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Using Data and Performance Measures to Evaluate State Health Reform … · 2007. 11. 9. · Health...
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Using Data and Performance Measures Using Data and Performance Measures to Evaluate State to Evaluate State
Health Reform ActivitiesHealth Reform Activities
Friday, November 9, 2007
1:00 pm EDT
This audioconference is sponsored by a generous grant from the Robert Wood Johnson Foundation, through the Forum for State Health Policy
Leadership
SpeakersSpeakersScott Scott LeitzLeitz, MPA, MPAAssistant CommissionerAssistant CommissionerMinnesota Department of HealthMinnesota Department of [email protected]@state.mn.us(651) 201(651) 201--35653565
Debra Lipson, MHSA Debra Lipson, MHSA Senior Researcher Senior Researcher MathematicaMathematica Policy Research, Inc.Policy Research, Inc.dlipson@[email protected](202) 484(202) 484--46844684
Anna WolkeAnna WolkeForum for State Health Policy Leadership Forum for State Health Policy Leadership National Conference of State LegislaturesNational Conference of State LegislaturesPhone: (202) 624Phone: (202) 624--3571 | 3571 | [email protected]@ncsl.org
Evaluation of State Health Access Initiatives: Concepts and Considerations
November 9, 2007
Scott Leitz, Assistant CommissionerMinnesota Department of Health
Overview
Context for state evaluationData sources and methodsSome additional thoughts and considerationsResources to assist and provide technical assistance
Number of Uninsured Children and Non-Elderly Adults, 2004-2006
34.6 35.6 37.0
9.48.78.4
2004 2005 2006
Source: KCMU/Urban Institute Analysis of the March CPS, 2005 to 2007.
In millions
Health Insurance Coverage by Income as a % of Poverty Levels, 2006
0%
20%
40%
60%
80%
100%
<100% FPG 100-199% FPG 200-399% FPG 400%+ FPG
Employer/Private Public Coverage Uninsured
Source: KCMU/Urban Institute Analysis of the March CPS, 2007.
Health Care Access Among Non-Elderly Adults, by Insurance Status, 2006
54%
26% 23%
10% 11% 9%10% 6% 3%0%
20%
40%
60%
No usual source ofcare
Post seeking caredue to cost
Needed care but didnot get it
Uninsured Public Coverage Privately Insured
Source: KCMU/Urban Institute Analysis of the March CPS, 2006.
12.0%
18.0%
14.0%
8.5%
0.8%
9.2%
7.7%
11.2%*
5.3%*
8.2%*
10.9%*
12.9%*
0%
2%
4%
6%
8%
10%
12%
14%
16%
18%
1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
Health Insurance PremiumsWorkers EarningsOverall Inflation
* Estimate is statistically different from the previous year shown at p<0.05.† Estimate is statistically different from the previous year shown at p<0.1.Note: Data on premium increases reflect the cost of health insurance premiums for a family of four. Source: KFF/HRET Survey of Employer-Sponsored Health Benefits: 1999-2004; KPMG Survey of Employer-Sponsored Health Benefits:1993, 1996; The Health Insurance Association of America (HIAA): 1988, 1989, 1990; Bureau of Labor Statistics, Consumer Price Index (U.S. City Average of Annual Inflation (April to April), 1988-2004; Bureau of Labor Statistics, Seasonally Adjusted Data from the Current Employment Statistics Survey (April to April), 1988-2004.
13.9%†
2.3%
2.2%
Increases in Health Insurance Premiums Compared to Other Economic Indicators, 1988-2006
Cumulative Change in Single and Family Insurance Premiums and the Federal Poverty Threshold, 1996 to 2004
Source: Kaiser Commission on Medicaid and the Uninsured.
