HHS Data Enhancements to Monitor Implementation and Impact of Health Reform Jim Scanlon Deputy 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 –

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 component NAMCS –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 Scanlon Deputy Assistant Secretary for Planning and Evaluation U.S. Department of Health and Human Services