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Recent SHADAC Projects

The following is a list of recent SHADAC projects. The list is not exhaustive but is meant to provide a general sense of the types of projects that SHADAC conducts.

Evaluation of the Implementation of Section 1115 Medicaid Expansion Waivers

SHADAC was commissioned in 2017 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. This analysis was completed in February of 2018. Access the report.

State Innovation Model (SIM) Technical Assistance

Since 2012, SHADAC has been part of a team led by NORC at the University of Chicago that is serving as the State Innovation Model (SIM) Resource Support Contractor for the Center for Medicare and Medicaid Innovation (the “Innovation Center”). SHADAC is currently supporting 38 states and territories and the Innovation Center in designing and testing innovative multi-payer health system transformation approaches.  SHADAC works with NORC and other technical assistance partners, including the Center for Health Care Strategies (CHCS), National Governors Association, Manatt Health Solutions, and Mercer Consulting to provide consultation and technical assistance to states as they develop and implement health care transformation models.

Robert Wood Johnson Foundation (RWJF) Culture of Health Measures

SHADAC provides ongoing updates to 16 of the measures maintained by the Robert Wood Johnson Foundation (RWJF) on its Building a Culture of Health website. This work involves obtaining restricted data from Census Research Data Centers; monitoring the release of updated data; procuring and cleaning micro-data as it becomes available; monitoring data sources for methodological and/or instrument changes; maintaining detailed documentation; and applying rigorous quality control techniques.

SHADAC's State Health Compare

SHADAC designed and maintains this new online data tool called State Health Compare that brings together estimates that were previously available separately through the SHADAC Data Center and the Robert Wood Johnson Foundation's (RWJF) Data Hub. The new, merged tool combines estimates on a wide range of health-related topics in an effort to allow analysts and policymakers to view state-level data through a broad Culture of Health Lens.

Evaluation of the Minnesota Accountable Health Model

In 2013, Minnesota was awarded a State Innovation Model (SIM) cooperative agreement by the CMS’s Center for Medicare and Medicaid Innovation (CMMI) to implement and test a model of state care delivery transformation and payment reform: the Minnesota Accountable Health Model. SHADAC managed the state-level evaluation efforts for this model from 2013 to 2017. Among the principal goals of the SHADAC evaluation were documenting variation in design, approaches, and innovation in MN Accountable Health Model activities; examining how the model has contributed to advancing state goals; identifying gaps and challenges under the model; and calling attention to opportunities for sustaining the model and improving its programs. Learn more about SHADAC's evaluation of SIM in Minnesota.

Study of the Impact of the Affordable Care Act (ACA) on Health Care Coverage, Access, Quality, Cost, and Outcomes in Kentucky

SHADAC conducted a mixed-methods study under a contract to the Foundation for a Healthy Kentucky from 2015 to 2017 that assessed the implementation and outcomes of Kentucky’s health reform efforts. The study used primary and secondary data from a telephone survey, regional site visits, and federal surveys. The results will inform ongoing implementation decisions and support continuous quality improvement efforts in Kentucky. The study findings were synthesized so that they could also inform ongoing health reform efforts in other states and at the federal level. Learn more about SHADAC's evaluation of the impacts of the ACA in Kentucky.

Value-Based Payment Reform in the Medicaid Program

The Medicaid and CHIP Payment and Access Commission (MACPAC) and SHADAC conducted site visits in 2013-2014 to a total of seven states—Arkansas, Connecticut, Maryland, Minnesota, Oklahoma, Oregon, and Pennsylvania—to learn about different payment and delivery system reforms aimed at improving value in Medicaid such as shared savings approaches, episode-based payment initiatives, and global budgeting. SHADAC produced an interim report reflecting the cross-state learnings from four of these site visits, entitled “Paying for Value in Medicaid: A Synthesis of Advanced Payment Models in Four States,” for MACPAC’s Commissioners and Congressional audiences.

Behavioral and Physical Health Integration Efforts in the Medicaid Program

SHADAC recently served as a contractor to The Medicaid and CHIP Payment and Access Commission (MACPAC) on a project to document behavioral and physical health integration efforts in Medicaid. Study questions included:

  • What populations are targeted by physical and behavioral health integration efforts?
  • At what level—state, community, provider organization, clinic, clinician—is physical and behavioral health integration occurring and not occurring?
  • How does integration of programs and financing at a state level facilitate clinical integration at the point of care for individuals?
  • To what extent do existing evaluations of state integrated care programs address outcomes?
  • Within unique state purchasing models, markets, and contexts, what strategies are used to: design and oversee vendor contracts and subcontracts, promote collaborative relationships with providers and between payers and providers; facilitate the exchange of data to monitor access to needed care; and align other payers around common goals like integrated care?
  • How are integration initiatives that operate under different regulatory authorities (e.g., different waivers, State Plan Amendments (SPA) alike, and how are they different?

To assess these questions, SHADAC conducted a comprehensive data scan for all states, followed by telephone interviews with officials from a subset of states. The focus was on integration programs that have been implemented or were currently underway that also had strong ties to Medicaid programs and funding.

Colorado Health Access Survey

SHADAC recently provided technical expertise to the Colorado Health Institute (CHI) on the development of the Colorado Health Access Survey (CHAS) questionnaire to be fielded 2015. SHADAC staff identified reform-relevant topics/domains of potential interest for consideration in the 2015 CHAS survey instrument; compiled specific health reform questionnaire items for CHI’s consideration based on SHADAC’s knowledge of relevant and new questions used in federal and other state surveys; provided guidance and made recommendations to CHI related to the inclusion of specific questionnaire items in the 2015 instrument per CHI data collection priorities; and reviewed and provided feedback on questionnaire revisions and additions for 2015.