Access
QualityCost
The Cost, Quality, and Access Triangle
Evaluation in a Broad Context
States frequently pass coverage and access expansions as part of broader health reform initiatives– Evaluation should consider these in combination where possible
“The Savings Offset Payment is determined based on all savings that are identified from the Dirigo Health reforms—not just the reduction in uncompensated care. In determining those savings we will measure the savings impact of the moratorium on the Certificate of Need; theimplementation of a Capital Investment Fund to limit future Certificate of Needs post-moratorium; the impact of rate regulation in the small-group insurance market; voluntary targets on hospital expenditures; the infusion of new state funds to match Medicaid for increases in physician and hospital payments to reduce cost shifting; and the costs associated with savings in the system resulting from insuring the previously uninsured”
– Trish Riley, State of Maine from “Profiles in Coverage: Maine Dirigo,” State Coverage Initiatives Program, May 2005.
Evaluation is important to:
See if what you thought would happen didLearn what didn’t and fix itCreate lessons for others and yourselfHold reforms accountableFigure out what to do next
Understanding what you want to evaluate is important
What you want to know will drive the data you need and the methods you usePerformance measurement versus program evaluation– Both important, but involve different methods and
answer different questionsAre you most interested in monitoring? Or do you want to answer a specific question about a specific intervention or policy?
Evaluating Access: Data sources and methods (a few examples)
QuantitativeSurveys– General population– Specific populations
Medicaid Administrative data
QualitativeFocus GroupsKey Informant interviews
Evaluating Access: Surveys
Surveys of the population can provide a snapshot of coverage– How many uninsured, demographic characteristics– Can also provide baseline to measure evaluation against
Can be designed to describe the state as a whole, or to survey specific subpopulations of interest (for instance, people who have disenrolled from a premium-based coverage expansion)National surveys versus state-specific surveys
National (Current Population Survey) versus state-specific surveys
Current Population Survey (CPS):– Conducted annually– Each state represented– Publicly available– Can be used to compare your state to other states– Useful for describing the general characteristics of the
uninsured population and overall trends in coverageBut:– For most states, lacks sufficient sample size to study
specific population groups or geographic areas– May lack questions that get at policy-level analysis– Is from a survey that isn’t specifically focused on collecting
information about health insurance coverage
State Conducted Surveys
Spurred by the HRSA state planning grant program, many states undertook efforts to conduct their own surveys of the population around access and insurance coverageState surveys:– Generally have larger sample sizes, allowing for better
analysis on subpopulations or geographically– Allow states to ask the specific questions of interest– Give state analysts greater control over the data
But:– State surveys are expensive– Generally are telephone surveys– Variability in vendors/survey design– And…again, they are expensive
Medicaid Administrative Data
All states collect information about enrollment in their Medicaid programs routinely as part of program administrationData can be used to look at a variety of issues surrounding MedicaidFor instance, can look at incomes and geographic location of enrollment are access expansions hitting their targets populations and enrollment numbers?But:– Medicaid administrative data doesn’t capture the entire
insurance market– Reliability can be questionable
Focus Groups
Involves talking to a group of individuals to gain insights into attitudes about a given topic – For instance, talking to young adults about their
attitudes toward purchasing health insurance coverage
Relatively low costCan get results relatively quicklyCan be used to supplement quantitative research, and more fully tell stories
Key Informant Interviews
Identifying different individuals who are especially knowledgeable about a given topicAsking them questions related to the evaluation or research question to gain a full understanding of the issueInterviews are usually conducted face to face and are used to gather information from people who have a deep level of understanding on a given issueFor instance, health care access for recent immigrants key informants might be community leaders, safety net providers, public health leaders, and othersLike focus groups, the qualitative nature of the interviews can yield information at a relatively low cost compared to quantitative survey work
Some Thoughts and Considerations
Consider methods that measure both quantitatively and qualitativelyWhen a state data source isn’t there, can national data be adapted?Get to know your local university (and help them to get to know you)– You scratch my back…
Leverage your Medicaid program– Survey and other evaluation related to the operation of the
Medicaid program can frequently be eligible for federal matching funds
Build an understanding of your private market
One Example: Minnesota’s Health Plan Financial and Statistical Survey
Conducted annuallyAll state licensed carriers required to complete a four page surveyIn aggregate, details:– Premium revenue by business line– Enrollment by business line– Claims expenditures by business line and service category (i.e.
