value-based care environment. One path to succeeding in this new environment and achieving more coordinated care is through formation of a clinically integrated network.
Yale New Haven Health System (YNHHS), a nonprofit academic medical center, is following a seven-phase plan to achieve a regional, clinically integrated network with the ultimate goal of population health management.
On March 16, 2016, President of Value-Based Care, Megan North and Amanda Skinner, Executive Director of Clinical Integration and Population Health for Yale New Haven Health System (YNHHS), co-presented at the 2016 American College of Healthcare Executives’ Annual Congress on Healthcare Leadership (ACHE Congress). North and Skinner shared “A Step-by-Step Approach to A Clinically Integrated Network,” to provide insights into each step of the clinical integration road map.
How to Assess and Continuously Improve Maturity of Health Information Systems...MEASURE Evaluation
This document describes a new toolkit for assessing and continuously improving health information systems (HIS) to achieve better health outcomes. The toolkit includes:
1) A five-stage scale to measure the maturity of six HIS components, from emerging to optimized.
2) An assessment tool that maps the current and desired future stages to guide improvement planning. It is administered through key informant interviews and a stakeholder workshop.
3) The goal is to help countries strengthen their HIS through a collaborative, participatory process focused on setting priorities and tracking progress over time.
This document discusses evaluation methods for health informatics projects. It defines evaluation and evaluation research, and describes formative and summative evaluation approaches. Formative evaluation occurs during a project to provide feedback, while summative evaluation assesses effectiveness at the end. Both qualitative and quantitative methods can be used to collect data to evaluate projects. Logic models are developed to identify inputs, activities, outputs and desired outcomes. Evaluation questions are then used to guide data collection and assessment of key aspects of the project.
Want to better understand what's driving value-based clinical and financial transformation? And, what you need to do to start planning for implementation?
Monitoring Scale-up of Health Practices and InterventionsMEASURE Evaluation
This guide provides information to help monitor the scale-up of health practices and interventions. It introduces the guide and its objectives, which are to provide background on monitoring scale-up initiatives. The guide includes a rationale for monitoring scale-up, a readiness assessment, 10 considerations for monitoring scale-up such as defining objectives and selecting indicators, and appendices with case studies and frameworks for scaling up health interventions. The goal is to create a practical resource that can help effectively monitor and evaluate the scale-up process.
WayPoint Healthcare Advisors is a deeply experienced solutions provider anchored by strategy and focused on cost, growth, patient experience, and clinical process improvement. We translate strategy into action.
Our experts are hands-on, directly involved in
every step from planning to implementation –
until the transformation is complete.
The document discusses how digitizing healthcare can transform the industry by moving from standalone systems to integrated systems that provide real-time access to data. It notes healthcare is moving from paper-based systems with data silos to integrated electronic systems that can improve quality of care through features like alerts and collaboration. The document also discusses how capturing unstructured data from sources like clinical notes using technologies like natural language processing can provide insights to help monitor metrics, identify conditions, and support research.
Achieving population health management through more coordinated care is becoming essential as healthcare organizations move away from fee-for-service models and begin operating in the new value-based care environment. One path to succeeding in this new environment and achieving more coordinated care is through formation of a clinically integrated network.
Yale New Haven Health System (YNHHS), a nonprofit academic medical center, is following a seven-phase plan to achieve a regional, clinically integrated network with the ultimate goal of population health management.
On March 16, 2016, President of Value-Based Care, Megan North and Amanda Skinner, Executive Director of Clinical Integration and Population Health for Yale New Haven Health System (YNHHS), co-presented at the 2016 American College of Healthcare Executives’ Annual Congress on Healthcare Leadership (ACHE Congress). North and Skinner shared “A Step-by-Step Approach to A Clinically Integrated Network,” to provide insights into each step of the clinical integration road map.
Monitoring and Evaluation at the Community Level: A Strategic Review of ME...MEASURE Evaluation
This document summarizes MEASURE Evaluation's accomplishments and lessons learned from supporting community-level monitoring and evaluation (M&E) systems over Phase III. It describes key challenges faced in community-based M&E like low capacity and lack of resources. Best practices identified include involving stakeholders, intensive capacity building, and using simple tools. Gaps around data use and accessibility are discussed, along with recommendations for integrating community data and indicators, improving capacity building strategies, and taking a more strategic approach to community-based information systems.
The document discusses managing medical costs through a multi-disciplinary team that analyzes cost drivers like unit costs, utilization, benefits and claims processing to develop and implement action plans. It identifies key unit cost drivers as provider contracts, technology, and billing practices. Utilization drivers include technology, benefits, demographics and unnecessary services. The team measures results of managing costs through strategies like renegotiating contracts, managing rates and utilization through pre-certification and disease management programs.
The way healthcare services are now planned, monitored and evaluated has considerably changed in the last decade. Many healthcare organizations have now moved from Activity-Based M&E(ie, what are we really doing?) to Performance-Based M&E which focuses on the overall results (ie what have we achieved?).
Therefore the focus now is on the Results and consequences of actions and implementations, rather than on the inputs (treatment, time, human resources) provided.
In Secondary Healthcare Management for instance, this is called Results-Based Management (RBM) and Performance-Based M&E play a vital role in Results-Based Management.
MEASURE Evaluation’s Health Information System Strengthening ModelMEASURE Evaluation
This PowerPoint presentation provides an updated overview of MEASURE Evaluation’s Health Information System Strengthening Model, or the HISS Model. The slides describe the purpose of the model and each of the model’s areas and sub-areas.
A Systematic Approach to the Planning, Implementation, Monitoring, and Evalua...MEASURE Evaluation
This document outlines a 6-step approach for monitoring and evaluating integrated health services at the national level. The steps include: 1) defining public health problems, 2) identifying primary points of care, 3) defining interventions and service packages, 4) creating a logic model, 5) conducting research and evaluation, and 6) using data for decision making. Strong M&E systems are needed to manage complexity, assess progress, generate information, refine programs, and produce evidence. National strategies should drive integration based on mortality and morbidity data. Standardized care, quality indicators, and interoperable health information systems are important for monitoring integrated services. Lessons learned should be shared globally.
