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Blog & News
New Brief: Using HCUP Data for State Health Policy Analysis
May 12, 2017:
The SHARE grant program has released a new brief examining the use of administrative data for the purpose of state health policy analysis. In particular, the brief highlights the hospital administrative data available from the Healthcare Cost and Utilization Project (HCUP) and presents a case study of a SHARE-funded project that uses HCUP data to evaluate the impacts of California’s early ACA Medicaid expansion on inpatient hospital utilization.
What is the HCUP?
The HCUP is a collection of six different databases sponsored by the federal Agency for Healthcare Research and Quality (AHRQ) that can be purchased through the HCUP Central Distributor. These databases consist of longitudinal hospital data—with a primary focus on community hospitals--based on de-identified discharge records for individual patients. The six different HCUP databases are:
- • National Inpatient Sample (NIS)
- • Kids’ Inpatient Database (KID)
- • Nationwide Emergency Department Sample (NEDS)
- • Nationwide Readmissions Database (NRD)
- • State Inpatient Databases (SID)
- • State Emergency Department Databases (SEDD)
Using HCUP Data to Examine State-Level Utilization
For state-focused health policy research, the State Inpatient Databases (SID), which consist of hospital inpatient discharge data on approximately 90 percent of all U.S. hospital discharges, are especially useful for understanding patient utilization. The SID not only allow researchers to examine hospital-level differences within states but also foster multi-state comparisons and analyses because of their uniformity.
Case Study: Early Medicaid Expansion in California
Researchers at Virginia Commonwealth University (VCU), led by Dr. Peter Cunningham, used the SID to examine the utilization impact of California’s early Medicaid expansion. Specifically, the research team compared
- Utilization at hospitals in California from 2010 to 2013 with utilization at hospitals in neighboring states without an early Medicaid expansion, and
- Utilization over the same time period at safety net and non-safety net hospitals within California.
Preliminary Findings: Highlights
Preliminary findings from the VCU study include (among others):
- • Inpatient volumes increased at California hospitals relative to the comparison states following California’s Medicaid expansion, when controlling for national trends.
- • Medicaid admissions as a percent of total admissions increased after California’s Medicaid expansion, while uninsured admissions declined when compared to non-expansion states (again, controlling for national trends).
- • Overall inpatient volumes at safety net hospitals within California increased to a greater extent than at the state’s non-safety net hospitals following the early Medicaid expansion.
- • Both safety net and non-safety net hospitals within California observed similar patterns in payer mix after the Medicaid expansion, with an increase in Medicaid admissions as a percent of total admissions and a decrease in uninsured admissions as a percent of total admissions.
Further Details
For more information on the HCUP, the SID, and preliminary findings from the VCU study, view the full issue brief: “Using HCUP Data for State Health Policy Analysis: A Case Study Examining the Impacts of an Early Medicaid Expansion.”
Publication
Using HCUP Data for State Health Policy Analysis: A Case Study Examining the Impacts of an Early Medicaid Expansion
This brief from the SHARE grant program examines a rich source of US hospital administrative data--the Healthcare Cost and Utilization Project (HCUP)--and provides an example of how a SHARE-funded research project led by Dr. Peter Cunningham at Virginia Commonwealth University has used these data to evaluate the impacts of an early ACA Medicaid expansion on utilization-related outcomes at hospitals in California.
Blog & News
Call for Proposals for SHARE Grant Funding
May 12, 2017:Proposal Deadline: June 1, 2016 (3:00 p.m. ET)
The Robert Wood Johnson Foundation (RWJF) is soliciting proposals to fund studies of state-level health reform through the State Health Access Reform Evaluation (SHARE) grant program.
Background
States have played and continue to play a critical role in the implementation of health reform. States have made different choices in the roll out of the ACA, including whether to establish a State-Based Marketplace, use a Federal-State Partnership Model, or participate in the Federally-Facilitated Marketplace. States have also made different decisions regarding Medicaid expansion, with several states opting to implement an early (pre-2014) expansion for adults without dependent children, some states expanding in 2014, and several states negotiating unique Medicaid expansion approaches post-2014. Further, some states are experimenting with new payment and delivery systems that integrate health care services, and exploring opportunities to bridge health and social sectors to improve population health.
Under a new SHARE call for proposals, RWJF seeks to fund timely, policy-relevant studies with strong empirical designs to improve the collective understanding of health reform at the state level and to inform policy and the reform implementation process. Eligible studies may be of a single state or a group of states, or they maybe be national analyses that use state-level data.
Proposals could focus on a broad range of topics, including state insurance market regulation and/or the potential use of 1332 waivers to expand coverage; Medicaid policy, including expansion or waivers; and payment and delivery system reforms including efforts to control health care costs, improve competition, and/or promote transparency.
How much funding is available?
Up to $1.3 million will be available under this solicitation to accommodate eight to 12 studies, with individual project funding ranging from $50,000 to $150,000. Studies can be six to 12 months in length, but preference will be given to rapid-turnaround projects that can be completed within six months.
Who can apply?
Researchers, as well as practitioners and public and private policy-makers working with researchers, are eligible to submit proposals through their organizations. Projects may be generated from disciplines including health services research, economics, sociology, program evaluation, political science, public policy, public health, public administration, law, business administration, or other related fields.
When is the submission deadline?
