Meeting on the Perspectives on Implementation of Administrative Simplification Provisions of P.L. 104-191.
Thank you for inviting me to present before your meeting on Implementation of Administrative Simplification Provisions of the Health Insurance Portability and Accountability Act of 1996. As the responsibility for programmatic decision making continues to devolve to states, there is a need for more timely, focused data and information on the health care activities within the state's borders. This act can help governors significantly, both as purchasers and regulators of health care.
Before I make my brief remarks, I would like to explain who I am and what my responsibilities are at the National Governors' Association. I direct the Health Division within the Center for Best Practices, the 501 (c)(3) entity that provides to Governors, their staff and key state agency policymakers, technical assistance on state-based policy and programmatic issues. It is important to note that my remarks do not constitute official NGA policy, nor do they represent the perspective of any particular Governor or their staff.
Instead my remarks represent the perspective of an individual that has worked with states on health policy, programmatic, and data issues over the years. This experience enables me to provide some observations that may be of value to the Subcommittee in its future deliberations. In particular, while the technical nature of your work requires detailed input on such intricate issues as computer technology, definition of data elements, and patient confidentiality, I want to remind you that there are larger trends to keep in mind when developing your recommendations.
As the federal government provides greater flexibility to states in administering state-federal programs (such as welfare reform), states are becoming more interested in obtaining information that is state specific in order to better inform state policymakers and better assist program managers in monitoring their programs so that they can be made more effective. No longer is it acceptable simply to use national figures when looking at state health issues. For example, with funding under the Robert Wood Johnson Foundation's State Initiatives in Health Care Reform, my unit is collaborating with RAND in helping a set of states to develop alternative methodologies to estimate the health expenditures within their states. Obviously, the information on providers can assist states not only in developing more precise estimates of the health expenditures within their state, it will aid in improving the effectiveness of their Medicaid and health programs.
I encourage you to learn not only from the experiences of states that are developing their own state health expenditure system, but also from those that have considered or tested similar electronic data exchange efforts such as the state of New York.
Just like the Government Performance Results Act, which instructs federal agencies to develop systems to measure the effectiveness of a program by focusing on the outputs and not just the inputs, states are interested in developing outcomes-based systems like the Oregon Benchmarks and Minnesota Milestones. These efforts have caused states to reconsider fundamentally how to transform the current categorical data sets into a system that can accurately measure a program's effect on the client. The promise of EDT is to provide more informative and detailed data to states in a less costly format.
And several states are fundamentally changing the way in which agencies are organized. Major consolidations are becoming common in the health and welfare agencies. Many are reorganizing by function (e.g., service delivery at the local level, regulatory responsibilities, data systems, etc.). This trend has highlighted the fact that there are numerous data systems that are so fragmented and categorical that they provide little useful information for decision making even when the programs are serving the same or similar populations. States are developing strategies on how to select the right type and amount of data, and how to make the best investments in computer technology so that the resulting information system is responsive to their managerial needs and is cost-effective.
The excellent questions listed in the invitation letter to me are too complex to address at this time. Therefore, in your coming deliberations I encourage you to work with Governors and their staff in developing your recommendations. While the intricate nature of your charge requires you to work with such state policymakers as Medicaid directors and insurance commissioners, please remember that there is a cross agency policy and information investment perspective that only the Governor can provide. I can state with certainty that NGA would welcome the opportunity to facilitate such an interactive process.
Never in my 19 years as a policy analyst in state-based health issues have I seen such a Gubernatorial demand for better information systems. Governors are very active in transforming their state agencies to be more information based and implementation plans are already being developed. I believe this presents a wonderful opportunity for state and federal government to work together in developing information systems that empower states to make programs and agencies more efficient and effective. Thank you allowing me to make these comments.