1 American Public Health Association 132 nd Annual Meeting Elaine Vowels, PhD Fern Johnson-Clarke, PhD Carl W. Wilson, MPH Building Public Health Data Infrastructure for the Uninsured

2  Overview  Selected Statistical Indicators  Examples of Data Comparisons  Components for Building and Data Infrastructure  District of Columbia Examples  Lessons Learned Agenda

3  Over 44 million people in the United States are uninsured  Comprehensive data collection systems are not in place to measure the health status and demographic characteristics of the uninsured.  Data systems need to be able to measure access to care and health care access disparities among special populations Overview

4  A considerable amount of data on the uninsured exists within state agencies but is not fully integrated or shared.  Data sharing agreements and systems for sharing data must be developed to better serve the uninsured.

5  Percentage of uninsured  Health status characteristics  Demographic & employment status  Insurance status  Health care coverage and the uninsured  Medicaid and Medicare coverage  Health care costs  Managed care enrolment  Uncompensated care levels  Disparities among minorities  Needs of special populations Selected Statistical Indicator Examples

6 How does the District Compare to other States?  The District’s rate of uninsurance is below the national average  The District’s uninsurance rate is similar to the rates in Maryland and Virginia

7 Population Distribution by Insurance Status, State Data , U.S 2003 IndicatorUnited States DistrictMarylandVirginia Employer54%52%63%60% Individua l 5% 4%5% Medicaid13%19%8%10% Medicare12%11% 12% Uninsured16%14% 13% Source: Kaiser Family Foundation State Health Facts Web Site

8 Rate of Non Elderly Uninsured By Race/Ethnicity, State Data , U.S IndicatorUnited States DistrictMarylandVirginia White13%6%10%11% Black21%18%17%20% Hispanic34%31%48% Other20%-21%12% Source: Kaiser Family Foundation State Health Facts Web Site

9 Distribution of Children 18 and Under by Insurance Status, state data , U.S IndicatorUnited States DistrictMarylandVirginia Employer57%43%70%65% Individua l 4%2%4% Medicaid27%44%17%20% Medicare0% Uninsured12%10%9%11% Source: Kaiser Family Foundation State Health Facts Web Site

10 Major Data Systems Building Blocks  Vision  Partnerships  Funding  Tools and systems  Opportunities  Confidentiality and privacy Building Public Health Data Infrastructure

11 Building public health data infrastructure requires the skillful use of a number of tools. T Partnerships Opportunities Vision Funding Confidentiality and Privacy Tools & Systems

12 A vision must be developed that articulates a direction for infrastructure development efforts.  Look ahead  Develop a strategy  Develop a plan  Leverage existing efforts Vision

13 Build partnerships with key agencies to increase data sharing opportunities.  Develop partnerships to share data  Build trust among partners  Collaborate on joint projects and grants Building Partnerships

14 Identify short term and long term funding opportunities that are attainable to build and sustain data systems.  Look for opportunities  Seek funding for building data systems infrastructure  Obtain funding for data integration  Leverage existing funding  Funding for old and new  projects  Funding for building technology infrastructure  Funding for data integration projects  Funding for leveraging grant dollars Funding for Sustainability

15 Develop and enhance health information systems using best practice models from other government or private agencies.  Look for other working best practice models  Transfer the technology where possible  Develop data sharing and linking capability  Use existing web based systems Tools and Systems

16 Identify short term and long term collaboration and funding opportunities.  Look for opportunities  Identify collaborating partners  Leverage existing efforts  Be prepared to take advantage of opportunities Opportunities

17 Maintaining confidentiality and privacy of health data is an important aspect of maintaining a data reporting system.  Follow state, local and federal laws  Adhere to HIPAA requirements  Follow IRB requirements Confidentiality and Privacy

18  Secured Federal grant funding  Obtained Local capital funding  Leveraged funding from other State Agencies District of Columbia Experience

19 Partnerships, Systems and Funding  Partnered with the District’s Medicaid Agency and the Safety-net Administration on developing data warehouses.  Designed a project to transfer the VA Medical Records System to the District  Developed the District’s Healthy People 2010 Plan District of Columbia Experience

20  Worked with the State Health Planning and Development Agency to develop regulations to monitor uncompensated care.  Developed a State Planning Grant to study insurance coverage options for the uninsured,  Secured funding for tracking systems to track public health and environmental health indicators. District of Columbia Experience

21 Developed a Vital Records Reengineering Project to allow for more strategic use of birth and death data to measure health status  Strengthened Health Department technology infrastructure to allow for better data sharing  Maintained system-wide HIPAA compliance District of Columbia Experience

22 Lessons Learned  Develop strategic partnerships to collaborate and share data. Transfer best practice projects from other government and private agencies. Maintain systems to ensure confidentiality and privacy of data Leverage funding to strengthen and maintain infrastructure gains.

23 For more Information, please contact: Fern M. Johnson-Clarke, PhD, Acting Director State Center for Health Statistics Administration District of Columbia Department of Health Elaine Vowels, PhD Health Consultant Carl W. Wilson, MPH Health Consultant Building Public Health Data Infrastructure for the Uninsured