These descriptions of SHADAC’s recent work demonstrate our breadth of health policy research expertise and depth of technical survey data analysis skills. For more information, click on topic areas or see our 2018 annual report.
Health Insurance Coverage and Access to Care
Monitoring the Impact of the Affordable Care Act (ACA 411 Project)
In support of the California Health Care Foundation’s efforts to track the impact of the Affordable Care Act (ACA) in the state, SHADAC continues to work with CHCF in order to provide policymakers, journalists, and advocates with focused, credible analysis and regarding Californians’ coverage, access, and affordability, particularly among low-income populations and others affected by the ACA. SHADAC provides data and data analysis on a number of measures under the three main topic areas (coverage, access, and affordability), and also provides guidance on developments that warrant further study or response by the Foundation or others in the state.
Minnesota’s Uninsured and the Communities in Which They Live
Supported by a grant from the Blue Cross and Blue Shield Foundation of Minnesota and essential guidance from the advisory board of MNsure navigators and policymakers, SHADAC used data from the American Community Survey (ACS) to create a new resource consisting of a profile and an interactive map, which provides rates and counts of the uninsured in Minnesota at the ZIP code level (i.e., Census-defined ZIP code) county, economic development region, and state. The focus of this resource is to (a) support targeted outreach and enrollment activities of health insurance navigators; and (b) provide information about the uninsured to policymakers as they develop strategies to reach the remaining uninsured in Minnesota and reduce geographic disparities in coverage.
Health Care Cost and Affordability
Minnesota Long-Term Services and Supports Projection Model
SHADAC collaborated with the Minnesota Department of Human Services to develop a model projecting the use of Long-Term Services and Supports (LTSS) in Minnesota and how this will affect state Medicaid spending on LTSS. The model uses national and state-specific data sources to estimate LTSS utilization and costs for the population 65 years and older for 2020 and 2030 under different contexts and scenarios for policy intervention. The model is intended to serve as a resource to the state as it plans for the future role of public financing of LTSS.
Minnesota Health Care Home Care Coordination Cost Study
The Minnesota Department of Human Services and Health contracted with SHADAC to conduct a study of the costs of Health Care Home care coordination for adults. In order to estimate the cost of care coordination, SHADAC used a case study approach and developed a list of activities (or “ingredients”) that define care coordination and collected information about the costs associated with each of these activities at six non-acute, primary care clinics.
State and Federal Health Policy and Health Reform Strategies
On-Demand State Policy Technical Assistance
SHADAC is a Technical Assistance Provider to the Robert Wood Johnson Foundation (RWJF) State Health and Value Strategies (SHVS), which by connecting states with experts in the field, assists states in transforming their health care systems to be affordable, equitable and innovative. SHADAC’s role is to help states use data to inform decision-making and to support evaluation and monitoring efforts.
Medicaid Section 1115 Waiver Evaluation
SHADAC researchers provide technical assistance to Alaska, Colorado, Illinois, and New Hampshire as they participate in an effort supported by the National Governors Association to help them develop data-driven evaluations of the new Medicaid policies they are pursuing under Section 1115 waivers. Ongoing technical assistance provided by SHADAC includes reviewing requests for proposals and planning documents, participating in convenings with state and federal officials, and producing resources to respond to state-specific evaluation needs.
Leveraging 1332 State Innovation Waivers to Stabilize Individual Health Insurance Markets
Funded by the Robert Wood Johnson Foundation, SHADAC researchers documented the strategies and rationale of the first three states to receive federal approval to establish state reinsurance programs with federal funding—Alaska, Minnesota, and Oregon—via Section 1332 State Innovation Waivers in order to address the volatility of their individual health insurance markets. SHADAC identified challenges, facilitators, and lessons learned during the waiver application and implementation processes that could be helpful for states considering similar policy action and for federal regulators interested in supporting similar state initiatives.
Payment and Delivery System Reform
Inventory of Evaluations of Integrated Care Programs for Dually Eligible Beneficiaries
Under contract to the Medicaid and CHIP Payment Access Commission (MACPAC), researchers at SHADAC conducted a systematic literature review and abstraction of studies that evaluate the impacts of integrated care programs for dually eligible beneficiaries in order to produce a “one-stop-shop” for the review of available evidence across a range of outcomes related to cost, quality, health outcomes, and access.
State Innovation Model (SIM) Technical Assistance
SHADAC was a member of a team led by NORC at the University of Chicago to serve as the State Innovation Model (SIM) Resource Support Contractor for the Center for Medicare and Medicaid Innovation (the Innovation Center). SHADAC supported 38 states and territories and the Innovation Center in designing and testing innovative multi-payer health system transformation approaches. SHADAC worked with NORC and other technical assistance partners, including the Center for Health Care Strategies (CHCS) and the Office of the National Coordinator for Health Information Technology to provide consultation and technical assistance to states in quality measurement, primary care infrastructure investment, and support strategies, and metrics for monitoring and evaluating progress toward improved system performance.