The document discusses strategic planning for health IT. It defines strategic planning and differentiates it from tactical planning. It describes the purpose and scope of health IT strategic planning, governance of the planning process, and maturity models to assess health IT adoption. The strategic planning process and documentation are outlined. Critical success factors include creating a vision, gaining agreement on the plan, developing financial and implementation strategies, and assessing benefits realization. Strategic planning for health IT is important but not always valued in organizations.
The document discusses lessons learned from state efforts to align quality measures across payers through State Innovation Model programs. It provides a strategic framework for developing a common measure set that includes determining an alignment strategy, articulating goals, setting the scope, engaging stakeholders, identifying selection criteria, inventorying measures, evaluating measures, selecting measures, and sustaining alignment. It highlights Washington state's development of a statewide common measure set as an example.
360 Policy Implementation Presentation and Understanding.Neville Shukla
The document discusses 360 Policy Implementation software which helps organizations streamline the generation, approval, and implementation of standard operating procedures (SOPs). It allows for drafting, reviewing, approving, and distributing SOPs digitally. It also automates tracking employee training on policies and retraining requirements. The software ensures all employees are aware of and following the organization's SOPs so that the organization is truly policy-driven. A demo and trial of the software are available upon request.
Successful organizations are constantly monitoring, evaluating, and improving based off of their successes and failures. Learn how to design your own monitoring and evaluation program with this deck from WAN, and learn more on our free Strategic Advocacy Course, available at: http://worldanimal.net/our-programs/strategic-advocacy-course-new/about
Suzanne Wait: Does benchmarking guide policyNuffield Trust
1) Benchmarking aims to guide health policy but faces challenges like measuring what is easy rather than important and indicator fatigue.
2) Benchmarking is intended to improve performance but there are questions around whether it actually influences patient choice or quality of care.
3) For benchmarking to effectively guide policy, objectives must be clear and indicators must reflect desired outcomes and priorities, with clinical and policymaker engagement.
The Health Finance and Governance (HFG) Project organized a multi-country workshop to support policymakers from public health and finance agencies in developing concrete action plans for mobilizing domestic resources for health. This presentation on the HFG toolkit addresses gaps in the Ministry of Health and Ministry of Finance relationship. The toolkit presents a set of strategies, self assessment methodologies and performance management processes to help the MOH better manage their own resources and to help foster more effective coordination between the MOH and the MOF.
Yes, this objective meets the SMART criteria:
- Specific: It clearly specifies increasing contraceptive prevalence as the desired outcome.
- Measurable: Contraceptive prevalence can be quantified by surveys to measure if it increased by 15%.
- Appropriate: Increasing contraceptive use is appropriately related to the overall goal of improving reproductive health.
- Realistic: A 15% increase may be achievable with the right interventions and resources.
- Timely: The objective does not specify a timeframe, but contraceptive prevalence increase could reasonably be expected and measured over the course of the program.
So in summary, this objective is SMART. Specifying a timeframe would make it even stronger.
Every hospital and health care system is significantly impacted by readmission policies mandated by new regulations.
And every facility must implement strategies to reduce the number of costly and unnecessary readmissions.
During this presentation you will discover how to decrease your readmission rates and take advantage of incentives, rather than suffer penalties that can significantly impact your bottom line.
Health system strengthening in LMICs and fragile states – what and how?ReBUILD for Resilience
Health system strengthening in low and middle income countries aims to improve health outcomes through strengthening the core functions and building blocks of health systems. Effective interventions strengthen governance, develop human resources, improve health facilities, and deliver high quality services. The evidence shows that multi-component interventions which reinforce each other across building blocks are most effective when designed and implemented through sustained political commitment, community engagement, capacity building, and iterative learning and adaptation to local contexts.
I gave this talk at a Nigeria Health Summit in March 2016. It was an introduction to impact evaluation: what it is, when it's a good idea, and some possible approaches.
Annual Results and Impact Evaluation Workshop for RBF - Day Six - Science of ...RBFHealth
The document summarizes the results of an impact evaluation of a performance-based financing (PBF) pilot program in the Haut-Katanga district of the Democratic Republic of Congo. The evaluation found that while the PBF model led to increased effort by health workers and a greater supply of targeted health services, it did not increase overall service utilization or impact health outcomes. Implementation of the PBF model in the pilot diverged from the planned design in several ways that may help explain the limited impact, such as incomplete coverage of services, weak verification of results, and limited community engagement. The evaluation concludes that rigorous design and implementation are needed for PBF programs to effectively influence health system performance and population health.
This document discusses information products to drive decision making in health systems. It summarizes research conducted in Kenya and Tanzania on the availability and use of information products from routine health information systems. Key findings include that staff value regular, standardized information products that provide feedback on performance against targets and recommendations for improvement. However, limited workforce and technical capacity are barriers to effective data use. The presentation provides examples of how information products can be designed and tested to promote greater use of routine health data for decision making.
Integrating Gender in the M&E of Health Programs: A ToolkitMEASURE Evaluation
This document introduces an integrated gender toolkit for monitoring and evaluating health programs. The toolkit was developed to provide guidance on integrating gender considerations into health program M&E activities. It includes modules on developing a rationale, identifying stakeholders, building a gender-integrated M&E plan, and developing an implementation plan. Each module includes activities and tools to help programs collect sex-disaggregated data, analyze how programs impact gender norms and inequalities, and improve health outcomes. The overall aim is to equip programs with the resources needed to understand the relationship between gender and health and incorporate gender perspectives into their M&E practices.
This chapter discusses developing metrics to support projects, interventions, and programs. It covers the Institute for Healthcare Improvement's framework, including identifying areas for improvement, selecting measures, obtaining a baseline, and remeasuring. The chapter also discusses organizational readiness, levels of evidence, cost analyses, selecting appropriate variables, and developing a data management plan including defining needs, identifying sources and measures, designing studies, retrieving and analyzing data. The goal is to select meaningful metrics to quantify cost and quality to improve outcomes as the healthcare system reforms.
This document discusses various quality processes and concepts including quality assurance, quality control, quality improvement, and total quality management. It defines each concept and describes the relationships between them. Quality assurance involves ensuring compliance to standards, quality control measures actual performance against expected standards, and quality improvement is a structured process to identify and implement improvements. Total quality management incorporates all these approaches and emphasizes continuous improvement through teamwork and a focus on customer needs. The document also outlines the key steps in a quality assurance cycle and roles/responsibilities of different stakeholders in quality improvement.
