Reports & Analysis

This article describes how a geographic health information system in Durham, North Carolina, links health system and social and environmental data via shared geography to provide a multidimensional understanding of individual and community health status and vulnerabilities. Geographic health information systems can be useful in supporting the Institute for Healthcare Improvement’s Triple Aim Initiative to improve the experience of care, improve the health of populations, and reduce per capita costs of health care. A geographic health information system can also provide a comprehensive information base for community health assessment and intervention for accountable care that includes the entire population of a geographic area.

With the recent release of data from the 2012 American Community Survey (ACS), SHADAC has created reports on state and county health insurance coverage estimates. Each state has an individualized report comparing 2011 coverage estimates with 2012 and examining coverage rates by age, race/ethnicity, citizenship status, education, work experience, and household income. There are several cross-state comparison reports available as well.

The Commonwealth Fund’s Scorecard identifies opportunities for states to improve their health systems for economically disadvantaged populations and provides state benchmarks of achievement. Analyzing 30 indicators of access, prevention and quality, potentially avoidable hospital use, and health outcomes, the Scorecard documents sharp health care disparities among states. Between leading and lagging states, up to a fourfold disparity in performance exists on a range of key health care indicators for low-income populations. If all states could reach the benchmarks set by leading states, an estimated 86,000 fewer people would die prematurely and tens of millions more adults and children would receive timely preventive care.

The share of children who were uninsured fell from 9.4 percent in 2011 to 8.9 percent in 2012 — a historic low — due primarily to gains in private coverage. Enrollment in Medicaid and the Children’s Health Insurance Program (CHIP) among children remained steady, likely in part because of a health reform requirement that states maintain their eligibility rules and procedures for Medicaid and CHIP. The 8.9 percent uninsurance rate among children is more than a quarter below the 1999 level.

A key method of stabilizing Medicaid coverage is to provide beneficiaries with twelve months of continuous eligibility. Following the passage of the Children’s Health Insurance Program Reauthorization Act in 2009, seven states adopted the continuous-eligibility option for children. That policy change led to a 1.8-percentage-point increase in the average length of child enrollment during fiscal year 2010 and increased annual costs for children by about 2.2 percent. The Medicaid and CHIP Payment and Access Commission has recommended offering states the option of giving adults twelve-month continuous eligibility for Medicaid. This study’s findings suggest that continuous eligibility could promote more stable coverage for adults enrolled in Medicaid at a modest cost.

Between 2010 and 2012, nearly one-third (32 percent) of U.S. adults ages 19 to 64, or an estimated 55 million people, were either continuously uninsured or spent a period of time uninsured. Data from the 2011 and 2012 Commonwealth Fund Health Insurance Tracking Surveys of U.S. Adults show that people with incomes below 133 percent of the federal poverty level (i.e., the level that will make them eligible for Medicaid in 2014 under the Affordable Care Act) were uninsured at the highest rates. Yet, fewer than half the states are currently planning to expand their Medicaid programs. In those states that have not yet decided to expand, as many as two of five (42 percent) adults who were uninsured for any time over the two years would not have access to the new coverage provisions in the law.

Starting January 1, 2014, new federal subsidies will be available for lower- to middle-income people to purchase private, nongroup coverage through new health insurance exchanges. A key issue for the exchanges is whether enough younger and healthier people will sign up for coverage to avoid significant adverse selection in which only older and sicker uninsured adults enroll, thus driving up premiums. This brief examines which uninsured adults ages 18 to 64 are most likely to purchase insurance through the exchanges.

With open enrollment in new insurance marketplaces set to begin October 1, this analysis provides an early look at insurance premiums in 17 states and DC that have publicly released comprehensive data about their rates and the impact of tax credits that will offset part of the costs for low- and moderate-income families. The analysis compares the premiums in the largest cities in each of the 17 states plus DC for individuals and families in different circumstances to illustrate the insurance rates they might pay, with and without the tax credits.

This summary provides an overview of several key statutory functions addressed in the final rule regarding eligibilty and minimum essential coverage.

In recent years there has been a significant expansion in the use of provider performance measures for quality improvement, payment, and public reporting. Using data from a survey of health plans, this study characterizes the use of such performance measures by private payers, and also compares the use of these measures among selected private and public programs. Twenty-three health plans with 121 million commercial enrollees, representing 66 percent of the national commercial enrollment, were studied. The authors found that there was much variation in the use of performance measures in both private and public payment and care delivery programs, despite common areas of focus that included cardiovascular conditions, diabetes, and preventive services.