1. State Health Access Program (SHAP) – Data and Evaluation Elizabeth Lukanen, MPH State Health Access Data Assistance Center University of Minnesota, Minneapolis, MN National Leadership Series Improving Operational and Leadership Success January 20, 2011
2. Overview About SHADAC SHADAC’s role as Technical Assistance Provider to SHAP Grantees SHAP Evaluations SHAP Progress SHAP and the Affordable Care Act (ACA) 2
3. 3 About SHADAC Bridging the Gap Between Research and Policy
4. 4 What is SHADAC? Independent research center located at the University of Minnesota School of Public Health Led by an interdisciplinary team of tenured faculty and supported by research fellows and graduate research assistants Primary funding from Robert Wood Johnson Foundation Additional project-specific funding from CDC, ASPE, CMS, state-specific contracts, etc. Funding from HRSA to provide technical assistance to SHAP grantees
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6. Participant Poll How often do you use data or evaluation results to make programmatic decisions? Frequently Occasionally We plan to , but Rarely do Never 7
7. SHADAC’s role as Technical Assistance Provider to SHAP Grantees 8 Portland, Oregon
8. SHAP Technical Assistance Review grantee evaluation plans Provide advice on outcome indicators, data sources, data availability, and evaluation methods Provide technical assistance to grantees in: Selecting appropriate metrics to allow measurement of progress toward objectives Identifying the types and sources of available data Assisting in the use of longitudinal data where feasible Advise on survey development Assessing differences between state and federal survey data Assist with small area estimation Support development of Return on Investment (ROI) methods 9
9. 10 SHAP Benchmark Data Collection Comparable information collected from all grantees Data on direct enrollment and residual enrollment Information about barriers, successes and lessons learned Used to demonstrate success of SHAP and provide lessons for implementation of Affordable Care Act (ACA) Collected bi-annually in concurrence with HRSA reporting Context is crucial for communicating key lessons
11. 12 SHAP Evaluation - Overview Vary in size and budget 5 year budgets range from $120,000 to >$2,000,000 From <1% to 10% of budgets 8 states contracting out evaluation Primarily local universities and health policy centers Evaluation progress is varied across grantees
12. 13 SHAP Evaluation Overview - Data and Methods All states are utilizing administrative data Cost, enrollment, demographics 9 states are conducting surveys Enrollee, employer, state-wide household 5 states are conducting focus groups or key informant interviews Enrollees, employers, eligibility staff 3 states are conducting Return on Investment (ROI) analysis as they related to multi-shares
15. Implementation Challenges Slow internal processes for hiring, procurement and contract execution State budget shortfalls and subsequent hiring freezes, which have impacted state personnel capacity Longer than anticipated time needed to engage stakeholders and build partnerships Uncertainty and need for programmatic restructuring due to the passage of the ACA 16
16. Implementation Lessons Stakeholder engagement, though time consuming, is crucial to program success Program take-up is slow unless accompanied by targeted outreach and messaging Coverage expansions must be accompanied by improvements in eligibility and enrollment systems The benefit of wellness initiatives may not be realized in the short term Lack of data and information hinders strategic planning and decision making 17
17. Participant Poll How much has the passage of the ACA affected your day-to-day work? A great deal A little bit Not very much Not at all 18
18. SHAP and the Affordable Care Act 19 Seattle, Washington
19. Medicaid Expansion in Affordable Care Act (ACA) New mandatory eligibility group for low-income individuals – 2014 implementation date Includes all persons with family incomes up to 133% of the FPL who are not: Age 65 and older Eligible for Part A Medicare or enrolled in Part B Undocumented (i.e. unauthorized) immigrants 20 Newly covered include children 6-19, parents of covered children, childless adults
23. SHAP & Affordable Care Act Many SHAP activities are relevant to health reform: Enrollment, outreach and coverage for low income adults Enrollment, outreach and coverage for small businesses No wrong door enrollment systems Insurance exchanges Coordinated safety net programs Testing medical home models And more…… 22
24. Using SHAP Evaluation to Inform Implementation of Affordable Care Act Information from the SHAP evaluation can inform implementation of Affordable Care Act: Best practices on enrollment and retention Indentifying outreach strategies to reach low income adults and small businesses Collecting characteristics and service use of newly insured, low income adults Process and models to build insurance exchanges Testing of “benchmark plan” type programs Examining medical home and care coordination models 23