Monitoring and Evaluation at the Community Level: A Strategic Review of ME...MEASURE Evaluation
This document summarizes MEASURE Evaluation's accomplishments and lessons learned from supporting community-level monitoring and evaluation (M&E) systems over Phase III. It describes key challenges faced in community-based M&E like low capacity and lack of resources. Best practices identified include involving stakeholders, intensive capacity building, and using simple tools. Gaps around data use and accessibility are discussed, along with recommendations for integrating community data and indicators, improving capacity building strategies, and taking a more strategic approach to community-based information systems.
The document discusses managing medical costs through a multi-disciplinary team that analyzes cost drivers like unit costs, utilization, benefits and claims processing to develop and implement action plans. It identifies key unit cost drivers as provider contracts, technology, and billing practices. Utilization drivers include technology, benefits, demographics and unnecessary services. The team measures results of managing costs through strategies like renegotiating contracts, managing rates and utilization through pre-certification and disease management programs.
The way healthcare services are now planned, monitored and evaluated has considerably changed in the last decade. Many healthcare organizations have now moved from Activity-Based M&E(ie, what are we really doing?) to Performance-Based M&E which focuses on the overall results (ie what have we achieved?).
Therefore the focus now is on the Results and consequences of actions and implementations, rather than on the inputs (treatment, time, human resources) provided.
In Secondary Healthcare Management for instance, this is called Results-Based Management (RBM) and Performance-Based M&E play a vital role in Results-Based Management.
MEASURE Evaluation’s Health Information System Strengthening ModelMEASURE Evaluation
This PowerPoint presentation provides an updated overview of MEASURE Evaluation’s Health Information System Strengthening Model, or the HISS Model. The slides describe the purpose of the model and each of the model’s areas and sub-areas.
A Systematic Approach to the Planning, Implementation, Monitoring, and Evalua...MEASURE Evaluation
This document outlines a 6-step approach for monitoring and evaluating integrated health services at the national level. The steps include: 1) defining public health problems, 2) identifying primary points of care, 3) defining interventions and service packages, 4) creating a logic model, 5) conducting research and evaluation, and 6) using data for decision making. Strong M&E systems are needed to manage complexity, assess progress, generate information, refine programs, and produce evidence. National strategies should drive integration based on mortality and morbidity data. Standardized care, quality indicators, and interoperable health information systems are important for monitoring integrated services. Lessons learned should be shared globally.
The document discusses strategic planning for health IT. It defines strategic planning and differentiates it from tactical planning. It describes the purpose and scope of health IT strategic planning, governance of the planning process, and maturity models to assess health IT adoption. The strategic planning process and documentation are outlined. Critical success factors include creating a vision, gaining agreement on the plan, developing financial and implementation strategies, and assessing benefits realization. Strategic planning for health IT is important but not always valued in organizations.
The document discusses lessons learned from state efforts to align quality measures across payers through State Innovation Model programs. It provides a strategic framework for developing a common measure set that includes determining an alignment strategy, articulating goals, setting the scope, engaging stakeholders, identifying selection criteria, inventorying measures, evaluating measures, selecting measures, and sustaining alignment. It highlights Washington state's development of a statewide common measure set as an example.
360 Policy Implementation Presentation and Understanding.Neville Shukla
The document discusses 360 Policy Implementation software which helps organizations streamline the generation, approval, and implementation of standard operating procedures (SOPs). It allows for drafting, reviewing, approving, and distributing SOPs digitally. It also automates tracking employee training on policies and retraining requirements. The software ensures all employees are aware of and following the organization's SOPs so that the organization is truly policy-driven. A demo and trial of the software are available upon request.
Successful organizations are constantly monitoring, evaluating, and improving based off of their successes and failures. Learn how to design your own monitoring and evaluation program with this deck from WAN, and learn more on our free Strategic Advocacy Course, available at: http://worldanimal.net/our-programs/strategic-advocacy-course-new/about
Suzanne Wait: Does benchmarking guide policyNuffield Trust
1) Benchmarking aims to guide health policy but faces challenges like measuring what is easy rather than important and indicator fatigue.
2) Benchmarking is intended to improve performance but there are questions around whether it actually influences patient choice or quality of care.
3) For benchmarking to effectively guide policy, objectives must be clear and indicators must reflect desired outcomes and priorities, with clinical and policymaker engagement.
The Health Finance and Governance (HFG) Project organized a multi-country workshop to support policymakers from public health and finance agencies in developing concrete action plans for mobilizing domestic resources for health. This presentation on the HFG toolkit addresses gaps in the Ministry of Health and Ministry of Finance relationship. The toolkit presents a set of strategies, self assessment methodologies and performance management processes to help the MOH better manage their own resources and to help foster more effective coordination between the MOH and the MOF.
Yes, this objective meets the SMART criteria:
- Specific: It clearly specifies increasing contraceptive prevalence as the desired outcome.
- Measurable: Contraceptive prevalence can be quantified by surveys to measure if it increased by 15%.
- Appropriate: Increasing contraceptive use is appropriately related to the overall goal of improving reproductive health.
- Realistic: A 15% increase may be achievable with the right interventions and resources.
- Timely: The objective does not specify a timeframe, but contraceptive prevalence increase could reasonably be expected and measured over the course of the program.
So in summary, this objective is SMART. Specifying a timeframe would make it even stronger.
Every hospital and health care system is significantly impacted by readmission policies mandated by new regulations.
And every facility must implement strategies to reduce the number of costly and unnecessary readmissions.
During this presentation you will discover how to decrease your readmission rates and take advantage of incentives, rather than suffer penalties that can significantly impact your bottom line.
Health system strengthening in LMICs and fragile states – what and how?ReBUILD for Resilience
Health system strengthening in low and middle income countries aims to improve health outcomes through strengthening the core functions and building blocks of health systems. Effective interventions strengthen governance, develop human resources, improve health facilities, and deliver high quality services. The evidence shows that multi-component interventions which reinforce each other across building blocks are most effective when designed and implemented through sustained political commitment, community engagement, capacity building, and iterative learning and adaptation to local contexts.
