Our Featured Work

2021 Research Highlights

Topic Area: State and Federal Health Policy

Strategies to Increase Access to Medications for Opioid Use Disorder during the COVID-19 Pandemic and Beyond
SHADAC researchers Carrie Au-Yeung and Lynn Blewett, along with Hennepin Healthcare researcher Tyler Winkelman, authored a policy brief that examines the federal and state policies changes put in place to improve access to medications for opioid use disorder (MOUD) during the COVID-19 pandemic, during which time MOUD became especially challenging to access as MOUD patients are typically required to have as many as six in-person clinic visits a week. The authors conclude with federal and state policy recommendations based on their analysis. Funded by Milbank Memorial Fund.

Borrowing Proven Policy Strategies to Vaccinate Kids Against COVID-19: Lessons from Past Successes can Provide a Roadmap for Ensuring Equity in Immunization Efforts
With the authorization of the first COVID-19 vaccine for children ages five and older, most kids in the United States became eligible to be immunized. The objective of this brief is to highlight the strategies and tools that have contributed to prior successful U.S. efforts to widely vaccinate children against contagious diseases and reduce vaccination disparities, so that they may be applied to initiatives to immunize kids against COVID-19. Funded by State Health and Value Strategies.

Topic Area: Payment and Delivery System Reform

Data to Inform Research on Integrated Care for Dual Eligibles
This report by SHADAC researchers Lacey Hartman and Elizabeth Lukanen summarizes the findings of a systematic review of data sources that could be used to study the broad topic of integrated care for dual eligibles. The paper concludes with a set of recommendations aimed at addressing key data gaps and advancing the availability of comprehensive, high-quality data for research in this area. Along with the report, a companion Excel chart was produced that contains all abstraction details for each data source. Funded by the Arnold Ventures.

Inventory of Evaluations of Integrated Care Programs for Dually Eligible Beneficiaries
Both federal and state policymakers are interested in integrating care for beneficiaries dually eligible for Medicare and Medicaid, and it remains a key priority for states and the federal government. A variety of models seek to do this, including the Program of All-Inclusive Care for the Elderly, the Financial Alignment Initiative (FAI), Medicare Advantage dual-eligible special needs plans, as well as fully integrated dual eligible special needs plans, managed long-term services and support programs, and demonstrations that predate the FAI. This inventory, conducted by SHADAC researchers, compiles available evidence on how these integrated care programs have affected spending, quality, health outcomes, and access. Funded by the Medicaid and CHIP Payment and Access Commission.

Evaluation of Minnesota State Employee Group Insurance Program (SEGIP) High Value Diabetes Care Program
SHADAC collaborated with the Minnesota State Employee Group Insurance Program (SEGIP) to evaluate a pilot program for high-value diabetes care. The Advantage Value for Diabetes (AVD) program aims to improve health through effective management of diabetes. The project focused on developing measures and a baseline analysis with two years of administrative claims data, before and after the program was implemented (2017-2018). Funded by the Minnesota State Employee Group Insurance Program.

Topic Area: Health Coverage and Access to Care

Impacts of the Affordable Care Act’s Medicaid Expansion in California
SHADAC conducted an analysis of the impact of the Medicaid expansion on healthcare coverage, access, health status, affordability, and disparities in these outcomes by race/ethnicity for low-income Californians. Researchers on this project used nationally representative survey data from the Behavioral Risk Factor Surveillance Survey (BRFSS) 2011-2019 data years and a difference-in-differences approach that compared California with non-expansion states. Funded by the California Health Care Foundation.

Minnesota Health Access Survey
SHADAC conducts a biennial telephone survey of Minnesota residents and analyzes survey results in partnership with the Health Economics Program at the Minnesota Department of Health. 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. Funded by the Minnesota Department of Health. 

Minnesota’s Uninsured and the Communities in Which They Live
Using American Community Survey (ACS) data, SHADAC researchers created an interactive resource—the Minnesota Community and Uninsured Profile—with a dual aim toward advancing equity-focused advocacy work through informing strategic plans, partnership development, assessment of community needs, and grant-writing while also providing rates and counts of the uninsured in Minnesota at different geographic levels. to support targeted outreach and enrollment activities of health insurance navigators and policymakers as they develop strategies to reach the remaining uninsured in Minnesota. Funded by Blue Cross Blue Shield of Minnesota Foundation. 

