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 Healthscott.leitz@state.mn.usscott.leitz@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@mathematicadlipson@mathematica--mpr.commpr.com(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 | anna.wolke@ncsl.organna.wolke@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 Health651-201-3565Scott.leitz@state.mn.us

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:–– health.chaps@ncsl.orghealth.chaps@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 atHealth.chaps@ncsl.orgHealth.chaps@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 || anna.wolke@ncsl.organna.wolke@ncsl.orghttp://www.ncsl.org/programs/health/forum/http://www.ncsl.org/programs/health/forum/