I gave this talk at a Nigeria Health Summit in March 2016. It was an introduction to impact evaluation: what it is, when it's a good idea, and some possible approaches.
Annual Results and Impact Evaluation Workshop for RBF - Day Six - Science of ...RBFHealth
The document summarizes the results of an impact evaluation of a performance-based financing (PBF) pilot program in the Haut-Katanga district of the Democratic Republic of Congo. The evaluation found that while the PBF model led to increased effort by health workers and a greater supply of targeted health services, it did not increase overall service utilization or impact health outcomes. Implementation of the PBF model in the pilot diverged from the planned design in several ways that may help explain the limited impact, such as incomplete coverage of services, weak verification of results, and limited community engagement. The evaluation concludes that rigorous design and implementation are needed for PBF programs to effectively influence health system performance and population health.
This document discusses information products to drive decision making in health systems. It summarizes research conducted in Kenya and Tanzania on the availability and use of information products from routine health information systems. Key findings include that staff value regular, standardized information products that provide feedback on performance against targets and recommendations for improvement. However, limited workforce and technical capacity are barriers to effective data use. The presentation provides examples of how information products can be designed and tested to promote greater use of routine health data for decision making.
Integrating Gender in the M&E of Health Programs: A ToolkitMEASURE Evaluation
This document introduces an integrated gender toolkit for monitoring and evaluating health programs. The toolkit was developed to provide guidance on integrating gender considerations into health program M&E activities. It includes modules on developing a rationale, identifying stakeholders, building a gender-integrated M&E plan, and developing an implementation plan. Each module includes activities and tools to help programs collect sex-disaggregated data, analyze how programs impact gender norms and inequalities, and improve health outcomes. The overall aim is to equip programs with the resources needed to understand the relationship between gender and health and incorporate gender perspectives into their M&E practices.
This chapter discusses developing metrics to support projects, interventions, and programs. It covers the Institute for Healthcare Improvement's framework, including identifying areas for improvement, selecting measures, obtaining a baseline, and remeasuring. The chapter also discusses organizational readiness, levels of evidence, cost analyses, selecting appropriate variables, and developing a data management plan including defining needs, identifying sources and measures, designing studies, retrieving and analyzing data. The goal is to select meaningful metrics to quantify cost and quality to improve outcomes as the healthcare system reforms.
This document discusses various quality processes and concepts including quality assurance, quality control, quality improvement, and total quality management. It defines each concept and describes the relationships between them. Quality assurance involves ensuring compliance to standards, quality control measures actual performance against expected standards, and quality improvement is a structured process to identify and implement improvements. Total quality management incorporates all these approaches and emphasizes continuous improvement through teamwork and a focus on customer needs. The document also outlines the key steps in a quality assurance cycle and roles/responsibilities of different stakeholders in quality improvement.
The document summarizes the proposed Medicare Shared Savings Program which aims to promote accountable care through accountable care organizations (ACOs). It discusses key elements of the proposed rule including ACO qualification requirements, benchmark calculations for determining savings, performance measures tied to quality, and a timeline for implementation beginning in 2012. The overall goal is to align payments with value through shared savings models to reduce costs while improving care quality.
This document provides an overview of monitoring and evaluation concepts for designing M&E frameworks and plans. It discusses the key components of an M&E framework including objectives, indicators, data collection, responsibilities and frequency. Examples are provided of frameworks for different public health programs addressing problems like maternal mortality and fertility. Participants are guided through exercises to identify health problems, program objectives, and indicators for sample case studies. The document emphasizes establishing valid, reliable and timely indicators that are consistent with program design and aid management and evaluation of progress toward objectives. It also covers developing a full M&E framework with defined indicators, data sources and collection responsibilities.
This document provides an overview of monitoring and evaluation concepts for designing M&E frameworks and plans. It discusses the difference between program frameworks and M&E frameworks, and how to identify appropriate indicators. Participants are guided through exercises to develop a program logic model and select indicators for a sample public health case study. Key aspects of M&E frameworks like data sources, collection methods and responsibilities are reviewed. The document emphasizes setting realistic expectations and adapting the M&E plan if funding is reduced.
This document outlines 7 steps for value-based commissioning of healthcare for a population: 1) Identify the target population and their needs through local data and stakeholder input. 2) Define the parameters of the population and build stakeholder commitment for change. 3) Raise awareness of the new approach across providers, patients, and local leaders to engage them in the process. 4) Determine the appropriate budget by analyzing historic spending and benchmarks. 5) Work with stakeholders to identify outcomes and quality measures for the population. 6) Check that the expected outcomes are realistic given the resources. 7) Determine the procurement approach to implement the new model of care.
A Seven Step Approach to a Clinically Integrated Network.pdfPatWilson13
This document outlines a seven-step approach to building a clinically integrated network (CIN). The steps include: 1) gathering interested stakeholders; 2) creating a value proposition; 3) developing governance and participation agreements; 4) selecting quality measures; 5) recruiting physicians; 6) measuring and improving programs; and 7) engaging payers. The presentation emphasizes using data to benchmark quality, utilization, and costs in order to develop a sustainable incentive structure for the CIN. Yale New Haven Health System's experience in establishing its CIN, called the Total Health Network, is discussed as a case study.
Plan and (hypothetically) evaluate a public health intervention util.docxajoy21
Plan and (hypothetically) evaluate a public health intervention utilizing the MAP-IT Tool.
Based upon the key findings, gaps, and recommendations obtained from the family assessment and the community assessment perform an evaluation of an actual or hypothetical public health intervention. The intervention
MUST address one of the Healthy People Topics & Objectives
No two public health interventions are exactly alike. But most interventions share a similar path to success: Mobilize, Assess, Plan, Implement, Track.
Otherwise known as MAP-IT, this framework can be used to plan and evaluate public health interventions to achieve Healthy People 2020 objectives. Whether you are a seasoned public health professional or new to the field, the MAP-IT framework will help you create your own path to a healthy community and a healthier Nation.
MOBLIZE -
Questions To Ask and Answer: What is the vision and mission of the coalition? Why do I want to bring people together?
Who should be represented?
Who are the potential partners (organizations and businesses) in my
community? Assess both needs and assets (resources) in your community.
