HHS Data Enhancements to Monitor Implementation and
Impact of Health Reform
Jim ScanlonDeputy Assistant Secretary for Planning and
Evaluation
Overview
• Health System Measurement Project• ACA Data Collection Standards• Enhancements to HHS Surveys • Survey Methodology Initiatives
Health System Measurement Project I
• Web Portal• Indicators in each of ten domains to monitor
implementation &impact of health reform– Insurance Coverage – Access to Care– Vulnerable Populations– Workforce– Population Health
Health System Measurement Project II
• Indicators in each of ten domains to monitor implementation &impact of health reform– Quality – Preventive Services – Innovation– Affordability – Health Information Technology Adoption – https://healthmeasures.aspe.hhs.gov/
ACA Data Collection Standards
• ACA Section 4302 requires Secretary to adopt data collection standards for inclusion in all HHS health surveys
• Race• Ethnicity• Sex• Primary language• Disability
ACA Data Collection Standards
• HHS Data Council developed recommendations
• Public comment• Adopted by Secretary in October 2011 for
inclusion in all HHS population health surveys • Based on self reports • Now being implemented in HHS surveys • Now considering standards for admin data.
What is your race? (One or more categories may be marked)
– White – Black or African
American– American Indian or
Alaska Native – Asian Indian – Chinese – Filipino– Japanese– Korean – Vietnamese – Other Asian
– Native Hawaiian – Guamanian or
Chamorro – Samoan – Other Pacific
Islander
Ethnicity
• Are you of Hispanic, Latino, or Spanish origin? (one or more categories may be marked)
– No, not of Hispanic, Latino, or Spanish origin; – Yes, Mexican, Mexican-American, Chicano; – Yes, Puerto Rican; – Yes, Cuban; – Yes, another Hispanic, Latino, or Spanish origin-
Sex
• What is your sex?– Female– Male
Primary Language
• Measure of English Proficiency• How well do you speak English? (5 years of age or
older)
– Very well– Well– Not well– Not at all
Primary Language
• Measures of spoken language, for additional and optional granularity:
• Do you speak a language other than English at home?– Yes– No
• If yes, what is this language?– Spanish– Other language: ______________
Disability (ACS)
• Are you deaf or do you have serious difficulty hearing? – Yes – No
• Are you blind or do you have serious difficulty seeing, even when wearing glasses?– Yes – No
• Because of a physical, mental, or emotional condition, do you have serious difficulty concentrating, remembering, or making decisions? (5 years of age or older)– Yes -- No
Disability • Do you have serious difficulty walking or climbing stairs? (5 years of age
or older)– Yes – No
• Do you have difficulty dressing or bathing? (5 years of age or older)– Yes – No
• Because of a physical, mental, or emotional condition, do you have difficulty doing errands alone such as visiting a doctor's office or shopping? (15 years old or older)_ Yes _ No
Current HHS Data Portfolio
• HHS currently supports a number of major data collection systems, including– Health surveys– Administrative data – Surveillance and research data – Also microsimulation modeling
Surveys and Health Reform
• Portfolio includes household, provider, and establishment-based surveys– Several household surveys are integrated– Certain surveys are linked to Medicare claims data– Some surveys provide state-level data – Certain surveys contain a longitudinal component
Enhancements to Surveys to Monitor Health Reform
• Working Group on Data to Monitor Health Reform• Medical Expenditure Panel Survey• National Health Interview Survey• Behavioral Risk Factor Surveillance Survey • National Health Care Survey• CMS Administrative Data• Work with Census Bureau on ACS and CPS
MEPS - HC
• MEPS Household Component– Already strong platform for measuring
insurance coverage, source, transitions, utilization and expenditures
– Added questions on high risk pools, health savings accounts, high deductible health plan, flexible spending accounts.
MEPS - IC
• MEPS Insurance Component• Potential additional questions on
– employer plans and offerings– firm size– actuarial value and stop loss policies– wellness programs, and – characteristics of self insured plans and small
employer anticipated exchange participation.
National Health Interview Survey
• Sample size expanded in 2011 to increase the number of state estimates
• Enhanced questions on access and utilization of services
• Additional Early Release reports are planned that will cover 6 months of data using the new access and utilization questions
NHIS - New Questions
• Changes in coverage for ages 19 to 25 • Coverage of family members living outside the
household & persons living outside household• Use of primary care physician required by
policy• Attempts at direct purchase of insurance• Affordability/Financial burden of medical care
NHIS Additions
• Awareness of long term care insurance; • Difficulty finding appropriate care when needed; • Emergency department visits; • Why no usual source of care• Use of ACA preventive services; • Using computers for health information, and• Skimping or nonuse of prescriptions drugs due to
cost
BRFSS
• BRFSS is a state-based, on-going telephone health survey system on health conditions and risk behaviors in 50 States.
• To help States monitor health reform, new questions and detail have been added on – Insurance coverage and source– Access to care– Use of preventive services
NAMCS
• Increase in sample will permit State estimates• Questions added for physicians on
– Average time for patients to obtain an appointment, time set aside for same day appts,
– EHR adoption – Is practice currently accepting new patients– For new patients, types of payment accepted– Percent of current patients with payment from
Medicaid/CHIP
Collaboration with Census
• Testing of exchange and subsidy questions on CPS
• ACS health insurance questions
Survey Methodology Initiatives
• NHIS– Web Panel for quick response data MEPS– Quick response telephone survey – Internet panel– Extend longitudinal componentNAMCS– EHR pilot studies
New Data Availability
• Administrative Data– Claims data– APCD– Exchange data- enrollment, eligibility, subsidies– Health plan reporting
• Electronic health records data– HMO Networks– Public health
Monitoring Health Reform• Importance of State Level Health Policy Data • Key Subpopulations Impact Data
– Race and Ethnicity, disabled, rural etc. • Baseline and progress measures
– Insurance coverage and source– Transitions into Medicaid/exchanges– Subsidies– Access to Care – Employer behavior
Issues
• Provider behavior• Plan behavior• Individual and family behavior• Key national indicators – coverage, access,
utilization, expenditures and affordability
Jim ScanlonDeputy Assistant Secretary for Planning and
EvaluationU.S. Department of Health and Human Services