Vol. 1, No. 1
July 2001

Contents

A Word from the Editors

Knowledge Path: Child Health Insurance and Access to Care

Trends in the Number of Uninsured Children Before and After SCHIP

Measurement of SCHIP Outcomes and Its Effects on Insurance Coverage

ROInfo™

About M. Davis and Company

A Word from the Editors

Program administrators and managed care executives are increasingly being called upon to demonstrate the efficiency and effectiveness of their program/organization. For programs like CHIP, these measurement indicators can include: effectiveness of outreach, displacement of private coverage and effects on access.

To access these efficiency and effectiveness indicators, program administrators and industry executives must:

• Conduct market research to identify greatest opportunities to effectively communicate a program to respective audience and prompt message recipient to action,
  
  
• Develop strategies that optimize these opportunities and effectively implement with available resources and employees
  
  
• Employ marketing and public relations strategies to educate the market- place about the value and advantages of the program.

These steps build public support and political consensus, employee understanding and "buy-in" as well as help overcome "perceptual' constraints, forge critical alliances with stakeholders, increase program participation and win the support of current and potential customers.

We hope to use this newsletter to highlight for public program managers, policy analysts and managed care executives some of the research, key findings, initiatives, and best practices in the managed care industry. We welcome your comments.

According to the U.S. Census Bureau, over ten million children in the United States are uninsured. Because these children are not insured, their families may only seek care for them in emergency situations, not able to afford the preventive health services necessary for their child's healthy growth and development. In an effort to insure many of these children, Congress initiated the State Children's Health Insurance Program (SCHIP). SCHIP provides $24 billion over five years to families who make too much to qualify for Medicaid, but who cannot afford to purchase health insurance on their own. In order for the SCHIP program to succeed in assuring that children have access to needed health services, state programs need to find eligible children, enroll them into the new program, and assure that they have access to needed services.

Link for more information on SCHIP: www.ncemch.org/RefDes/InsuranceKP.htm

SCHIP enrollment continues to grow at a steady pace. One issue of great interest to policy makers is whether the growth in SCHIP enrollment is producing a measurable reduction in the number of uninsured children or whether the enrollment growth is being offset by losses in coverage else- where, including a substitution of public for private coverage. The possibility of a substitution effect is a particular concern in the states with broad expansions that target families with incomes above 200 percent of the Federal Poverty Level. A fundamental measure of the effectiveness of SCHIP is the extent to which SCHIP has reduced the proportion of low-income children without health insurance. A related measure is the distribution of health insurance coverage among low- income children, to ensure that children eligible for Medicaid are enrolled and that children who are covered by employer sponsored insurance (ESI) maintain that coverage, rather than substituting SCHIP for other coverage.

Cited from Implementation of the State Children's Health Insurance Program: Momentum is Increasing After a Modest Start. Mathematica Policy Research. January, 2001

Link to report: www.hcfa.gov/init/children.htm

Measurement of SCHIP Outcomes and Its Effects on Insurance Coverage

Officials at both the Federal and state levels want to know whether SCHIP programs are "living up to their promise." Each state SCHIP program is faced with the challenge of monitoring performance as well as measuring both quality and impact. States need to assess the following seven SCHIP performance indicators.

• Effectiveness of Outreach. How did applicants find out about the program? What brought them into the enrollment site? Sources of outreach data may include:
  • Administrative data (characteristics of new enrollees).
  • Site visits to where CHIP eligible children are likely to receive medical care).
  • Media Tracking information
    
    
• Effectiveness of Enrollment Strategies. What barriers are facing applicants at the enrollment sites? Who enrolls at a center versus mail? What are the characteristics of children enrolling in the program? Enrollment information can be gathered through:
  • Administrative data.
  • Enrollment-site visits.
  • Telephone surveys of applicants (i.e., exploring characteristics of those who do and do not enroll).
    