This will help you get a sense of what you can do, versus what you would like
to do. Work together as a coalition to set priorities.
What do community members and key stakeholders see as the most important issues? Consider feasibility, effectiveness, and measurability as you determine your priorities. Start collecting State and local data to paint a realistic picture of community needs.
The data you collect during the assessment phase will serve as baseline data. Baseline data provide information you gather before you start a program or intervention. They allow you to track your progress.
CRITICAL ELEMENTS -
1. Key individuals and organizations are identified to address the community need
2. Appropriate community coalitions already in place are asked to join the MAP-IT project 3. Vision for the community defined and stated
ASSESS -
Questions To Ask and Answer:
Who is affected and how?
What resources do we have?
What resources do we need?
Assess both needs and assets (resources) in your community.
This will help you get a sense of what you can do, versus what you would like to do. Work together as a coalition to set priorities.
What do community members and key stakeholders see as the most important issues? Consider feasibility, effectiveness, and measurability as you determine your priorities.
Start collecting State and local data to paint a realistic picture of community needs.
The data you collect during the assessment phase will serve as baseline data. Baseline data provide information you gather before you start a program or intervention. They allow you to track your progress.
CRITICAL ELEMENTS -
4. Community assessment includes all required demographic data 5. Assessment includes all required morbidity and mortality data
6. Three behavioral risk factors that are modifiable are identified the com.
Sills MR. Overview of the SAFTINet Program. Presented to the Emergency Department Research Committee, Department of Pediatrics, University of Colorado School of Medicine. 6 January 2015.
While this list represents the desirable attributes of indicators most useful for these purposes, it is recognized that few indicators are likely to meet all of these criteria.
Hence, these criteria serve as a benchmark for weighing the potential costs and benefits of selecting one indicator over another.
This document discusses program evaluation in public health. It begins by defining key terms like program, evaluation, and monitoring. It describes the need for evaluation to improve health programs and allocate resources. The types of evaluation include formative, process, outcome, and economic evaluations. Steps of evaluation involve engaging stakeholders, describing the program, focusing the design, gathering evidence, justifying conclusions, and ensuring use. Frameworks for public health evaluation include CDC's 30 standards across utility, feasibility, propriety and accuracy.
State Reform Survey Workgroup Meeting, February 2015soder145
A year has passed since full ACA implementation, and several states are gearing up for data collection in 2015. To guide this process and generate ideas, SHADAC is convened a web-assisted conference call. Colorado and Oregon shared their experiences selecting new reform-relevant content for their surveys, and researchers from the Urban Institute shared lessons learned from the Health Reform Monitoring Survey (HRMS).
There are several current trends in HR that employers are responding to, particularly rising health care costs. To control costs, employers are requiring higher deductibles, co-payments, and employee contributions to health insurance. They are also promoting wellness programs and consumer-driven health plans. Some employers are focusing on improving health outcomes for their sickest employees through top doctors and preventative services. On-site medical clinics are growing in popularity as well. Additionally, employers face pressure to increase wages through pay-for-performance programs and effective performance management.
Planning the Evaluation
Impact models
Types of inference and choice of design
Defining the indicators and obtaining the data
Carrying out the evaluation
Disseminating evaluation findings
Working in large-scale evaluations
The PPS [Prospective Payment System] to PDPM Pendulum: An Analysis of PDPM Co...PYA, P.C.
The Skilled Nursing Facility (SNF) industry has faced disruption with Medicare Part A’s transition to the Patient Driven Payment Model (PDPM) in the fall of 2019. Providers seeking additional guidance to further develop and shape their compliance programs are encouraged to view the presentation given by join PYA at the AHLA Long Term Care and the Law program in March of 2020.
PYA Post-Acute Service Line Manager Amy Dalton co-presented with Liz Steffen, MJ CHC CPHRM MBA HCM MA CCC-SLP, Senior Divisional Corporate Compliance Officer of Promedica Health System. “The PPS [Prospective Payment System] to PDPM Pendulum: An Analysis of PDPM Compliance Matters Post Go-Live” covers the following topics:
• Trends in care provision related to value-based outcomes and quality of care.
• Relevant compliance updates from the Department of Health and Human Services, Department of Justice, and Office of Inspector General.
• Clinical operational and compliance-related hurdles for SNFs post-PDPM go-live.
• How PDPM fits into the larger context of a SNF compliance program.
• PDPM recommendations and best practices going forward.
The document provides an overview of the Comprehensive Primary Care Initiative (CPC Initiative) which aims to establish a new model for purchasing and delivering comprehensive primary care. It discusses the goals of better health outcomes, better care experiences, and lower costs. Practices will receive care management fees and have opportunities for shared savings. They will be required to meet milestones related to care management, access, patient experience, use of data, care coordination, and meaningful use of EHRs. The webinar invites primary care practices to apply and outlines the application process and requirements.
Disaster managment can save many lives.This presentation enumerates all steps required for Damage-control.It also stresses upon the importance of Primordial mode of prevention.
If you like this presentation and want to make for yourself,Please do contact me at rohit.bhansalis@gmail.com
Trends and Disparities in Children's Health Insurance: New Data and the Impli...soder145
This document summarizes key findings from an analysis of trends in children's health insurance coverage between 2016 and 2017. Some key points:
- The uninsured rate among children in the U.S. increased from 4.7% in 2016 to 5% in 2017, reversing over a decade of decline. This represented nearly 270,000 additional uninsured children.
- The increase was driven by a decline in public coverage, particularly Medicaid. Uninsurance rose across most demographic groups.
- There was considerable variation between states, from a low of 1.4% uninsured in Vermont to a high of 10.7% in Texas.
- States with low uninsurance typically had high rates of employer-sponsored insurance or
Exploring Disparities Using New and Updated MEasures on SHADAC's State Health...soder145
Slides from webinar webinar introducing two new measures of health outcomes and social determinants of health on SHADAC’s State Health Compare—Unhealthy Days and Unaffordable Rents. This presentation, hosted by SHADAC researchers Brett Fried and Robert Hest, examine these new measures and highlight how the estimates can be used to explore disparities between states and among sub-populations.