hospital, physician, drugs, etc.)– Detailed administrative cost breakdown
Allows tracking of how fast premiums and underlying costs are growing, as well as enrollment in the commercial market Combined with data from surveys on the uninsured, Medicare and Medicaid enrollment, allows ongoing estimates of where Minnesotans get their insurance coverage by source
Insurance markets are becoming increasingly consolidated, making collection of this information more feasible
Evaluation Resources
State Health Access Data Assistance CenterState Health Access Reform Evaluation (SHARE) InitiativeState Coverage Initiatives programHealth policy and analysis firmsNational studiesAnalysis of other states
Contact
Scott Leitz, Assistant CommissionerMinnesota Department of [email protected]
Evaluation ofMaine Dirigo Health Reform:
Selection of Measures and Data to Assess Progress
Evaluation ofMaine Dirigo Health Reform:
Selection of Measures and Data to Assess Progress
National Conference of State LegislaturesUsing Data and Performance Measures to Evaluate State Health
Reform Activities
November 9, 2007
Debra J. Lipson
National Conference of State LegislaturesUsing Data and Performance Measures to Evaluate State Health
Reform Activities
November 9, 2007
Debra J. Lipson
26
Overview of PresentationOverview of Presentation
Background on Dirigo Health Reform
Evaluation questions, study design
Selection of measures and data sources
Pros & cons of different data sources – and a sneak preview of results
Caveats & cautions in interpreting results
Background on Dirigo Health Reform
Evaluation questions, study design
Selection of measures and data sources
Pros & cons of different data sources – and a sneak preview of results
Caveats & cautions in interpreting results
27
Dirigo Health Reform GoalsDirigo Health Reform Goals
Make affordable health care coverage available to every Maine citizen by 2009 (~ 140,000 uninsured in 2003)
Slow the growth of health care costs through cost containment
Improve quality of care—for example, by comparing provider performance to quality measures
Make affordable health care coverage available to every Maine citizen by 2009 (~ 140,000 uninsured in 2003)
Slow the growth of health care costs through cost containment
Improve quality of care—for example, by comparing provider performance to quality measures
28
Dirigo Health Coverage Expansion Initiatives
Dirigo Health Coverage Expansion Initiatives
DirigoChoice –subsidized insurance product for small groups, self-employed, and individuals
Increased Medicaid eligibility for parents of dependent children –from max. of 150% FPL to 200% FPL
DirigoChoice –subsidized insurance product for small groups, self-employed, and individuals
Increased Medicaid eligibility for parents of dependent children –from max. of 150% FPL to 200% FPL
29
Evaluation QuestionsEvaluation Questions
Are low-income uninsured people gaining coverage under DirigoChoice or Medicaid?
How have small employers responded to the availability of DirigoChoice?
Are the DirigoChoice subsidy financing sources adequate and sustainable to cover many more low-income uninsured?
Is Maine’s approach to health coverage expansion relevant elsewhere? What can other states learn from its experience?
Are low-income uninsured people gaining coverage under DirigoChoice or Medicaid?
How have small employers responded to the availability of DirigoChoice?
Are the DirigoChoice subsidy financing sources adequate and sustainable to cover many more low-income uninsured?
Is Maine’s approach to health coverage expansion relevant elsewhere? What can other states learn from its experience?
