This is the Health Chairs e-bulletin for January and February 2006.
Two Forum Meetings Now On-Line
The December Chairs meeting in Chicago can be found at http://www.ncsl.org/programs/health/forum/chairs/chairsdec05.htm
We did several things differently, in part so that the meeting would be available to many of you who could not attend as well as all who did come.
- For the first time, audio recordings of the sessions are available on the NCSL web site. You will see “listen to the audio” beside each speaker in the agenda. You may start the audio, then shrink down the image and go through the slides as the speaker presents.
- Instead of the big notebooks that we handed out in the past, all materials presented at the meeting are available through the web. This includes copies of slides and handouts as well as additional background documents recommended by speakers and staff. Resources associated with specific sessions can be reached by clicking “resources” by the agenda item. Additional resources are also available at the end of the section. E-mail Faith (faith.chang@ncsl.org) if you would prefer this material on a CD.
As always, we want to give a big thank you to the Henry J. Kaiser Family Foundation, whose support makes the meeting possible.
Those of you who were able to attend know that we were convening our first meeting of a new project for emerging health leaders at the same time. That session is also available now. These sessions, funded by the Robert Wood Johnson Foundation, were designed to provide introductions to four critical health areas. They were not recorded but the slides and additional resources are on line. http://www.ncsl.org/programs/health/forum/chapsdec05.htm
We encourage you to share any materials you wish from the two meetings with your members and staff.
Looking Ahead
We have not scheduled the spring Chairs meeting yet but are looking at some time between June 8 and June 20. We’d like to try to coordinate it with a meeting on health information technology that you will be invited to attend at the same time, if you are interested.
NCSL’s annual meeting is in Nashville this year, August 15-19. We’ll continue our tradition of a Chairs tea that looks at the host state’s Medicaid program. Since Tenncare has such a dramatic tale to tell, we hope to schedule a longer block of time than usual.
More details on both meetings will be coming in the next bulletin.
Resources on Line
2005 in Review
’Tis the season for roundups and reviews.
From NCSL’s state-federal desk, a summary of federal health legislation in 2005 http://www.ncsl.org/statefed/health/legup.htm
The Robert Wood Johnson Foundation rounds up some of the most significant evidence-based policy research it funded this year. In the good news: states were able to make it easier for eligible children to get covered by changing enrollment procedures; collaborative quality efforts improved care for patients with chronic heart failure; and treatment for chemical dependencies brought medical costs down significantly for both Medicaid and non-Medicaid patients. The nation has faltered in preparing for emergencies, reducing disparities in care, and keeping kids from smoking. Read more about what has been proven to work—and not to work—at http://www.rwjf.org/newsroom/featureDetail.jsp?featureID=1266&type=3
The RWJ State Coverage Initiatives (SCI) annual report on state coverage expansions is out. State of the States 2006: Finding Their Own Way includes information on initiatives under way in Illinois, Massachusetts, Maryland, New York and Kentucky. It is available at http://www.statecoverage.net/pdf/stateofstates2006.pdf
Forbes editors predict health care in the marketplace for 2006, http://www.forbes.com/home/business/2005/12/12/health-2006-predictions-sneakpeek_sp06_13_x_health.html An accounting firm with a major health practice, Wipfli offers its predictions for 2006 at http://www.wipfli.com/Wipfli/Impact_Magazine/Industry_Archive/Health_Care/General/200512HCA_Predictions_for_2006.htm
By the Numbers, 2005 is an annual overview of industry data from Modern Healthcare. Be patient while the 37-page file downloads at http://www.modernhealthcare.com/docs/mhBTN2005.pdf
Measuring Quality
The federal Agency for Healthcare Research and Quality (AHRQ) has just released its latest compilation of data to measure progress in improving quality and reducing disparities in care and outcomes, National Healthcare Quality Report, 2005 and National Healthcare Disparities Report 2005. Results are sobering. Despite gains in many measures and for most populations, disparities are widening in many measures for Hispanics. The disparities report is available at http://www.ahrq.gov/qual/nhdr05/nhdr05.pdf
AHRQ is testing an attractive interface for states to use to compare their data (I was a guinea pig last week) We’ll let you know where to find it as soon as it comes on line. For now, there are tables with this state data in the appendix that you can use to compare yourself to national performance. The quality report http://www.ahrq.gov/qual/nhqr05/nhqr05.htm includes maps showing how states compare on specific areas, and identifies six states with particularly strong, sustained improvement in several areas (see map below).
