190099 Measuring performance in health insurance expansion programs for children

Tuesday, October 28, 2008: 1:30 PM

T. Em Arpawong, MPH , Department of Preventive Medicine, Institute for Prevention Research, University of Southern California, Alhambra, CA
Chris Feifer, DrPH , Keck School of Medicine/Department of Family Medicine, University of Southern California, Los Angeles, CA
Michael Cousineau, DrPH , Family and Community Medicine, University of Southern California, Alhambra, CA
Gregory Stevens, PhD , Family and Community Medicine, University of Southern California, Alhambra, CA
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.

Learning Objectives:
Describe how HEDIS performance measures can be used to compare health care experiences across state programs. Recognize advantage and disadvantages to using HEDIS access, utilization, and quality measures. Identify potential issues in using existing data to assess healthcare among children.

Keywords: Public/Private Partnerships, Performance Measures

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: My experience comes from graduate education public health, 6 years research experience, and prior employment in both Medical Informatics at a health insurance company and in Bioinformatics at a National Medical Center. I have been involved in the statewide evaluation for this study since 2006, have managed this project since my involvement began, and have composed reports and presented on it in the past to public audiences and state funders. Currently, I am a doctoral student in Preventive Medicine at the University of Southern California, however the study results being presented are not a direct part of my student research.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.