Leveraging 1332 State Innovation Waivers to Stabilize Individual Health Insur...soder145
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Modeling State-based Reinsurance: One Option for Stabilization of the Individ...soder145
This document summarizes research on modeling state-based reinsurance programs to stabilize individual health insurance markets. Key findings include:
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- State reinsurance programs with varying parameters could reduce insurer costs by $6-14 billion nationally per year.
- Estimated reinsurance costs for four states range from $300,000 to $1.8 billion depending on the attachment point and coinsurance rate.
- Federal transitional reinsurance and proposed legislation allocated $10 billion annually, consistent with these estimates.
2017 Health Insurance Coverage Estimates: SHADAC Webinar Featuring U.S. Censu...soder145
Join us for an overview of the 2017 health insurance coverage estimates from two key, large-scale federal data sources: The American Community Survey (ACS) and the Current Population Survey (CPS).
This webinar will examine the new estimates with technical insight from experts at the U.S. Census Bureau, which administers both the ACS and CPS, and from SHADAC researchers.
Attendees will learn about:
The new 2017 national and state coverage estimates
When to use which estimates from which survey
How to access the estimates via Census reports and American FactFinder
How to access state-level estimates from the ACS using SHADAC tables
SHADAC researchers and Census experts will answer questions from attendees after the presentation.
Exploring the New State-Level Opioid Data On SHADAC's State Health Comparesoder145
Between 2000 and 2016, the annual number of drug overdose deaths in the United States more than tripled, from 17,500 to 63,500, and most of these deaths involved opioids. Despite widespread increases in overdose death rates from natural and semi-synthetic opioids, synthetic opioids, and heroin, individual states’ death rates varied widely. For example, in 2016, Nebraska’s rate of 1.2 deaths per 100,000 people was the lowest in the U.S. for natural and semi-synthetic opioids, while West Virginia’s rate (the highest) was more than 15 times larger, at 18.5 deaths. These deaths are the most glaring indication of the growing crisis of opioid abuse and addiction that has been spreading unevenly throughout the country over the past two decades.
On this SHADAC webinar, Research Fellow Colin Planalp will examine the United States opioid epidemic at the state level, analyzing trends in overdose deaths from heroin and other opioids, such as prescription painkillers. Using data available through SHADAC’s State Health Compare, he will look at which states have the highest rates of opioid-related deaths and which have experienced the largest increases in death rates.
Mr. Planalp will be joined by SHADAC Research Fellow Robert Hest, who will discuss the data on opioid-related overdose deaths from the U.S. Centers from Disease Control and Prevention (CDC) that are available on SHADAC’s State Health Compare. He will also discuss State Health Compare data from the U.S. Drug Enforcement Administration (DEA) on sales of common prescription opioid painkillers. Mr. Hest will show users how to access and use the data for state-level analyses.
This document summarizes research on the intersection of structural risk factors and insurance-based discrimination on healthcare access inequities. The study analyzed data on over 3,800 non-elderly adults in Minnesota to examine how experiences of insurance-based discrimination vary across gender, race, income and insurance status, both independently and combined. It also assessed how the synergistic effects of structural risk factors and reported discrimination influence access to a usual source of care and confidence in getting needed healthcare services. The results show that structural factors like race, income and insurance status combine to produce greater reported discrimination, which then interacts with those factors to further reduce healthcare access. The implications are that reducing inequities requires attention to the convergence of these structural barriers
This study analyzed characteristics associated with accurate reports of health insurance coverage in census surveys. It found that reporting of public insurance was most accurate among low-income, less educated individuals who likely needed care. Reporting varied by specific public program, with family characteristics impacting Medicaid accuracy and respondent characteristics impacting MinnesotaCare accuracy. Private insurance reporting in the ACS was more accurate among advantaged groups, while the CPS saw greater accuracy among older respondents with long-term coverage. The results provide insight into survey design, editing, and using survey data for policy analysis by identifying who reports coverage most reliably.
- The document presents preliminary results from the Minnesota Long-Term Services and Supports Projection Model (MN-LPM), which projects LTSS utilization and costs for Minnesota's Medicaid elderly population through 2030.
- In 2015, over 54,000 Minnesotans received LTSS through Medicaid, costing $991 million total. The model projects these numbers will double by 2030, with LTSS costs reaching $1.7 billion as HCBS use grows significantly faster than nursing home use.
- The model uses Minnesota-specific data on the characteristics of elderly residents and current LTSS spending patterns to generate projections. It is intended to help evaluate potential policy changes that could impact future LTSS needs and costs in
Modeling Financial Eligibility for Medicaid Payment of LTSS
1) Medicaid long-term services and expenditures (LTSS) are a large and growing part of state budgets. States may restrict LTSS eligibility rules to control costs.
2) The researchers modeled LTSS eligibility rules to understand their impact and potential consequences of restricting access.
3) The model found that restricting income eligibility rules had a larger impact on reducing the number of eligible individuals than restricting asset rules. This is because income rules are more broadly applied and generous under current policies.
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3) It expanded access to health information exchange capabilities needed to coordinate care across settings.
- Structured interviews were conducted with 33 current and former state agency and health plan staff across 4 states to understand challenges implementing Section 1115 Medicaid expansion waiver programs.
- Key challenges included the significant administrative resources and coordination required across entities, educating enrollees, and reconciling complex program rules across systems.
- While waiver programs allowed for innovative policy testing, the administrative complexity was substantial and ongoing. Implementation involved major efforts to develop new IT systems and operational protocols within tight timelines.
1. The document analyzes the potential impact and costs of state-based reinsurance programs using data from 2012-2015.
2. It estimates that reinsurance subsidies could range from $6.4 billion to $16 billion annually depending on the attachment point and coinsurance rate.
3. Reinsurance costs are estimated to range from close to $300,000 in Illinois to $2 billion in California under sample programs with an 80/20 coinsurance split.
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This document summarizes a study that compared survey responses about health insurance from the American Community Survey (ACS) and Current Population Survey (CPS) to actual administrative insurance records to assess accuracy. The study found that both surveys produced reasonably accurate aggregated estimates but that some types of coverage, like direct purchase plans, were less accurately reported. Specifically:
- Both surveys had high sensitivity in detecting those with any insurance but the ACS performed better for direct purchase plans.