Medicaid, Medicare, and Pharmacy Assistance Programs
NCSL has released a new report with information on state pharmacy assistance programs (known as SPAPs) and efforts that more than 20 states have taken to coordinate state programs with Medicare part D. State Pharmaceutical Assistance Programs in 2006: Helping to Make Medicare Part D Easier and More Affordable http://www.ncsl.org/programs/health/spapcoordination.htm
Map of State SPAP Programs
The Pew Center on the States has just issued an overview of Medicaid and the issues the program faces. The 25-page report provides a concise and lively overview while thoroughly probing the complexities of reform. Special Report on Medicaid: Bridging the Gap Between Care and Cost. You may read by section at http://www.governing.com/medicaid/intro.htm or download the entire report from http://www.pewtrusts.com/pdf/medic06.pdf
Medicaid waivers have a new home on CMS. The page allows you to search by state, date or keyword. The search function is awkward but a nice addition here is links to the documents associated with each waiver. You can download documents related to specific waivers if you want to see more detail about a state’s program. Donna points out that the date listed is the date of the original waiver approval. Several states are building on previously approved waivers as they propose reforms. http://www.cms.hhs.gov/MedicaidStWaivProgDemoPGI/MWDL/list.asp.
Workforce and Providers
The U.S. Census has released two new reports that are likely to be of interest.
The Consolidated Federal Funds Report for Fiscal Year 2004 (State and County Areas) shows direct payments, grants, procurement awards, and salaries and wages, by federal agency and program, for state and county areas of the United States, including the District of Columbia and U.S. outlying areas. According to the press release, “Social Security, Medicare and Medicaid account for more than $1 trillion of the $2.2 trillion the federal government spent in 2004.” Click on “report” (110 pages, mostly tables) and “detailed tables” to get more information. http://www.census.gov/prod/2005pubs/cffr-04.pdf
New health sector economic performance data are also available, although only at a national level. These data show 2004 trends for various provider groups. Click the link to “Latest Data” to download charts from http://www.census.gov/svsd/www/services/sas/sas_summary/62summary.htm
The American College of Emergency Physicians (ACEP) has issued a state-by-state and national reportcard on emergency services. States were scored on 50 measures related to four areas: Access to Emergency Care, Quality and Patient Safety, Public Health and Injury Prevention, and Medical Liability Environment. The overall national score is a scant C-. Download the whole report at http://my.acep.org/site/DocServer/2006-NationalReportCard.pdf?docID=221 or see how your state ranked by clicking on the map at http://my.acep.org/site/PageServer?pagename=wp1_homepage
National Clearinghouse on the Direct Care Workforce has state by state data on best practices for improving recruitment, retention and work life of the direct care workforce and also on statistics, regulations, initiatives and contacts. http://www.directcareclearinghouse.org/index.jsp
Hospitals are the theme of the current issue of Health Affairs. Articles deal with pricing, quality, staffing, governance and mission. A don’t-miss issue. You can access abstracts here, and pick articles to request from your library. http://content.healthaffairs.org/current.shtml
Health Information Technology
The federal government is passing funds through NGA to 40 states to study how laws on privacy and security can be reconciled with a more connected health system. States are setting up teams to respond to the RFP, with applications to come through the governor’s office. You can download the RFP at http://www.rti.org/page.cfm?objectid=09E8D494-C491-42FC-BA13EAD1217245C0K
Meanwhile, the National Association of Chain Drug Stores Foundation has just posted a HIPAA Preemption Analysis of State Privacy and Security Laws. You must register to download them but it is free. You can download section by section, or get them all in a zip file at the end of the list of states. http://www.nacdsfoundation.org/wmspage.cfm?parm1=91
Public Health
HHS announced how pandemic preparedness awards were to be distributed to the states. http://www.hhs.gov/news/press/2006pres/20060112.html. More information on monitoring and preparing for possible global infectious crises can be found at http://www.pandemicflu.gov/
Two takes on trauma
Annual data from the AHRQ’s Medical Expenditure Panel Survey (MEPS) for each year from 1996 to 2003 are available on line. Topics include health care utilization and expenditure by condition, access, insurance and quality indicators. You can customize some of the tables at http://meps.ahrq.gov/CompendiumTables/TC_TOC.htm
The big news in the MEPS data is that trauma is now topping the charts as the most expensive condition. Interestingly enough, on January 26 the NEJM (Volume 354:366-378) published “A National Evaluation of the Effect of Trauma-Center Care on Mortality” showing that trauma centers significantly improve outcomes.
