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

Jim.Scanlon@hhs.govwww.aspe.hhs.gov