- The predictive power of reported coverage types varied, with direct purchase again less accurately predicted than employer-sponsored coverage.
- Prevalence estimates based on surveys were generally within a few percentage points of administrative records, though CPS estimates were less accurate for
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This document summarizes a study examining factors associated with accurate reporting of health insurance coverage type. The study used survey data matched to enrollment records from a health plan. It found:
1) Reporting accuracy was highest for those with employer-sponsored insurance and lowest for those with direct purchase or Medicaid coverage.
2) Among those with direct purchase insurance, reporting accuracy was higher for those who were white, non-Hispanic, fully employed, and from higher income households.
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- The results show Medicaid expansion decreased worker eligibility for ESI offers by 4 percentage points but had no effect on ESI offers or out-of-pocket premiums. There was also no differential effect for low-wage establishments.
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1. Funded by a grant from the Robert Wood Johnson Foundation
Thinking Ahead – Monitoring the Impact
of Health Reform
Elizabeth Lukanen, MPH
SHADAC, University of Minnesota
National Association of Medicaid Directors (NAMD)
Spring Meeting
Denver, Colorado
May 21, 2013
2. Presentation Overview
• Why should states develop a monitoring
framework (and why should Medicaid be
involved)?
• Steps to develop a monitoring or evaluation
framework
• State examples
2
4. 2015 and Beyond
4
Everyone will be clamoring for data
and analysis on the impact of health
reform
• States will be looking to report on “early
wins”
• Policymakers and operational staff will
need information to make ongoing
implementation decisions
• Heated debate is likely to continue and both sides will be
looking for information on the impact
• The media will be looking for ANY story
• The public and key stakeholders will want a progress
report
5. Objectives for Generating a
Monitoring/Evaluation Framework
• Encourages agreement on goals,
priorities, and how progress will be
measured
• Defines how each component of
reform (e.g., Medicaid, exchange)
contributes to those goals
• Establishes program/agency
collaboration to focus on the “big
picture”
• Avoids duplication of data collection
and provides consistency in
measurement
5
• Provides opportunity to select lead agency or individual accountable for
monitoring efforts
• Prepares state staff to respond to future questions from policymakers
6. 6
o National surveys and analyses are a great, especially
when cross-state comparisons are important, but…
• Each state will be unique in how it implements the ACA
• State-led efforts will track progress toward state
priorities
• States often have richer data to examine questions in-
depth
Why Should Monitoring Efforts be State-
Led?
Why not just rely on
national studies or 50-
state analyses from
other 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 in
evaluation/monitoring work
• Many key evaluation measures will rely on
Medicaid 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 the
messaging 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 the
gaps
– Take advantage of opportunities to “build in” to new data
systems
• Stay ahead of “story”
8
Why can’t I focus on
implementation now and deal
with evaluation later?
9. Evaluation and Monitoring
Framework Development
Define scope
Choose and
operationalize measures
Select appropriate data
and identify data gaps
Setting benchmarks and
goals (or not)
Stakeholder engagement
9
10. Defining Scope
10
• 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 newly
uninsured;
• Who is the audience?
11. Choosing Measures
• Keep the number of measures
manageable - prioritize
• Choose measures that are directly
related to policy goals and levers
• Think about near-/medium-/long-term
impacts and include some measures for
each
• Include some measures that might be
“early success signs” or “early warning
signs”
• Consider feasibility - existing data vs.
possibility of collecting new data
11
12. Operationalize the Measure
• Create a working definition or preferred method for
calculating the measure
– e.g., how do you calculate churn?
• Defining the “universe”
– e.g., population-wide? exchange
vs. total market?
• Specify the level of detail you want to capture
– e.g., disenrollment or disenrollment by reason
12
13. Select Appropriate Data
1. Conduct a data scan
2. Assess data against
a defined set of
criteria
3. Identify gaps
4. Prioritize ways of
filling gaps
13
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 be
challenging
14
15. Stakeholder Engagement
• “Stakeholder” can be defined narrowly
or broadly
• Stakeholders can be engaged at any
point in the process
• Best to present stakeholders with
something to react to
• Need clear boundaries on scope and
purpose
15
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 coverage
3. 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 developed
http://www.shadac.org/publications/framework-tracking-impacts-affordable-care-
act-in-california
16
17. California - Coverage Measures
17
Uninsured Public Coverage Employer Coverage
Distribution of Insurance Coverage
Health Insurance
Exchange
Point in time
Enrollment as Share of
Nongroup Market
Employer participation
Employees in firms
that offer
% Eligible
Enrollment trend
Employers paying
penalty
Participation rate
Churning
Uninsured for a year
or longer
Uninsured at some
point in past year
Reasons for
uninsurance
Exempt from mandate
Paying penalty
Employers offering
Families with ESI
offer
% Enrolled
All family
members enrolled
18. California - Affordability &
Comprehensiveness of Coverage
Measures
18
Insurance Premiums
Subsidies
Comprehensiveness Financial Burden
% of families with high
cost burden
“Affordable” premium
as % of income
Employer coverage
Total premium
Employee share
Single
Family
Nongroup coverage
Per enrollee
Enrollment by benefit
level
ESI
Nongroup
Deductibles
ESI: single, family
Nongroup: single,
family
Single
Family
# receiving premium
and cost sharing
subsidies in exchange
Average value of
subsidies
19. California - Access to Care Measure
19
Individuals System
Use of services Barriers to care
Has usual
source of care
Did not get
necessary care
(& reasons)
Preventable/
avoidable ER visits
Safety net
Volume and type of
services provided
by safety net clinics
Uncompensated
care
Type of place
for usual source
of care
% of physicians
participating in
public programs
Difficulty finding
provider that
accepts
insurance type
Difficulty finding
provider to take
new patients
Not able to get
timely
appointment
Any doctor visit
in past year
Preventive care
visit in past year
County indigent
care volume and
cost
Ambulatory care
sensitive hospital
admissions
Emergency room
visit rate
% of physicians
accepting new
patients, by payer
20. Maryland - Approach
• Led by the Maryland Health Connection (work done by
SHADAC)
• 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 core
measurement categories:
– Affordability
– Access (includes seamless and non-seamless coverage
transitions)
– Consumer Satisfaction
– Stability
– Health Equity
20
21. Maryland Approach - Continued
• Considerations for measures selection
– Drawn from data currently produced by other state agencies, data
currently collected or analyzed by other state agencies or
generated through exchange
– Highly prioritized, no more than 10 measures in each category
• Exchange board developed measurement categories and
gave feedback throughout the selection of measures
• Public comment period after draft list of measures was
developed
http://marylandhbe.com/wp-
content/uploads/2012/12/Performance-Management.pdf
21
23. Too Daunting? Leverage Available
Resources!