Medicaid and CHIP Policy
Assessment and Synthesis of Selected Medicaid Eligibility, Enrollment, and Renewal Processes and Systems in Six States
SHADAC worked as a contractor for the Medicaid and CHIP Payment Access Commission (MACPAC) to conduct an assessment of Medicaid eligibility, enrollment, and renewal processes and systems in six study states—Arizona, Colorado, Florida, Idaho, New York, and North Carolina. Utilizing a multi-case study methodology as well as key informant interviews with state and local agency staff and advocacy organizations, SHADAC collected and synthesized data on Medicaid enrollment processes and systems for individuals whose income eligibility is based on Modified Adjusted Gross Income (MAGI) in order to assess the extent to which states were achieving desired goals such as program efficiency and a simplified beneficiary experience.
Addressing Social Determinants of Health through Behavioral Health-focused 1115 Waivers: Implementation Lessons from Six States
Through the Robert Wood Johnson Foundation’s “Research in Transforming Health” program, SHADAC researchers are conducting a study to understand how three states—Illinois, Texas, and Washington— are addressing the needs of justice-involved populations through implementation of Section 1115 Medicaid waiver programs. The specific aim of the study is to identify promising practices and lessons learned related to the development, implementation, and management of these innovative behavioral health policies with the purpose of informing policy development in states considering similar 1115 waivers.
Evaluation of the Implementation of Section 1115 Medicaid Expansion Waivers
SHADAC was commissioned by the Medicaid and CHIP Payment and Access Commission (MACPAC) to conduct an analysis of how four states implemented Section 1115 Medicaid expansion waivers. SHADAC examined how these four states--Arkansas, Indiana, Iowa, and Michigan--approached the implementation of key provisions of their waivers, including exchange plan premium assistance, enrollee contribution requirements, health savings accounts, healthy behavior incentives, and graduated copayments for emergency department use.
Health and Health Care Quality Measurement
SHADAC's State Health Compare
SHADAC’s State Health Compare is a user-friendly and easily accessible online data tool for obtaining state-level estimates on a range of topics related to health and health care. Analysts and policymakers can use State Health Compare to view measures of insurance coverage, access, cost, utilization, and outcomes—as well as social and economic measures related to health. State Health Compare allows users to compare these measures across states and look at trends over time through user-generated maps, bar charts, trend lines, and tables. Users can also explore these measures within states by characteristics (e.g., age, race/ethnicity, and education level). There are currently 45 measures drawn from 16 data sources available on State Health Compare, drawn from the most currently available data, and estimates are available for timespans ranging between 4 and 17 years. SHADAC also provides ongoing updates to 16 of the measures maintained by the Robert Wood Johnson Foundation (RWJF) on its Building a Culture of Health webpage.
State and Federal Survey Analysis
On-Demand Analysis of Federal Survey Data
The Medicaid and CHIP Payment and Access Commission (MACPAC) is a non-partisan legislative branch agency that provides policy and data analysis and makes recommendations to Congress, the Secretary of the U.S. Department of Health and Human Services, and the states on issues related to Medicaid and the State Children’s Health Insurance Program (CHIP). To support this work, SHADAC assists MACPAC in scaling work to meet their information needs, producing sound estimates, and developing documentation that supports the reproducibility of results over time. SHADAC provides on-demand, short-turn around data analysis using a wide variety of federal surveys, including restricted data only available in a Research Data Center. Data used on this project include: American Community Survey (ACS), Centers for Disease Control (CDC) Natality, Current Population Survey (CPS), Medical Expenditure Panel Survey (MEPS), Nationwide Adult Medicaid Consumer Assessment of Healthcare Providers & Systems (NAM CAHPS), National Ambulatory Medical Care Survey (NAMCS), National Electronic Health Records Survey (NEHRS), National Health Interview Survey (NHIS), National Survey of Children’s Health (NSCH), National Survey on Drug Use and Health (NSDUH), Pregnancy Risk Assessment Monitoring System (PRAMS), and Survey of Income and Program Participation (SIPP).
Minnesota Health Access Survey (MNHA)
SHADAC conducts a biennial telephone survey of Minnesota residents in partnership with the Health Economics Program at the Minnesota Department of Health. Our work includes survey item development, designing a sampling strategy, implementing a weighting scheme and analyzing and interpreting the results. Findings from the survey provide an overview of the state’s uninsured population and changes in their composition over time as well as trends in how Minnesotans obtain health insurance coverage.