This presentation discusses metrics and data sources for measuring the impact of state-level health reform. It identifies priority measures for health insurance coverage, affordability and comprehensiveness of coverage, and access to care. Existing data sources like surveys are identified, but there are also gaps, particularly for private insurance premiums and nongroup coverage comprehensiveness. Challenges in using population surveys across states are discussed. Planning is needed to uniformly collect high-priority data not currently available to accurately measure state health reform impacts.

1. Measuring State-Level Health Reform Impact: Metrics and Data SourcesJulie Sonier, Deputy DirectorState Health Access Data Assistance Center University of MinnesotaMarch 1, 2011This presentation draws on ongoing work supported by a grant from the Robert Wood Johnson Foundation ; by the RWJF State Health Access Reform Evaluation (SHARE) program; and by the California HealthCare Foundation, based in Oakland, California

2. GoalsWhat is most important to monitor? Identify priority measuresWhat do we know now? Identify and compare existing data sourcesWhere are the gaps? Identify priorities for new/modified data collection2

3. Identifying Priority MeasuresWhat are the most important things to know about state-level impacts on: Health insurance coverage? Affordability and comprehensiveness of coverage? Access to care?3

4. Criteria for Selecting MeasuresMeasures that reflect major goals and provisions of the lawOutcomes rather than implementation processRelevant/meaningful to policymakers4

5. Priority Measures: Coverage5Distribution of Insurance CoverageUninsuredPublic CoverageEmployer CoveragePoint in timeEmployers offeringParticipation rateUninsured for a year or longerEmployees in firms that offerRetention of eligible enrolleesUninsured at some point in past year% EligibleHealth Insurance Exchange% EnrolledReasons for uninsuranceFamilies with ESI offerNongroup coverageExempt from mandateAll family members enrolledEmployer coverage

6. Priority Measures: Affordability & Comprehensiveness of Coverage 6Financial BurdenInsurance PremiumsComprehensivenessEmployer coverage% of families with high cost burdenEnrollment by benefit levelTotal premium“Affordable” premium as % of incomeESISingleNongroupFamilyDeductiblesEmployee shareSubsidiesSingleESI: single, family# receiving premium and cost sharing subsidies in exchangeFamilyNongroup: single, familyNongroup coverageAverage value of subsidiesPer enrollee

7. Priority Measures: Access to Care 7SystemIndividualsUse of services% of physicians accepting new patients, by payerBarriers to careSafety netVolume and type of services provided by safety net clinicsHas usual source of careDid not get necessary care (& reasons)Ambulatory care sensitive hospital admissionsPreventive care visit in past yearUncompensated careNot able to get timely appointmentEmergency room visit rateAny doctor visit in past yearDifficulty finding provider to take new patientsPreventable/ avoidable ER visitsDifficulty finding provider that accepts insurance type

8. Potential Data SourcesSurveys Federal surveys: Population, employersGovernment programs/agencies State Medicaid/CHIP programs Health insurance exchanges Tax informationOther Health carriers, hospitals, physicians8

9. Criteria for Selecting Data SourcesAbility to compare across states and over timePopulation coverage – complete population of interestAbility to do in-depth analysis within states (e.g., by age, income, race/ethnicity)Often, this is a sample size issueTimeliness of estimatesAccessibility of data9

10. What can be measured now? Coverage10*Reason previous coverage ended

11. What can be measured now? Affordability/Comprehensiveness11

12. What can be measured now? Access12*Questions planned for addition to 2011 survey

13. Where are the biggest gaps?Private insurance: premiums and comprehensiveness of coverageGaps are especially large for nongroup coverageNeed to measure across the whole market, not just inside the exchangeProvider and safety net measures New entities/requirements under ACA:Information related to insurance exchanges (enrollment, subsidies, exemptions from coverage mandate)Information related to comprehensiveness of coverage (actuarial value)13

14. Challenges and opportunitiesPopulation surveys: no one data source is clearly “best”CPS and ACS have accessible 50-state estimates but are limited in scopePotential to use NHIS and MEPS HC – but smaller sample sizes and restricted access to state-level dataFor high-priority measures not currently available, will need a uniform way to collect across statesPlanning should be part of ACA implementation14

15. 15Contact InformationJulie Sonier, Deputy DirectorState Health Access Data Assistance Center University of Minnesota, Minneapolis, MNwww.shadac.orgjsonier@umn.edu(612) 625-4835