State Health Access Program (SHAP) – Data and Evaluation

Elizabeth Lukanen, MPHState Health Access Data Assistance Center University of Minnesota, Minneapolis, MN

National Leadership Series

Improving Operational and Leadership Success

January 20, 2011

www.shadac.org

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

www.shadac.org 3

About SHADAC

Bridging the Gap Between Research and Policy

www.shadac.org 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

www.shadac.org 5

SHADAC Objectives

• Support states in their data, survey, policy and evaluation activities– Help states monitor rates of insurance coverage and

understand factors associated with uninsurance– Provide assistance to states on policy development,

program evaluation and assessment

• Provide support to federal agencies related to conducting health insurance surveys

• Disseminate research findings in a manner that is meaningful to state and national policy-makers

www.shadac.org 6

SHADAC’s Core Activities

• Technical Consultation with States– State survey design and implementation– Clarify variance between state estimates from different surveys

• Targeted Policy and Evaluation Work– Evaluation design and implementation– Policy analysis of coverage options

• Best Practices for Surveys on the Uninsured– Best way of asking insurance, income, race/ethnicity questions– Reviewing and improving estimates from national surveys

• Promoting Use of Sound Data and Methods– Production of issue briefs, webinars, presentations, web content– Translating research into useful information

www.shadac.org

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

www.shadac.org

SHADAC’S ROLE AS TECHNICAL ASSISTANCE PROVIDER TO SHAP GRANTEES

8

Portland, Oregon

www.shadac.org

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

www.shadac.org 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

www.shadac.org

SHAP EVALUATION OVERVIEW

11

Madison, Wisconsin

www.shadac.org 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

www.shadac.org 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

www.shadac.org

SHAP PROGRESS

14

Albany, New York

www.shadac.org 15

Enrollment as of July 1, 2010State Total Enrollment Residual Enrollment

Colorado 191 Report pendingKansas

981241 from Title 19 and 21

programsMaine 13 Report pendingMinnesota

7931022 enrollments in

Minnesota's public health care programs 11/1/09 - 6/30/10

Nevada 137 Report pendingNew York 1,861 Report pendingOregon 67,137 Report pendingWisconsin

5,30020,960 applied for FoodShare (but acceptance not tracked)

North Carolina

Enrollment hadn’t opened as of July, 2010. Updated enrollment figures will be collected in February, 2011.

TexasVirginiaWashingtonWest VirginiaTOTAL 76,413

www.shadac.org

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

www.shadac.org

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

www.shadac.org

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

www.shadac.org

SHAP AND THE AFFORDABLE CARE ACT

19

Seattle, Washington

www.shadac.org

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

Small Employer Tax Credit

Exchange

55-64 Reinsurance

Dependent Care

Coverage

High Risk Pool

Early Medicaid

Today2010 2014

Bridge to Reform

HRSA SHAP

CoverageMandate133%

Medicaid200-400

Tax Credit

www.shadac.org

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

www.shadac.org

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

www.shadac.org 24

Contact Information

Minnesota SHAP Project Team:• Lynn Blewett, Ph.D.• Kelli Johnson, MBA• Elizabeth Lukanen, MPH

* Primary contact – elukanen@umn.edu, 612-626-1537

Website: www.shadac.org/shap

State Health Access Data Assistance Center

University of Minnesota, Minneapolis, MN

www.shadac.org

©2002-2009 Regents of the University of Minnesota. All rights reserved.The University of Minnesota is an Equal Opportunity Employer