30
Study Design & MethodsStudy Design & Methods
Mixed Methods: Qualitative & Quantitative
– Analysis of DirigoChoice & Medicaid administrative data on enrolled firms and individuals
– Survey of small businesses in Maine
– Key stakeholder interviews
– Comparison of Maine to other states vis-a-vis: health insurance coverage, small group and individual market regulations, health care delivery system, Medicaid policies
Mixed Methods: Qualitative & Quantitative
– Analysis of DirigoChoice & Medicaid administrative data on enrolled firms and individuals
– Survey of small businesses in Maine
– Key stakeholder interviews
– Comparison of Maine to other states vis-a-vis: health insurance coverage, small group and individual market regulations, health care delivery system, Medicaid policies
31
Data Sources & AnalysesData Sources & Analyses
Relevance to Other StatesRelevance to Relevance to Other StatesOther States
Key stakeholders’ views of progress, problems
Key stakeholders’ Key stakeholders’ views of progress, views of progress, problemsproblems
Small employersurvey
Small employersurvey
DirigoChoice & Medicaidenrollment
DirigoChoice & Medicaidenrollment
32
Outcome MeasuresShort-term vs. Long-Term
Outcome MeasuresShort-term vs. Long-Term
Program Enrollment- Administrative Data
Uninsured rate- CPS, MEPS
Stakeholder views on program design/ implementation- Surveys, Focus groups
Sufficient and sustainable financing for coverage expansion
Employer opinions & enrollment rates- Surveys, admin. data, focus groups
Rate of (small) Employer Health Benefits Offers- MEPS
Risk profile of enrolleesDiagnoses, 6-month claims data
Risk selection in state programYearly claims data, Insurer MLRs
33
Short-Term Outcome
Program Enrollment
Short-Term Outcome
Program Enrollment
34
Dirigo Choice EnrollmentJanuary 2005–September 2006
Dirigo Choice EnrollmentJanuary 2005–September 2006
12,000
0
2,000
12,000
Jan05
Feb05
Mar05
Apr05
May05
Jun05
Jul05
Aug05
Sep05
Oct05
Nov05
Dec05
Jan06
Feb06
Mar06
Apr06
May06
Jun06
Jul06
Aug06
Sep06
Mem
bers
Small group Sole proprietor Individual
6,000
4,000
10,000
8,000
35
Enrollment in Dirigo HealthMedicaid Expansion GroupsEnrollment in Dirigo HealthMedicaid Expansion Groups
0
5000
10000
15000
30000
Sep-02
Nov-02
Jan-03
Mar-03
May-03
Jul-0
3Sep
-03Nov-0
3Ja
n-04Mar-
04May
-04Ju
l-04
Sep-04
Nov-04
Jan-05
Mar-05
May-05
Jul-0
5Sep
-05Nov-0
5Ja
n-06Mar-
06May
-06Ju
l-06
Sep-06
Nov-06
Date
Mon
thly
Cas
eloa
d
Childless Adults Medicaid Expansion to Parents
January 05: DirigoChoice began March 05: Childless adult freeze instituted
July 06: Childless adult freeze lifted
April 05: Parent Expansion (150-200% FPL)
2500025000
2000020000
36
Administrative Data IssuesAdministrative Data Issues
Data completeness and reliability– Incomplete data, data entry errors
– Question wording, e.g. uninsured at time of enrollment or for entire previous year
Data Interpretation – Enrollment procedures, market developments
Differences between State and National Data
Data completeness and reliability– Incomplete data, data entry errors
– Question wording, e.g. uninsured at time of enrollment or for entire previous year
Data Interpretation – Enrollment procedures, market developments
Differences between State and National Data
37
2006 Enrollment in DirigoChoice by Uninsured - Administrative Data
2006 Enrollment in DirigoChoice by Uninsured - Administrative Data
4%4%3%9%2006
responses not usable
31%28%30%37%Uninsured
65%68%67%54%Prior coverage
TotalIndividualsSole
proprietorsSmall firm workers
2005 responses not usable
83% 77% 75% 80%
38
Short-Term Outcomes
Small Employer Survey Results
Short-Term Outcomes
Small Employer Survey Results
39
Small Employer SurveyFirm Characteristics by Offer Type
Small Employer SurveyFirm Characteristics by Offer Type
24++
(17%)36++
(30%)89++
(17%)149
(19%)Professional services & management (industry type)
Average wage
55%**26%**45%44%Mean percent who earn less than $12 per hour
5.0**17.7**6.78.1Mean number of employees
143(18%)
121(16%)
509(66%)
773(100%)All firms
Coverage offered
None Another plan DirigoChoice All firms
responding Firm characteristics
