Measuring performance in health insurance expansion programs for children

Several California counties have formed Children's Health Initiatives (CHIs) and designed locally-operated health insurance programs known as Healthy Kids. In many California counties, the Healthy Kids product administration occurs in partnership between local community-based agencies and a public or private health plan, forming the CHI. Using health plan data, administrators can use HEDIS performance measures to provide the only consistent information across counties to monitor access to, utilization, and quality of health care being delivered to children. The limitation of HEDIS measures is they focus on process of care and they set eligibility criteria for inclusion based on continuous enrollment in the plan. However, with these measures, the providers/plans are not penalized for care that could not be delivered because of access problems due to gaps in insurance coverage. These limitations are offset by the greater buy-in of health plans to report this information for health insurance expansion programs and using HEDIS measures increases the ability to acquire comparison information for state Medicaid and SCHIP programs. This session will describe and discuss the use of HEDIS measures in public health systems research, the applicability in assessing the health of children enrolled in health insurance expansion programs, and specific lessons learned from a statewide evaluation study conducted in 26 counties across California.