This week’s national football league conference championship games and the theme my colleague, Jocelyn Guyer, picked for her latest blog (where she admits to an obsession with Tom Brady) got me was thinking about statistics and scores as it relates to children’s coverage. While the uninsured rate is the final score, there are a lot of factors that impact it including the prevalence of private insurance coverage in a state. I’m a fan, not a sports expert, but I know that teams need quarterbacks who can complete passes, runners who can gain yardage rushing, blockers who can get inside to make a sack, kickers who can keep it within the goalposts (sorry Ravens fans!), and the list goes on.
The same is true in children’s coverage. Eligibility levels aside, we know that how a state handles enrollment and retention can make a huge difference in how successful they are in covering children (as well as others eligible for coverage). No NFL team manages its players without tracking their results, nor plans for the next game without looking at their competition. Likewise, we need good data that tells us how well our Medicaid and CHIP programs are doing in terms of enrolling and retaining kids. By comparing states, we can identify successes as well as opportunities to make improvements and reach more eligible children.
For far too long, we’ve heard that state eligibility systems just weren’t designed to collect and report data; that state Medicaid agencies are handicapped by the lack of timely data. Hopefully, that’s all about to change.
Given the unprecedented 90% federal financial match for states to overhaul or build new Medicaid eligibility systems (known as the 90/10 rule) and 100% federal funding for Exchange Information Technology systems (IT), a large number of states are embarking on major systems development projects. According to the 2012 50-state survey on state Medicaid and CHIP eligibility, enrollment, retention and cost-sharing practices that we released with our friends at the Kaiser Commission on Medicaid and the Uninsured last week, 29 states have received approval or submitted their plans for approval of 90/10 funding to transform their Medicaid eligibility systems. And 19 of the remaining 22 states plan to move in that direction in 2012.
There are a number of reasons why states need to bring their use of technology into the 21st century but a key one for me is building in the capacity for collecting and reporting data that allows us to assess and compare the performance of Medicaid, CHIP and, beginning in 2014, coverage through new state-based Exchanges.
Two new reports provide some useful insight into the kind of reporting that is needed. In December 2011, the Kaiser Commission on Medicaid and the Uninsured released its brief, “Performance Measurement Under Health Reform: Proposed Measures for Eligibility and Enrollment Systems and Key Issues and Trade-offs to Consider.” Just a month earlier, the Maximizing Enrollment: Transforming State Health Coverage program, an initiative of the Robert Wood Johnson Foundation administered by the National Academy of State Health Policy also published “Using Data to Drive State Improvement in Enrollment and Performance.”
As our policymakers continue to debate the role of government in health care, assessing and disclosing the performance of our public health coverage programs is a critical step in demonstrating their effectiveness. Data also is an unparalleled tool to pinpoint opportunities for improvement and track progress over time. Ask any sports team statistician. Each of the reports I noted earlier, as well as this paper I wrote a couple of years ago, offer states a rich inventory to draw from in designing their systems as they await further direction from CMS.
Some policy makers say we need to run government more like business and major league sports certainly qualifies as “big” business. When it comes to using data to make informed decisions, I agree. Making sure our new systems are built with the capacity to track the right data is step one. But it doesn’t end there. We need to make such data publicly available on a routine and timely basis. (For example, I know that Tom Brady tied the record set by Joe Montana for most playoff wins – public information.) Moreover, we need to use the enrollment and retention data to celebrate our successes (just as Jocelyn and I are relishing the Patriots’ win yesterday) and make program improvements (yes, the Giants beat the Pats in 2008) to ensure that all eligible children, families and individuals get and stay covered.