12%*32%**17%18%Mean percent who earn more than $18 per hour
33%*43%**39%38%Mean percent who earn $12 to $18 per hour
*p < .05 ** or ++ p < .01
40
Why Firms That Considered DirigoChoice Did Not Enroll (n = 78)
Why Firms That Considered DirigoChoice Did Not Enroll (n = 78)
Too costly or not affordable
Benefits offered do not fit employees’ needs
Did not qualify for DirigoChoice
Other reasons
Too costly or not affordable
Benefits offered do not fit employees’ needs
Did not qualify for DirigoChoice
Other reasons
45 (58%)45 (58%)
19 (25%)19 (25%)
6 (8%)6 (8%)
8 (10%)8 (10%)
41
Survey Data IssuesSurvey Data Issues
Sample design tailored to purpose:– Compare small firms enrolled in DirigoChoice to
firms eligible but not enrolled
Versus
-- DirigoChoice firms only-- Firms disenrolled from DirigoChoice
Assuring sample representativeness can be costly
Sample design tailored to purpose:– Compare small firms enrolled in DirigoChoice to
firms eligible but not enrolled
Versus
-- DirigoChoice firms only-- Firms disenrolled from DirigoChoice
Assuring sample representativeness can be costly
42
Survey vs. Administrative DataSurvey vs. Administrative Data
SourceMean number of
Employees in DirigoChoice Firms
MPR Survey6.7
Dirigo Administrative Data 4.3
43
Short-Term Outcome
Stakeholder Views of Progress, Problems and Prospects
Short-Term Outcome
Stakeholder Views of Progress, Problems and Prospects
44
Key Stakeholder Viewsof DirigoChoice
Key Stakeholder Viewsof DirigoChoice
Benefits more comprehensive than most small group and individual policies in the market
Small firm enrollment depressed by high premiums, 60% employer contribution requirement, weak incentives, administrative burden, marketing problems
Legal and political clashes over SOP undermined support for program
Insurers “agreed” to recover SOP by reducing provider payments and passing on the savings to consumers via lower premiums, but instead passed on the costs
Benefits more comprehensive than most small group and individual policies in the market
Small firm enrollment depressed by high premiums, 60% employer contribution requirement, weak incentives, administrative burden, marketing problems
Legal and political clashes over SOP undermined support for program
Insurers “agreed” to recover SOP by reducing provider payments and passing on the savings to consumers via lower premiums, but instead passed on the costs
45
Stakeholder ViewsPros Cons
Stakeholder ViewsPros Cons
Understand why things occur: reasons for results, how reforms did or did not cause intended effects
Learn what else is going on simultaneously that may affect results, e.g. new insurance products for small groups, economic developments, politics
Understand why things occur: reasons for results, how reforms did or did not cause intended effects
Learn what else is going on simultaneously that may affect results, e.g. new insurance products for small groups, economic developments, politics
Interest groups may try to use researchers to promote their agendas
Nuances of state history, context, and relationships can make it hard to translate lessons to other states
Interest groups may try to use researchers to promote their agendas
Nuances of state history, context, and relationships can make it hard to translate lessons to other states
46
Translating Lessons to Other StatesTranslating Lessons to Other States
Problemcharacteristics of
uninsured
Design of coverage strategies
Implementation
Policy goals & focusCoverage expansion
Cost containmentQuality
Market & regulatory context
Insurance marketsHC delivery system
Insurance regulation
Financing sourcesFMAP
State tax policiesUncomp. care pool
47
Caveats and ChallengesCaveats and Challenges
Comparisons – useful for assessing progress, but what’s the right benchmark?
– State goal?– Actual to projected performance?
Reconciling differences between state and national data
Program changes during evaluation
Taking into account state officials views/information
Comparisons – useful for assessing progress, but what’s the right benchmark?
– State goal?– Actual to projected performance?