Topic Area: Medicaid and CHIP Policy

MACPAC Analysis of Survey Data
SHADAC has served as the on-demand survey analysis vendor for the Medicaid and CHIP Payment and Access Commission (MACPAC) since June 2016. Over the last year, SHADAC successfully executed tasks using a broad range of data (e.g., ACS, CPS, MEPS-IC, NHIS, HCUP, NHANES, NSDUH, NAMCS, USTS, NSCH, HPS, CDC Natality Data, etc.). In this role, we respond to on-demand task order work to produce sound estimates and to develop documentation that supports the reproducibility of results over time. SHADAC’s analysis has contributed to a number of products and report chapters, such as the 2021 Report to Congress, the 2021 MACStats data book, factsheets, issue briefs, and presentations to the Commission. Funded by The Medicaid and CHIP Payment and Access Commission.

Assessing the Need for a Medicaid Equity Monitoring Tool
With support from the Robert Wood Johnson Foundation, SHADAC is leading a multi-phase project to assess whether identifying a set of key equity-related indicators (i.e., a “Medicaid Equity Monitoring Tool”) could be a helpful, feasible, and reliable way of tracking and advancing health equity in Medicaid at the state and federal levels. In the current phase, SHADAC researchers are consulting key informants, convening an advisory committee, and conducting an environmental scan to carry out this work. Under the guidance of the advisory committee, which consists of data experts as well as individuals who bring diverse perspectives on the Medicaid program, SHADAC researchers are working to better understand whether and how a Medicaid Equity Monitoring Tool could be most useful and for whom. Funded by the Robert Wood Johnson Foundation.

Topic Area: Health Equity

Collection and Availability of Data on Race, Ethnicity, and Immigrant Groups in Federal Surveys that Measure Health Insurance Coverage and Access to Care
The aim of this recently produced SHADAC brief is to assist state and federal analysts with survey development and/or analysis of existing survey data to generate estimates of health insurance coverage and access to care across racial and ethnic groups and according to nativity and/or immigrant status. The brief presents the collection and classification of survey data for populations defined by race, ethnicity, and nativity/immigrant (REI) status as well as the availability of these data in public use files. Funded by the Robert Wood Johnson Foundation.

Collection of Sexual Orientation and Gender Identity (SOGI) Data: Considerations for Medicaid and Spotlight on Oregon
Thirteen million people identify as part of a sexual or gender minority (SGM) in the United States, and an estimated 1.17 million of those SGM adults (age 18-64) have Medicaid as their primary source of health insurance. This brief, authored by SHADAC researchers, documents the few examples of SOGI data collection efforts occurring at the federal level and in Medicaid, and highlights the efforts of an Oregon community stakeholder process that identified several key areas for SOGI data improvement. Funded by State Health and Value Strategies.

Topic Area: Population Health

Escalating Alcohol-Involved Death Rates: Trends and Variation across the Nation and in the States from 2006 to 2019
In the midst of the opioid epidemic, the United States has been quietly experiencing another mounting public health crisis as deaths involving alcohol have grown to historic highs. In an effort to shed light on the growing issue of alcohol-involved deaths, SHADAC researchers produced an issue brief that describes trends and variation in alcohol-involved death rates at the state and national levels and among demographic subgroups, using vital statistics data from the Centers for Disease Control and Prevention (CDC) for 2006 to 2019. Funded by the Robert Wood Johnson Foundation.

Monitoring Childhood Poverty During and After COVID-19
The COVID pandemic brought renewed attention to childhood poverty and accompanying concerns about the impact of pandemic restrictions on these families. The number of children in poverty is expected to grow by an estimated 2.5 million between May 2020 and September 2020. This blog includes an interactive map to explore child poverty rates in 2019 by state, which provides a useful baseline comparison for evaluating the impact of the COVID pandemic on this issue. Funded by the Robert Wood Johnson Foundation.

2020 Responsive Research: COVID-19

The arrival of the novel coronavirus in 2020 irrevocably impacted and altered the lives of individuals across the United States, though research has since shown that the magnitude of the virus’ effects has varied greatly across different states and populations. Like many other organizations, SHADAC altered the focus of our work and research toward providing our audience with information and resources related to COVID-19. Our data experts have worked around the clock to provide guidance, tools, analyses, and other resources to inform state response efforts and provide insights on best practices as states continue to seek solutions to address the many facets of the lingering pandemic and respond to the disparate impacts of COVID-19 on their resident populations. Listed below are highlights from SHADAC’s COVID-related work in 2021.

