Better Data Equals Better Public Policy, Researchers Say

Lilo H. Stainton | March 29, 2018 | Health Care
State developing interactive app that will let patients, providers, and policymakers work directly with Medicaid stats

Imagine the possibilities: online maps and other tools that allow patients and policymakers to visualize how much Medicaid spends on specific medical procedures — and how these costs vary between counties, towns, or election districts. Then envision layering on data related to disease outbreak, income and education, healthcare availability, even race.

While these capabilities don’t exist — yet — in New Jersey, a number of states, including South Carolina and Oklahoma, have effectively harnessed data from their Medicaid programs in unique and beneficial ways, according to a national survey from the New Jersey Health Care Quality Institute. These systems can help government officials better protect public health and allocate resources, and can also be helpful to providers, patients and advocates, the group notes.

“The lack of available data inhibits state policymakers and researchers from seeing the impact of the policy changes on the cost and use of Medicaid services. It also impedes providers from participating in value-based purchasing strategies [through which insurance companies pay for outcomes, not per treatment] and inhibits the work of consumer advocates,” the report states.

Data dashboard under wraps

But change is pending in the Garden State. The Department of Human Services, which oversees Medicaid, has been looking at systems in more than a dozen other states as it crafts a public-facing online data dashboard that would provide more information on Medicaid use, spending, and other elements of the program. The project, funded in part by a federal grant, is still under development, but the DHS expects to roll it out in the coming months.

“We believe data is essential to driving good health outcomes and look forward to working with stakeholders on bringing Medicaid data to bear on our policy and programmatic decision making,” DHS acting commissioner Carole Johnson told NJ Spotlight Wednesday.

Improving data collection, in part to reduce worrisome healthcare disparities, is also a priority for Dr. Shereef Elnahal, the acting health commissioner, who highlighted the concern during a panel discussion last week.

Senate health committee chairman Joseph Vitale (D-Middlesex) has also introduced a bill that would force the state to post more detailed data on its website; the measure was scheduled for a hearing earlier this month, but was held at the last minute to give the DHS time to develop its own program.

Matt D’Oria, the Quality Institute’s chief transformation officer, said his organization intends to track the state’s progress on the effort. The data gaps came to light through the group’s work on the Medicaid 2.0 blueprint, a reform plan it released in March 2017.

Transparency is a goal

“An important part of our mission is to promote data transparency as a way of improving quality and reducing cost,” D’Oria said, stressing that the goal is to create an easily accessible database of Medicaid spending that could be used as “the bible,” or unquestioned source, for comparing costs in the Garden State. “And there are regional variances in the state that we’re trying to drill down on and understand why,” he added.

New Jersey’s Medicaid program, called Family Care, insures nearly 1.8 million residents and costs about $15 billion, at least two-thirds of which is covered by the federal government. The DHS posts detailed monthly enrollment statistics, broken down by income level and county, among other factors, allowing viewers to track changes over time.

The DHS also publishes Family Care annual reports, with detailed information on program trends, and some analysis of spending by category and patient type in its annual reports. For example, the 2015 report — the most recent currently available — shows that annual Medicaid spending ranged from nearly $2,500 on average for a child in the traditional program to more than $62,000 for someone in a nursing home. Or that long-term care involves 2 percent of the enrollment, but 21 percent of the total cost. But there is no regional breakdown, or average cost by procedure.

This level of disclosure appears to be the norm, according to the Quality Institute’s report, which reviewed public Medicaid data systems in all 50 states. While federal law requires that reams of information be collected monthly, the report found vast differences in how states use this information to make policy decisions and how much they make it publicly accessible. The problem isn’t legal restrictions, it notes, but a lack of resources and a limited willingness to commit scarce dollars to software and other technology.

Compare and contrast

A handful of states — including California and Massachusetts — also make it easy to compare program eligibility with actual enrollment, by posting data from other social service programs that depend on the same income standards, the report notes. This can help policymakers identify operational gaps in the enrollment process and better ensure those who qualify get the help they need. (Efforts by the administration of former New Jersey Gov. Chris Christie to create a comprehensive, coordinated system to track all welfare benefits failed and the state lost tens of millions of dollars on the contract.)

A few states — primarily South Carolina and Oklahoma — even make public details on costs, or Medicaid spending, and utilization, or what services patients actually use, researchers found. This enables policymakers to spot trends and redirect resources. If they see a spike in emergency room use in one area, they can do more to ensure access to primary care, which can provide more appropriate care at lower cost.

In fact, South Carolina was able to reduce unnecessary C-sections and neonatal admissions to save more than $6 million during the first quarter of 2013. (Lawmakers and patient advocates in New Jersey have urged the state to develop a maternity care report card, hoping that the availability of more data can help expectant mothers connect with the best care.) The interactive dashboard maintained by the Oklahoma Health Authority allows users to search for the cost of key healthcare services, including dental and pharmacy charges.

“We believe these best practices can be replicated in New Jersey, improving both performance in eligibility processing and service delivery,” the report states. Posting Medicaid data that summarizes spending in certain categories is consistent with state and federal regulations, it notes.

In New Jersey, 95 percent of the Medicaid claims are covered through managed care, or processed by an insurance company that collects the data. While the industry has raised concerns about disclosing all details around its spending, which is influenced in large part by confidential contracts with providers, D’Oria said much of this data is already shared with state officials, who use it to set Medicaid payment rates each year.

Some of the most successful state programs have involved collaborations with university-based research centers, the researchers found, including South Carolina, which benefitted from a partnership with the University of South Carolina Institute for Families in Society. The Quality Institute urged New Jersey leaders to build on their existing partnership with the Rutgers Center for State Health Policy, which has already initiated a number of data projects.

“States that have partnered with their universities are able to critically evaluate the programs performance at an arms-length distance,” the report notes.