Reconciling differences between state and national data
Program changes during evaluation
Taking into account state officials views/information
48
Credits and AcknowledgmentsCredits and Acknowledgments
Co-authors– Jim Verdier, Lynn Taylor, Shanna Shulman,
Elizabeth Seif, Matt Sloan, Bob Hurley
Sponsors– The Commonwealth Fund– The Robert Wood Johnson Foundation,
Changes in Health Care Financing and Organization
Co-authors– Jim Verdier, Lynn Taylor, Shanna Shulman,
Elizabeth Seif, Matt Sloan, Bob Hurley
Sponsors– The Commonwealth Fund– The Robert Wood Johnson Foundation,
Changes in Health Care Financing and Organization
Any QuestionsAny Questions
Among the Panelists?Among the Panelists?
From the audience?From the audience?–– Please use the Q and A panel to submit your Please use the Q and A panel to submit your
questions.questions.
After the call, email questions and After the call, email questions and suggestions for future websuggestions for future web--conferences conferences to:to:–– [email protected]@ncsl.org
Exploring Accountability in Health Care from Exploring Accountability in Health Care from Four PerspectivesFour Perspectives
This is the fourth and final part of the series Exploring AccounThis is the fourth and final part of the series Exploring Accountability in Health Care from Four Perspectives. Archived tability in Health Care from Four Perspectives. Archived copies of the first three parts of this series are available at copies of the first three parts of this series are available at http://www.ncsl.org/programs/health/webcast2.htmhttp://www.ncsl.org/programs/health/webcast2.htm..
Transparency in Health CareTransparency in Health CareThis webThis web--assisted assisted audioconferenceaudioconference will explore the idea of transparency in health care, what it mwill explore the idea of transparency in health care, what it means and howeans and howconsumers can lower their health care costs and receive more effconsumers can lower their health care costs and receive more effective and higher quality care. This discussion willective and higher quality care. This discussion willinclude state activities to increase transparency in their systeinclude state activities to increase transparency in their systems. ms. View the archive at View the archive at http://www.ncsl.org/programs/health/webcastoct07.htm#Ihttp://www.ncsl.org/programs/health/webcastoct07.htm#I..
–– Nancy Wilson, Senior Advisor to the Director, Agency for HealthcNancy Wilson, Senior Advisor to the Director, Agency for Healthcare Research and Qualityare Research and Quality
–– Patricia Patricia KolodzeyKolodzey, Associate Director, Associate Director--Legislative Affairs, Texas Medical AssociationLegislative Affairs, Texas Medical Association
Provider Incentives to Improve AccountabilityProvider Incentives to Improve AccountabilityThis webThis web--assisted assisted audioconferenceaudioconference will focus on performance measurement from a provider perspectiwill focus on performance measurement from a provider perspective, and willve, and willexplore pay for performance programs and physician incentives.explore pay for performance programs and physician incentives. Dr. Dr. GlaseroffGlaseroff will focus on the challenges andwill focus on the challenges andtriumphs of California's experience with pay for performance, antriumphs of California's experience with pay for performance, and will also address what other states can do to buildd will also address what other states can do to buildan accountable health system.an accountable health system. View the archive at View the archive at http://www.ncsl.org/programs/health/webcastoct07.htm#IIhttp://www.ncsl.org/programs/health/webcastoct07.htm#II. .
–– Moderator: Representative Moderator: Representative PebblinPebblin Warren, AlabamaWarren, Alabama–– Alan Alan GlaseroffGlaseroff, President of the Humboldt , President of the Humboldt -- Del Norte Foundation for Medical Care and chief medical officerDel Norte Foundation for Medical Care and chief medical officer
of the Humboldtof the Humboldt--Del Norte Independent Practice AssociationDel Norte Independent Practice Association
The Outcomes of Addiction Treatment and Approaches to Measuring The Outcomes of Addiction Treatment and Approaches to Measuring PerformancePerformanceThis webThis web--assisted assisted audioconferenceaudioconference will help legislators address issues of performance measurementwill help legislators address issues of performance measurement and treatmentand treatmentefficacy in addiction treatment, including performanceefficacy in addiction treatment, including performance--based contracting and how states are increasing their returnbased contracting and how states are increasing their returnon investments.on investments. Dr. Brooks will discuss outcome and performance measures and thDr. Brooks will discuss outcome and performance measures and their use in quality improvementeir use in quality improvementand accountability, new ways to look at treatment effectiveness,and accountability, new ways to look at treatment effectiveness, and legislators' options for promoting accountabilityand legislators' options for promoting accountabilitythrough performance improvement initiatives. Ms. Johnson will dithrough performance improvement initiatives. Ms. Johnson will discuss the Maine Office of Substance Abuse'sscuss the Maine Office of Substance Abuse'sperformanceperformance--based contracting with its substance abuse treatment providers.based contracting with its substance abuse treatment providers. View the archive atView the archive athttp://www.ncsl.org/programs/health/webcastnov07.htm#Ihttp://www.ncsl.org/programs/health/webcastnov07.htm#I. .
