Pres mnhsr2011 mar1_sonier


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Pres mnhsr2011 mar1_sonier

  1. 1. Measuring State-Level Health Reform Impact: Metrics and Data Sources<br />Julie Sonier, Deputy Director<br />State Health Access Data Assistance Center <br />University of Minnesota<br />March 1, 2011<br />This 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<br />
  2. 2. Goals<br />What is most important to monitor?<br /> Identify priority measures<br />What do we know now?<br /> Identify and compare existing data sources<br />Where are the gaps?<br /> Identify priorities for new/modified data collection<br />2<br />
  3. 3. Identifying Priority Measures<br />What are the most important things to know about state-level impacts on:<br /> Health insurance coverage?<br /> Affordability and comprehensiveness of coverage?<br /> Access to care?<br />3<br />
  4. 4. Criteria for Selecting Measures<br />Measures that reflect major goals and provisions of the law<br />Outcomes rather than implementation process<br />Relevant/meaningful to policymakers<br />4<br />
  5. 5. Priority Measures: Coverage<br />5<br />Distribution of Insurance Coverage<br />Uninsured<br />Public Coverage<br />Employer Coverage<br />Point in time<br />Employers offering<br />Participation rate<br />Uninsured for a year or longer<br />Employees in firms that offer<br />Retention of eligible enrollees<br />Uninsured at some point in past year<br />% Eligible<br />Health Insurance Exchange<br />% Enrolled<br />Reasons for uninsurance<br />Families with ESI offer<br />Nongroup coverage<br />Exempt from mandate<br />All family members enrolled<br />Employer coverage<br />
  6. 6. Priority Measures: Affordability & Comprehensiveness of Coverage <br />6<br />Financial Burden<br />Insurance Premiums<br />Comprehensiveness<br />Employer coverage<br />% of families with high cost burden<br />Enrollment by benefit level<br />Total premium<br />“Affordable” premium as % of income<br />ESI<br />Single<br />Nongroup<br />Family<br />Deductibles<br />Employee share<br />Subsidies<br />Single<br />ESI: single, family<br /># receiving premium and cost sharing subsidies in exchange<br />Family<br />Nongroup: single, family<br />Nongroup coverage<br />Average value of subsidies<br />Per enrollee<br />
  7. 7. Priority Measures: Access to Care <br />7<br />System<br />Individuals<br />Use of services<br />% of physicians accepting new patients, by payer<br />Barriers to care<br />Safety net<br />Volume and type of services provided by safety net clinics<br />Has usual source of care<br />Did not get necessary care (& reasons)<br />Ambulatory care sensitive hospital admissions<br />Preventive care visit in past year<br />Uncompensated care<br />Not able to get timely appointment<br />Emergency room visit rate<br />Any doctor visit in past year<br />Difficulty finding provider to take new patients<br />Preventable/ avoidable ER visits<br />Difficulty finding provider that accepts insurance type<br />
  8. 8. Potential Data Sources<br />Surveys<br /> Federal surveys: Population, employers<br />Government programs/agencies <br /> State Medicaid/CHIP programs<br /> Health insurance exchanges<br /> Tax information<br />Other<br /> Health carriers, hospitals, physicians<br />8<br />
  9. 9. Criteria for Selecting Data Sources<br />Ability to compare across states and over time<br />Population coverage – complete population of interest<br />Ability to do in-depth analysis within states (e.g., by age, income, race/ethnicity)<br />Often, this is a sample size issue<br />Timeliness of estimates<br />Accessibility of data<br />9<br />
  10. 10. What can be measured now? Coverage<br />10<br />*Reason previous coverage ended<br />
  11. 11. What can be measured now? Affordability/Comprehensiveness<br />11<br />
  12. 12. What can be measured now? Access<br />12<br />*Questions planned for addition to 2011 survey<br />
  13. 13. Where are the biggest gaps?<br />Private insurance: premiums and comprehensiveness of coverage<br />Gaps are especially large for nongroup coverage<br />Need to measure across the whole market, not just inside the exchange<br />Provider and safety net measures<br /> New entities/requirements under ACA:<br />Information related to insurance exchanges (enrollment, subsidies, exemptions from coverage mandate)<br />Information related to comprehensiveness of coverage (actuarial value)<br />13<br />
  14. 14. Challenges and opportunities<br />Population surveys: no one data source is clearly “best”<br />CPS and ACS have accessible 50-state estimates but are limited in scope<br />Potential to use NHIS and MEPS HC – but smaller sample sizes and restricted access to state-level data<br />For high-priority measures not currently available, will need a uniform way to collect across states<br />Planning should be part of ACA implementation<br />14<br />
  15. 15. 15<br />Contact Information<br />Julie Sonier, Deputy Director<br />State Health Access Data Assistance Center <br />University of Minnesota, Minneapolis, MN<br /><br /><br />(612) 625-4835<br />