Proposed Evaluation Collection Plan for a Health Benefit Exchange in West Virginia Thomas K. Bias, Ph. D. Health Researc

1. Proposed Evaluation Collection Plan for a Health Benefit Exchange in West Virginia Thomas K. Bias, Ph. D. Health Research Center WVU School of Public Health M. Paula Fitzgerald, Ph. D. Nathan Haddad Professor of Business Administration Marketing Department West Virginia University Tami Gurley-Calvez, Ph. D. Kansas University School of Medicine

2. Purpose of Evaluation • Three-pronged approach: Evaluate outcomes of a Health Exchange in the State of West Virginia • Health • Economics • User knowledge & experience

3. Research Questions • Appendix I in evaluation report • Covers areas related to health, economics, marketing • These questions were based on feedback from stakeholder groups, the WV OIC, other state evaluation efforts, academic literature, and past experience.

4. (1) Monitoring Existing Data • Regularly collected data on insurance, health outcomes and demographics • Chronic disease rates • Self-reported health status • Access to and utilization of health care • Mental health • Substance abuse

5. Existing Data Source Examples • Some important data sources include: • CAHPS • HCUP • BRFSS • YRBS • Why recommended: These existing measures help us understand the impact of the exchange from a population health perspective as well as access to hospital administrative data to answer key evaluation questions.

6. (2) State Clinical Data and De-identified Health Outcomes • Focus on the quality of care of West Virginians • Use electronic medical records to assess patient outcomes in primary care centers and federally qualified health centers (FQHCs) • Important source of care for rural West Virginians • Look into potential hospital and other provider related data to supplement health outcomes related to the exchange • Why recommended: These data will provide us with a look at health outcomes for participants in the exchange, especially in rural areas including primary care centers, a key source of care for West Virginians.

7. (3) Consumer, Navigator & Assister Feedback on Exchange • Face-to-face “verbal protocol” assessment of the actual Exchange electronic shopping experience (e.g., Beta version) • Why recommended: These groups must be able to successfully navigate the website and understand the information provided and choices they are making for maximum enrollment

8. (4) Survey of West Virginia Residents • Users and non-users • Affordability perceptions • Attitudes toward and awareness of Exchange • Ability to navigate (health and financial literacy) • Perceived advantage of Exchange • Health insurance status—past, current and future • Allows us to understand non-users • Why Recommended: Maximum participation needed to make the Exchange viable. This allows West Virginia to identify and correct obstacles to participation to increase enrollment and re-enrollment

9. (5) Exit Survey from Exchange • ServQual (reliability, responsiveness, empathy, tangibles) • WebQual (usefulness, ease-of-use relative advantage over other purchase methods) • Satisfaction • Understanding of information/health literacy • Why Recommended: West Virginia can improve repeat purchases and diagnose problems with “empty shopping carts”

10. (6) Economic Modeling Direct Effects Indirect Effects Insurance Market Employer Individuals Why Recommended: Understanding intended and unintended responses is key to assessing the overall affect of the Exchange. • Operating Expenses • Insurance Coverage and Churning • Informational value • Cost vs. Benefit • Secondary data • Administrative Costs • Risk Pooling • Employer Effects

11. (7) Small Businesses • Focus groups to gain an understanding of • Owner/Manager’s perceptions of the attractiveness of the Exchange in helping them meet their employee-related goals • Owner/Manager’s understanding of subsidies and the actual working of the Exchange • Annual or Bi-annual surveys • Why Recommended: • Small business behavior is an “unknown” that affects many families’ access to healthcare

12. (8) Carriers • NAIC Annual Statements • Key Informant design – speak with the decision-makers on whether and how they chose to bring products to market on the Exchange • Why Recommended: Allows West Virginia to identify any systematic difficulties encountered by carriers which may reduce their participation on the Exchange

13. (9) Providers • Existing Provider Related Data • Focus groups for learning about how the Exchange impacts their practice (utilization, costs, reimbursements) and attitudes • Some can be conducted through relationships with FQHCs • Why recommended: Providers will have important input into the quality of care and concerns with exchange implementation

14. (10) Navigator, Market Assistant, and Agent Feedback • Most likely a small design to capture feedback or input from navigators, market assistants. • May include monitoring existing feedback mechanisms • Will take into consideration concerns of existing insurance agents about the role of navigators. • Why Recommended: These intermediaries are critical to consumer adoption.

15. Work Schedule • The first 6 months of the working period would be dedicated to creation and refinement of evaluation measures including getting everything in place to begin collection just prior to the launch of exchange (baseline) • Year to year collection would continue and reports produced. Optimally, at least 4-5 years of data collection for evaluation.

16. Other State Evaluation Budgets

17. Sample Wakely Plan • http://hcr.vermont.gov/sites/hcr/files/HIX_docs/9_Vermont%20Evaluation%20plan%206.14.pdf • The link above is to a draft version, we have the final version.

18. Additional Information • The West Virginia Evaluation Plan is similar to other evaluation plans in terms of existing data sources and survey research. • It is more robust in economic modeling and health outcomes evaluation. • Contracting with a team inside WV provides the advantage of affordability and direct input into evaluation process/flexibility/an understanding of the local populations. • We draw from the resources of the Business School, School of Public Health, and WVU Health Sciences Center

19. West Virginia Advantage

20. Key Evaluation Team Members

21. Thomas K. Bias, PhD • Specializes in public health policy, specifically issues related to access to care, rural populations, and program evaluation. • Key experience as lead and co-investigator on a number of important health evaluation projects in West Virginia • Published in the areas of health prevention, return on investment and policy. • Brings experience from both academia and past work experience with West Virginia Division of Rehabilitation Services as a Research and Evaluation Specialist as well as commitment from the perspective of a life-long West Virginian.

22. M. Paula Fitzgerald, Ph. D. • Published in the areas of health literacy and financial literacy primarily in Journal of Public Policy and Marketing and Journal of Consumer Affairs • Co-editor of special issue of Journal of Consumer Affairs devoted to health literacy • Member of the WV Medicaid reform evaluation team • Consumer behaviorist with a public policy perspective: knowledgeable in common errors in consumer decision making and in decision environments. Experienced in examining products/services and marketing strategies from the consumers’ perspective, (which frequently varies greatly from the organization’s perspective).

23. Tami Gurley-Calvez, Ph.D. • Specializes in economic impacts and program evaluation, with particular expertise in the state of West Virginia • WV Medicaid Reform • The economic impact of cancer and a cancer trial network in WV • Car access and employment for welfare recipients • Out-of-state residential placement of young children in WV • An expert on tax incentives and small businesses • 9 research reports for the US Small Business Administration and the Internal Revenue Service • 8 refereed journal publications • Experience evaluating health insurance incentives and ‘job lock’ for the self-employedusing IRS tax return data