State Health Access Reform Evaluation

1. State Health Access Reform Evaluation Lynn A. Blewett, Ph.D. State Health Access Data Assistance Center State Coverage Initiatives (SCI) National Meeting Nashville, Tennessee February 8, 2007 Funded by a grant from the Robert Wood Johnson Foundation

2. Presentation Objectives • To get you to think about measurable outcomes during your discussions of health reform • To be specific about your expectations for reform initiatives • How you will know if the program achieved its objectives? What data will you need? • To talk to each other and reach consensus on expectations….. • Think about state-specific data needs and build those into your legislation

3. States Are in Different Phases of Reform Process

4. Public Sector Initiatives Framework for Reform SCHIP premium assistance HIFA expansion waivers Small employer purchasing pools Tax credits Employer-Based Initiatives Insurance Reform

5. INPUTS Preferences of individuals, organizations, interest groups, along with cultural Demographics, ethical, legal, social and technological inputs Legislation POLICY Adoption • POLICY FORMULATION • Agenda Setting • Assessment of Options • Political Setting POLICY IMPLEMENTATION Rulemaking Operation Window of Opportunity POLICY MODIFICATION Program Evaluation, Assess impact of policies Influence future policy formulation Longest, 1988.Policy Making Process in the US Source: Longest, 1998

6. Performance Assessment or Program Evaluation? • Performance Measurement • ongoing assessment • use of performance standards • early warning system to management • vehicle for improving accountability to the public • Program Evaluation • typically more in-depth examination of program • broader context of environment and alternatives • overall assessment of whether the program works • identification of adjustments that may improve its results Source: U.S. Government Accountability Office, 1998.

7. 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

8. Program Evaluation Data • Quantitative Data • Surveys, secondary data (uninsured rate) • Measures activities carried out • Administrative data: 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

9. Performance Assessment • How do you know if your health reform was successful? • Key Areas to Assess: • Coverage • Cost and Efficiency • Fairness and Equity • Choice and Autonomy • Develop goals that are measurable, assessable and realistic. • Consider short-term and long-term outcomes.

10. On Average Uninsurance Estimates from State Surveys are 22% Lower than CPS Uninsurance Estimates for Select States

11. Increased Sample Size in State Surveys

12. State Health AccessData Assistance Center • Funded by the Robert Wood Johnson Foundation • University of Minnesota, School of Public Health • Goals: • Help states monitor rates of health insurance coverage using state and federal data • Research factors associated with access and coverage • Provide targeted policy analysis and technical assistance to states • Bridge between state and federal agencies; between survey data and state health policy • Technical assistance on use of federal survey data and best practices on state surveys

13. State Health Access Reform Evaluation • National Program Office of the RWJF • Co-located with SHADAC at University of MN, SPH • Goals: • Fund and coordinate evaluations of state health reform • Identify and fill gaps on research to identify what works and why • Organize and disseminate findings in a manner that is meaningful and user-friendly • Inform state and national policy on health care access and coverage • Technical assistance on program evaluation and assessment

14. State Health Reform If States are the Laboratories….. Where are the lab reports?

15. Concluding Comments • Staff - Ask key legislative leaders what they will want to know next year? • Discuss long- and short-term program objectives and identify the monitoring process up front • Make sure staff understand legislative/policy objectives • Make sure policy makers understand limitations of data/measurement • Build performance assessment into legislative initiatives

16. More Concluding Comments Don’t forget to think about…. • Performance assessment and • Monitoring along the way • Likely within state government • Program evaluation • How are we going to know in 2-3 years if the program achieved its objectives? • Possible outside vendor/contractor • Thinknow about what you will want to know later • It’s more difficult to go back and evaluate a program without good baseline data and information

17. The SHADAC Vision Increase Coverage and Access Better Understanding of the Characteristics of the Uninsured Federal Data(e.g., CPS) State Data (e.g., State Surveys) THANK YOU!

18. 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)