    
• Effects on Stability of Coverage. Do those enrolled keep coverage? Why do they drop out? Do those who drop out obtain other coverage - (from where)? Sources of coverage stability information may include:
  • Administrative data: linking SCHIP and Medicaid files to track children moving back and forth between the two programs.
  • Follow-up survey of those who drop SCHIP coverage to assess reasons why coverage was dropped.
    
    
• Cost Per Newly Covered Child. System cost versus Federal cost. Have SCHIP dollars displaced some state and private non-profit funds? Sources of information include:
  • Administrative data.
  • Telephone surveys of covered child's parent or guardian.
    
    
• Displacement of Private Coverage. Would children enrolled in SCHIP otherwise have had other insurance coverage? Data sources include:
  • Administrative data.
  • Surveys of enrolled children's parent or guardian.
  • Surveys of small employers and low-income workers.
    
    
• Effects on Access. What difference has enrollment in SCHIP made for participants? Data sources include:
  • Administrative data from plans.
  • Participant surveys regarding physician visits and well-child care visits.
    
    
• Effects on Appropriate and Inappropriate Use of Services. Data sources include:
  • Administrative data from plans.
  • Health status surveys.
  • Comparison of National Immunization Survey (NIS) data before and after enrollment.
    

Link for source:
www.ahrq.gov/chip/text/content/monitoring_evaluation/data_collection_methods2.htm

Related links:
www.ahrq.gov/chip/content/monitoring_evaluation/fed_reporting_regs_quality.htm
www.ahrq.gov/chip/content/monitoring_evaluation/fed_reporting _regs_success.htm

ROInfo™

Today's environment requires both public and private sector executives to make significant decisions in a timely manner, using the best market research information available. Decision makers must have high returns on the information provided. It is our aim at M. Davis and Company, Inc., to provide program managers, policy analysts and managed care executives a product - high return on information (ROInfo™) - that most effectively identifies challenges facing their organizations and best solutions to those challenges.

ROInfo™ through the use of a range of research methods and techniques, program designs and monitoring tools, provides clients with critical information in real time. This timely presentation of critical performance information, improves executive decision making and organizational performance.

ABOUT M. DAVIS AND COMPANY

M. Davis and Company, Inc., is a market research and consulting firm that provides complete services from project conception through implementation. We aim to ensure that our clients receive a high return on information (ROInfo™) by employing our unique perspective and market insights. We help clients make the most of their opportunities and implement solutions based on the information we provide. Our clients include federal and state agencies as well as private sector companies from healthcare, retail and transportation industries. Projects have included:

• Immunization Campaign Effectiveness. M. Davis and Company, on behalf of the U.S. Department of Health and Human Services - Centers for Disease Control, conducted a multi-wave national telephone survey to assess the level of awareness and impact of the national immunization advertising campaign.
  
  
• Health Risk Assessments. M. Davis and Company - on behalf of a multi-state managed care organization serving SCHIP, Medicaid and Medicare members - developed and administered a customized health status survey. Over 50,000 assessments have been completed by telephone interviews.
  
  
• Enrollee Satisfaction Surveys. M. Davis and Company has designed and administered over one dozen managed care enrollee satisfaction surveys for six organizations, whose memberships ranged from 30,000 to 100,000 covered lives. These surveys have included SCHIP, Medicaid and Medicare enrollees.

We are pleased to announce, M. Davis and Company, Inc. was recently selected by the U.S. Department of Transportation to administer the Omnibus Household Survey. This multi-year engagement involves the monthly administration of over 1,000 telephone surveys to randomly selected households to gather information regarding commuting habits and awareness of various Federal safety initiatives.

We believe our clients are buying solutions, not volumes of data. To achieve success, our clients need "added value" and we supply it. We forge a close relationship with our clients, becoming their trusted partner, instead of a supplier. With better understanding of our clients, we narrow the gap between their objectives and operations by providing information tailored to their needs and designed to help them achieve: "high margin" information. Our clients can then employ strategies and tactics that produce success.

For more information on our capabilities, please visit our web site: www.mdavisco.com.
To speak directly with one of our consultants, please call 215-790-8900.

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