• 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 these
efforts
– 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 at
www.shadac.org
@shada
c
Contact Information
Elizabeth Lukanen
Senior Research Fellow
elukanen@umn.edu
612.626.1537
Editor's Notes
Framework can be A broad framework helps focus attention on:Big picture goalsHow each component (e.g., Medicaid, exchange) contributes to those goalsOutcomes, not just processesWhere it makes sense, ensure that individual programs are collecting data and measuring consistentlySelect a lead agency or person to be accountable
Scope: Selected your domainsFocus: articulated your policy goalsMeasure: determined the mechanisms for achieving policy goals, keeping in mind near/medium/long termLevel of measurement: Given some thought to the level of measurement – system/population, subpopulation geography, employer size, health provider tpe
overall enrollment, completed applications, transfers from CHIP to Medicaid, spells of enrollment, retention rates, new applicants versus re-entries, reasons for denials, and reasons for disenrollment
Churn: number of program disenrollees in a given month who later reenroll in the program following a gap in coverage of one to six months. (Chris Trenholm)Coverage from admin data – what time frame? Who is excluded (elderly)? Point in time?**Don’t need to remake wheel, use exiting definitions (other data frameworks), SHADAC can helpCoverage: uninsured? Public program – all or aggregate?System/populationSpecific population groups – e.g., age, income, health insurance coverage type, race/ethnicity, immigration statusGeographyEmployer sizeHealth care provider type – e.g., safety net providers
Start with list of priority measures, then do data scanOtherwise:might miss key measures of interest highlight less important measure just because you have the data.Do a lot of work assessing data sources on topics that don’t make the cutSurvey dataAdministrative dataData from health carriers, hospitals, providersOther?Level of Geography Subpopulation analysis , Available benchmarks, Timeliness, Ability to trend, Breadth and depth of topics Methodology, Ease of use and procurementConsider ways of collecting additional data through existing collection efforts : Existing state surveysProvider licensure process State tax returnIdentify data that might come out of new systems/processes Enlist outside support (e.g., state foundations)
51 measuresVery focused on IDing data gapsGoalsInform stakeholders Help CHCF prioritize next steps and resources for filling data gapsBuild coalitions and momentum to move process forwardApproach6 structured group discussions over 3 daysProfessional facilitatorRange of invited participants: advocates, providers, safety net, legislative staff, state and county government, insurers, researchers, foundationsTried to keep groups of “like minded” together
Coverage, continued from previous slide:Health insurance exchange: The insurance exchange plays a key role in the ACA’s coverage reforms, both as a vehicle for subsidies and as a means of organizing the market and making it easier for individuals and employers to shop for coverage. To understand how well the exchanges are performing these functions, trends in enrollment should be tracked over time (both in total and as a percentage of the individual and relevant employer markets, and separately for subsidized vs non-subsidized coverage).AAt a high level, the major gaps in data related to health insurance coverage relate to compliance with the Affordable Care Act’s individual mandate and employer requirements, and to the health insurance exchange. These are the sort of gaps that represent fundamental changes that are specific to the ACA and that can’t be filled until 2014. However, it’s important to be planning now for how to collect this information in a way that will be reliable and useful. REFERENCE TO LYNN’S PRESENTAITON ON REPORTING REQUIREMENTS UNDER THE ACA?One thing to note is that gaps for these recommended measures will of course look very different in differnet states. CA has a pretty rich existing data infrastructure to draw from, and this won’t be the case in all states. For example, we recommend the CHIS and CEHBS in CA for many measures, but in states that don’t conduct their own state specific population and employer based surveys other alternatives, such as the NHIS and MEPS-IC would have to be considered, and in some cases, such as the NHIS in smaller states, data sources may not be available at all.
With regard to affordability and comprehensiveness, there are significant gaps in the information available now, especially with regard to the nongroup health insurance market. We know very little right now about premiums, enrollment, and what kinds of products are being purchased in this market. We know more about the market for employer-sponsored coverage, but will need to track comprehensiveness of coverage in new ways once the exchanges are implemented. And finally, it will also be important to track premium and cost sharing subsidies that are provided through the exchanges beginning in 2014.
With regard to individuals’ access to care, the main gap related to use of services relates to the percentage of people who have preventive care visits; but there are several important gaps related to barriers to care that individuals experience. Specifically, these relate to people being able to get appointments in a timely way, having difficulty finding a provider that will accept new patients, and having difficulty finding a provider that accepts their insurance; it’s probably a good idea to track these measures separately for primary care and specialty care. Key gaps in the information that will be important to track access to care at a system level include the percentage of physicians who are accepting new patients, and the percentage that participate in Medi-Cal and Healthy Families. Again, tracking these measures separately for primary care and specialty care will be useful. And finally, the gaps in information related to the safety net relate mainly to the fact that the safety net system is pretty fragmented, with no data sources that provide a picture of the system as a whole. Many of the California data experts that we talked to mentioned the lack of information from county clinics as a very important gap here, since these clinics play a crucial role in delivering safety net services. There are also gaps in available information about the volume and cost of indigent care provided by counties. And finally, there are also some gaps in the data for hospitals – because not all hospitals report their financial information the same way, the picture of uncompensated care at the state level is currently incomplete.Transition to Barbara
25 measure's in totalState staff drivenDomains were generated based on the state goals of the exchange
Health Equity Number of individuals that attempt to obtain coverage through exchange (Access)Distribution of insurance status (Access)Number of individuals receiving premium subsidies (Affordability)Number of individuals receiving cost sharing subsidies (Affordability)Percentage of adults who cannot afford a doctor visit (Affordability)Percent of families with high cost burden (Affordability)Composite measure of satisfaction (Consumer Satisfaction)