Anticipating COVID-19 Vaccination Challenges through Flu Vaccination Patterns
An issue brief from SHADAC researchers, funded by the California Health Care Foundation (CHCF), uses data from the U.S. Centers for Disease Control and Prevention’s (CDC) Behavioral Risk Factor Surveillance System (BRFSS) survey to examine flu vaccination rates across multiple years for U.S. adults (age 18 and older) in all 50 states and the District of Columbia as a proxy to identify population subgroups that may be harder to reach with a COVID-19 vaccine. The brief also provides an analysis of several demographic categories, including indicators of health and health care access for the U.S. and California.

State-Specific Surveys Encompassing Residents’ COVID-19 Experiences
This resource provides a summary of state efforts to capture information on the coronavirus pandemic through state and local surveys fielded between March 2020 and January 2021. We include information on topics covered within the surveys as well as some results where they are available. Additionally, we have put together a clickable state-level map that provides links to the data collection instruments and results we identified in our search.

COVID-19 Pandemic Coincided with Elevated and Increasing Anxiety and Depression Symptoms
This brief analyzes data from the U.S. Census Bureau’s Household Pulse Survey (HPS) to estimate rates of anxiety and depression in the U.S. adult population from April to December 2020. The analysis showed high rates of anxiety and depression symptoms reported throughout the year for all adults, never falling below one-third (33%) of the total adult population and ending with the highest levels of the year in December 2020 (42%). The brief also found disproportionately heightened mental health burdens for young adults, adults with lower incomes and lower education levels, and adults who experienced income loss during the COVID pandemic.

Pandemic Drinking May Exacerbate Upward-Trending Alcohol Deaths
This blog discusses the impact of COVID on another crisis: The increasing alcohol-involved death rate. From 2006 to 2019, the national alcohol-involved death rate rose from 7.0 to 10.4 per 100,00 individuals, respectively. Data analyzed in the brief indicated a worsening correlation between trends of alcohol consumption and related deaths and the continued duration of the COVID pandemic. Research has found rising alcohol sales since the beginning of the pandemic and that U.S. adults are consuming more alcohol to cope with pandemic-related stress. This includes an uptick in more high-risk behaviors, such as heavy drinking and binge drinking.

COVID-19 illness personally affected nearly 97 million U.S. adults
The SHADAC COVID-19 Survey is a two-part survey that was conducted as part of the AmeriSpeak Omnibus Survey by NORC at the University of Chicago and designed to measure the impacts of the pandemic on adults in the United States and their experiences with COVID-related issues of health care access and insurance coverage, as well as pandemic-related stress. In a continuation of that initial survey, SHADAC circulated a new series of questions aimed at understanding respondents’ experiences with COVID-related illness and death. This brief presents findings from the second iteration of the survey and provides data breakdowns by racial and ethnic subgroups, income and education levels, as well as age.

Measuring Coronavirus Impacts with the Census Bureau's Household Pulse Survey: Blog Series
Utilizing the near-real-time data available from the U.S. Census Bureau’s Household Pulse Survey (HPS), this six-part blog series analyzed bi-weekly COVID vaccination rates at the national level, state level, and by certain subpopulations, including age, income level, and race/ethnicity. SHADAC's initial examination of the survey results looked at data collected from January 6 to January 18, 2021, with the final update highlighting data from June 9 to June 21, 2021.

Changes in Federal Surveys Due to and During COVID-19 Brief
One impact of the coronavirus pandemic that has recently come to light is the disruption to data collection processes and response rates for federal surveys that measure health-related items such as insurance coverage. A recent SHADAC brief examines the changes and challenges that COVID has wrought on 2020 data collection, data release, methodology, and usage for four major federal surveys—the American Community Survey (ACS), the Current Population Survey (CPS), the Medical Expenditure Panel Survey (MEPS), and the National Health Interview Survey (NHIS).

Vaccine Hesitancy Decreased During the First Three Months of the Year: New Evidence from the HPS
An analysis by SHADAC researchers uses data from the Census Bureau’s Household Pulse Survey (HPS) to examine changes in vaccine hesitancy among U.S. adults (ages 18 and older) between January and March 2021 by region, race/ethnicity, income, and reported reasons for hesitancy.

Vaccinating Children May be Key to Reaching COVID-19 Herd Immunity
This blog highlights the importance of  COVID vaccination for children in order to reach herd immunity in the U.S. Due to the sizeable portions of children in any given state’s resident population, the analysis predicts that it would be difficult to meet thresholds for immunity (which experts suggest is at least 70%) through only the vaccination of the adult population, and the accompanying graphic shows different percentages of adult populations that would need to be vaccinated within each state to reach the threshold for herd immunity. As vaccines are approved for children, however, the likelihood of reaching herd immunity increases.