–– Adam Brooks, Ph.D., Scientist, Treatment Research Institute Adam Brooks, Ph.D., Scientist, Treatment Research Institute
–– Kimberly Johnson, former Director, Maine Office of Substance AbuKimberly Johnson, former Director, Maine Office of Substance Abusese
To follow upTo follow up
To register for other parts of this series exploring To register for other parts of this series exploring accountability in health care please go here accountability in health care please go here http://www.ncsl.org/programs/health/webcast2.htmhttp://www.ncsl.org/programs/health/webcast2.htm
Feel free to contact us for more information atFeel free to contact us for more information [email protected]@ncsl.org
For more program information and related links, and to see For more program information and related links, and to see past programs:past programs:http://www.ncsl.org/programs/health/webcast2.htmhttp://www.ncsl.org/programs/health/webcast2.htm
This program was recorded and will be made available on This program was recorded and will be made available on line.line.
Speakers’ resourcesSpeakers’ resourcesState Health Access Data Assistance Center (SHADAC) at the UniveState Health Access Data Assistance Center (SHADAC) at the University of rsity of Minnesota School of Public Health Minnesota School of Public Health http://www.shadac.umn.edu/http://www.shadac.umn.edu/
State Health Access Reform Evaluation (SHARE) Initiative State Health Access Reform Evaluation (SHARE) Initiative http://www.statereformevaluation.org/http://www.statereformevaluation.org/
State Coverage Initiatives program State Coverage Initiatives program http://statecoverage.net/http://statecoverage.net/
MathematicaMathematica Policy Research, Inc. Policy Research, Inc. http://www.mathematicahttp://www.mathematica--mpr.com/index.aspmpr.com/index.asp
Robert Wood Johnson Foundation Robert Wood Johnson Foundation http://http://www.rwjf.orgwww.rwjf.org::–– Changes in Health Care Financing and Organization Changes in Health Care Financing and Organization
http://http://www.hcfo.net/index.cfmwww.hcfo.net/index.cfm
The Urban Institute The Urban Institute http://www.urban.org/http://www.urban.org/
Center for Health Care Strategies Center for Health Care Strategies http://www.chcs.org/http://www.chcs.org/
The The LewinLewin Group Group http://www.lewin.com/http://www.lewin.com/
Resources from NCSLResources from NCSLCHAP page for Healthcare Access CHAP page for Healthcare Access http://www.ncsl.org/programs/health/forum/chap/ahttp://www.ncsl.org/programs/health/forum/chap/access.htmccess.htm
State Health Notes articles on Healthcare AccessState Health Notes articles on Healthcare Accesshttp://www.ncsl.org/programs/health/shn/access.hthttp://www.ncsl.org/programs/health/shn/access.htmm
Subscribe to our biSubscribe to our bi--weekly newsletterweekly newsletterState Health NotesState Health Notes
http://www.ncsl.org/shn/http://www.ncsl.org/shn/Anna Anna WolkeWolkeForum for State Health Policy Leadership Forum for State Health Policy Leadership National Conference of State LegislaturesNational Conference of State LegislaturesTel: 202Tel: 202--624624--3571 3571 || [email protected]@ncsl.orghttp://www.ncsl.org/programs/health/forum/http://www.ncsl.org/programs/health/forum/