The deadline to submit proposals under this call is June 1, 2016, at 3:00 p.m. ET.
Where can I learn more?
Click here to access the full call for proposals, with details about potential research questions, eligibility and selection criteria, and the application process. For a list of previously funded SHARE projects, publications, lessons learned, and policy impacts click here.
State Health Access Reform Evaluation (SHARE) is a national program of the Robert Wood Johnson Foundation that supports rigorous research on issues surrounding state health reform. The SHARE program is managed by the State Health Access Data Assistance Center (SHADAC), an RWJF-funded research center in the Division of Health Policy and Management, School of Public Health, University of Minnesota. Staff at AcademyHealth are conducting the call for proposals and the proposal review process, and staff at SHADAC will monitor the awarded grants and assist grantees with the translation, promotion, and dissemination of research findings.
Blog & News
SHARE Research in Health Affairs: Value-Based Insurance Design Influenced Consumer Behavior in Connecticut
October 03, 2018:In the April 2016 issue of Health Affairs, SHARE grantee Richard Hirth and his research team published findings on the effectiveness of a value-based insurance design (V-BID) program for Connecticut state employees. The SHARE-supported analysis focuses on the effects of Connecticut’s Health Enhancement Program (HEP), which is a voluntary program for state employees that incorporates V-BID principles by encouraging consumers to utilize high-value medical services. The authors found that among HEP enrollees relative to comparison groups the use of targeted services and adherence to medications for chronic conditions increased, while emergency department use decreased over a two-year time period.
Learn more at the Health Affairs briefing on Patients’ and Consumers’ Use of Evidence in Washington, D.C., on Thursday, April 7th at 9:00 a.m. ET. Use #patientevidence to follow University of Michigan V-BID Center Director Dr. Mark Fendrick’s discussion of the paper.
Blog & News
SHADAC Analysis Tracks ACA Impact in Kentucky
November 30, 2016:Foundation for a Healthy Kentucky released a report today evaluating the impact of the Affordable Care Act (ACA) implementation in Kentucky. This analysis was conducted by SHADAC with funding from the Foundation for a Healthy Kentucky and evaluates Kentucky’s progress in five areas: coverage, access, cost, quality, and health outcomes.
The analysis, which provides an update to baseline data from 2012, uses data from federal and state data resources and compares Kentucky metrics to the U.S. as a whole and to other states.
“Kentucky has made significant gains in health insurance coverage and access to needed care through its commitment to implementation of the Affordable Care Act. The Commonwealth has been at the forefront in designing effective strategies to get and keep people covered providing lessons for the rest of the country. As change continues in KY’s health reform agenda it will be important to monitor and document the impact on Kentuckians and their families over time,” notes Lynn Blewett, SHADAC Director and Principal Director of the Kentucky ACA impact study.
The following are highlights from the report.
COVERAGE
Kentucky has substantially improved coverage rates across most race, gender, age, and income groups since 2012. 
Kentucky’s overall rate of uninsurance fell to 8.7% in 2014--a 4.9 percentage-point drop from 2012. This rate is statistically significantly lower than the overall U.S. and a number of neighboring states (Figure 1.2).
People with lower incomes saw greatest declines in uninsurance.
Kentuckians with household incomes at or below 138 percent of the Federal Poverty Level (FPL) saw a 11.2 percentage-point decline in uninsurance from 2012 to 2014, and those with household incomes from 139 percent FPL to 200 percent FPL saw a 5.3 percentage-point decline. Kentuckians with incomes above these levels saw no significant change in uninsurance from 2012 to 2014 (Figure 1.5).
Disparities in insurance coverage still persist, especially by Race/Ethnicity.
The uninsurance rate for the Hispanic/Latino population, at 28.9 percent (Figure 1.3), is more than triple the state’s overall uninsurance rate of 8.7 percent.
ACCESS
Access to health care in Kentucky has remained relatively stable since 2012.
The share of the population reporting a usual source of care increased from 83.6 percent to 88.4 percent from 2012 to 2013. During this same time period, emergency department visits dropped from 30.4% to 24.9% a statistically significant decrease.
COST
In 2013, Kentucky citizens had a harder time paying medical bills compared to the U.S.
Overall, 42.8 percent of Kentuckians had trouble paying medical bills, well above national rate of 30.2 percent. The rate of Kentuckians having trouble paying bills was also higher than the rate in several neighboring states , including Illinois (28.5%), Missouri (36.9%), Ohio (31.1%), and Virginia (29.5%; Figure 3.2). 
QUALITY
Among neighboring states, Kentucky was the only one that had a significant increase in the percentage of respondents who reported having a colorectal cancer screening from 2012 to 2014 (62.4% to 66.4%); however, the ACA is likely not the only factor for this increase—Kentucky has programs promoting colorectal cancer screening.
Racial disparities continue in low birth weight, wiith non-Hispanic blacks continuing to have the highest rate of low birth weight (13.2 percent) in 2014.
OUTCOMES
Overall, health status measures were relatively stable from 2012 to 2014.
At 31.6 percent, Kentucky’s adult obesity rate in 2014 remained unchanged from 2012.
The percentage of adult Kentuckians who reported having one or more chronic conditions did increase from 26.8 percent in 2012 to 29.1 percent in 2014, but it is important to note that increases in chronic disease prevalence can be expected with increases in coverage and access to care.