Classics
We thought we’d start off the new year—and the new session—with links to some of our favorite sites.
Access, Coverage, and General Compilations
Health, United States is an annual report on national trends in health statistics including highlights, a chartbook, and trend tables with statistics on such topics as birth and death rates, infant mortality, life expectancy, morbidity and health status, risk factors, use of ambulatory and inpatient care, health personnel and facilities, financing of health care, health insurance and managed care, drug utilization, and other health topics.
Trend tables can be downloaded as spreadsheet files for data manipulation or graphical analysis. http://www.cdc.gov/nchs/hus.htm
State Health Facts, brought to you by the Henry J Kaiser Family Foundation, is a great starting point for background information and interstate comparisons. It is very easy to use and contains a wealth of state data. You can look at information by state or nationally, and tailor comparisons using maps or tables. Information can be sorted by state name, rank or region. Public Insurance is Kaiser’s strong suite, and that shows in strong details for Medicaid, Medicare and SCHIP, but this site also has a wealth of information on demographics, health status, health costs, insurance, http://www.statehealthfacts.org/
While you are on the Kaiser site, you may also want to check out their latest reports (http://http://www.kff.org/), see what new webcasts are available at http://kaisernetwork.org/ and explore the background material they’ve created for policy students at http://www.kaiseredu.org/
The State Coverage Matrix is a deceptively simple table of state policies related to access. Click on any of the cells in the table, and you go to a page that describes the program and links to related sites, including state and national reports on the program. Click on a header and you’ll get a description of the category and a table with thumbnail sketches for each state in the category. And of course, clicking on the state will take you to links for all of its access programs. This site is part of the Robert Wood Johnson Foundation’s State Coverage Initiative at AcademyHealth. http://www.statecoverage.net/matrix.htm
Lots of other resources are available on this site including a database of state reports, and publications on coverage from AcademyHealth.
Center for Studying Health System Change. The policy research on this site includes insurance coverage and costs, access to care and local markets and managed care. There are also specific community reports about various localities. http://www.hschange.org/
The Centers for Medicare & Medicaid Services (CMS) is the federal agency concerned with these two public insurance programs. http://www.cms.hhs.gov/researchers/default.asp takes you to a variety of federal data resources related to Medicaid and Medicare. http://www.cms.hhs.gov/researchers/statsdata.asp lists available data. It also publishes other health financing data in its Healthcare Financing Review. For example, national expenditure accounts estimates were highlighted in http://www.cms.hhs.gov/HealthCareFinancingReview/downloads/web_exclusive_cowan.pdf It still takes a couple of years to reconcile and clean up data for the national compilation. The Kaiser site listed above also summarizes much of their data and may be easier to use.
Chronic Conditions and Long Term Care
For information on disability law, look at the Law, Health Policy and Disability Center. http://disability.law.uiowa.edu/ It includes a map of state rules and resources on state work incentive initiatives. http://www.uiowa.edu/~lhpdc/work/map.html
For information on long term care in the community, see the site for Real Choice Systems Change (RCSC) grantees, http://www.hcbs.org/. The site brings together the federal government, states, and persons of all ages with all types of disabilities to expand access to high quality, cost-effective, consumer-directed home and community-based services and supports. It has promising practices, practical tools, good state data, recent federal announcements and research abstracts.
If you are researching chronic illness, start at CDC’s National Center for Chronic Disease Prevention and Health Promotion. http://www.cdc.gov/nccdphp/ Don’t miss the state profiles http://www.cdc.gov/nccdphp/states/index.htm. If you’re looking for ideas about ways to provide better care with greater accountability, the Center for Healthcare Strategies (http://http://www.chcs.org/ ) is a good source of information on state activities in this area.
Workforce and Providers
Workforce resources from the Federal government are found at http://bhpr.hrsa.gov/ , with state health workforce profiles, http://bhpr.hrsa.gov/healthworkforce/reports/profiles/
Staff Contacts
Donna Folkemer, Group Director
Forum for State Health Policy Leadership
National Conference of State Legislatures
ph: 202-624-8171 fx: 202-737-1069
Donna.Folkemer@ncsl.org
Kala Ladenheim, Ph. D. Program Director
Forum for State Health Policy Leadership
National Conference of State Legislatures
ph: 202-624-3557 fx: 202-737-1069
kala.ladenheim@ncsl.org
 Health Chairs Project
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