The Arkansas Opportunity Project

Funded Proposal

More change has occurred in the health care system in the last 18 months than in the past 18 years. By simply giving it the attention that it needs, President Bill Clinton has already brought about significant change in the health care delivery system - all without Congress passing a single line of legislation. In Arkansas, as in many states, health care reform is running at a fever pitch And the Arkansas Opportunity Project is in the middle of it all.

In April 1993, the Arkansas Legislature abolished the body that had been the Interagency Working Group for the Arkansas Opportunity Project. In its place, it created the Arkansas Health Resources Commission. The legislation mandates that the Commission serve as the "advisory body" to the Arkansas Opportunity Project. Only two legislators were members of the previous IWG; 12 of 23 members of the new Commission are legislators. Since the goal of the Project is to work with policy makers to develop, implement and effectively utilize data systems in the formulation of policy, these developments have greatly improved our chances for success.

The executive branch is also very interested in health care reform. Governor Jim Guy Tucker (then Lieutenant-Governor) was a member of our previous IWG. In anticipation of difficulties that Arkansas might encounter under health care reform, he appointed the Governor's Task Force on Health Care Reform. (Funding for staff support to the Task Force is provided under a State Initiatives grant by The Robert Wood Johnson Foundation.)

The charge to the Task Force is to identify the issues associated with health care reform in Arkansas and to outline the major options, preparatory to legislation that may be enacted by Congress. As a member of the Task Force, I see my role as acting as a consultant on data systems and their application in the formulation of policy.

Arkansas is talent rich but data poor. Consequently, the Health Resources Commission and the Task Force quickly realized that significant health care reform cannot proceed without an information base. In that regard the Arkansas Opportunity Project has succeeded in accomplishing its most difficult objective: getting policy makers to understand the importance of information systems.

The Commission and Task Force continue in their deliberations. As such, no specific recommendations have yet been made. However, relations between the Commission and Task Force and the Arkansas Opportunity Project are excellent. Our goal is to have the Center for Health Statistics designated as the state health data organization for the state of Arkansas. This would give the Center for Health Statistics primary responsibility for health related data collection, analysis, and research for the state health alliance.

There are four principal initiatives under Phase II of the Arkansas Opportunity Project. First, a Hospital Discharge Data System is the single most important health related data system that Arkansas does not yet have. With the financial support received from The Robert Wood Johnson Foundation, this data system will be implemented in late 1995, and possibly sooner.

Second, the Family Health Survey is a telephone survey of a randomly selected households. Interviews are conducted with the most knowledgeable person in that household, obtaining a wide range of health related information concerning the people living there. This presages the Consumer Health Surveys called for under the Clinton Plan.

The third activity is the enhanced analysis of Medicaid Paid Claims data. Although Medicaid policy officials have access to many administrative data tabulations, these are not designed to meet political and policy concerns that frequently arise. Our analytical and research expertise will prove invaluable.

The fourth and perhaps most important, is the dissemination initiative. This consists of newsletters, reports, briefings, and public use files.

Structure and Size of the IWG:

Issues:

Fiscal Issues
Health Access and Reform

Effected Data Systems:

Household Population Survey (New)
Hospital Discharge (New)
Medicaid Data (Linkage)

Dissemination:

Reports
Newsletter
Public Use Tapes
Briefings

Electronic Products:

Public Use Tapes
Data Inventory
E-Mail (Bulletin Board)

Title of the project:
The Arkansas Opportunity Project: Information for State Health Policy- Phase II

Name and title of the proposed Project Director:
Douglas R. Murray, Director, Center for Health Statistics, Arkansas Department of Health

Description of the proposed structure and the process to be employed by the lead agency and its relationship to the interagency working group:
The Arkansas Opportunity Project is housed within the Arkansas Department of Health which as been designated by Governor Jim Guy Tucker as the lead agency for this initiative. The Interagency Working Group (IWG) is the Arkansas Health Resources Commission, a statutorily defined body; 12 of the 23 members are senior state Legislators and the other 11 are drawn from alI major sectors of health and medicine in Arkansas.

Short- and long-term health policy(s) issues to be addressed:
The Interagency Working Group identified and ranked 34 separate state health policy issues. The six leading health policy issues identified by the IWG can readily be subsumed under two general rubrics: (1) Fiscal Issues (health insurance reforms, cost containment, and financing indigent health care), and (2) Sexual Consequences (teenage pregnancy, infant mortality and low birthweight babies, and sexually transmitted diseases). The major focus of the activities of the Arkansas Opportunity Project will be to provide information which can be used by policy makers to address these two groups of health policy issues. None of these issues can be considered 'short-term' in their prospects for solution. Therefore, these issues constitute both the short- and long-term health policy issues for the state of Arkansas.

The plan for implementing data system improvements:
All existing and potential data systems that could be used to provide information to policy makers on the major issues identified by the IWG were identified. Each data system was given a score, based on its potential relevancy to each of the issues. In the first two years of Phase II, project staff will work with the Arkansas Health Resources Commission to implement: (1) a Family Health Survey, using telephone interviews to elicit information on the priority health policy issues, (2) Enhanced Medicaid Analysis which will increase analysis and improve the reports from existing Medicaid data, (3) a statewide, hospital- based Arkansas Perinatal Database. These three information systems initiatives can all contribute, in varying degrees, to a fuller understanding of these and many other health policy issues. In the third year of the project, these activities will be supplemented with the implementation of a Hospital Discharge Data System. Every effort will be made during the first 18 months of the project to create a favorable Legislative climate for full funding of a Hospital Discharge Data System. In the event that Legislative funding is not forthcoming in this next session, it is proposed that the Hospital Discharge Data System be funded jointly by State of Arkansas and The Robert Wood Johnson Foundation monies, the latter becoming available as other sources of support are found for the Family Health Survey, the Enhanced Medicaid Analysis, and the Arkansas Perinatal Database.

Reports ranging from brief overviews to comprehensive reviews of the issues will be produced. They will be distributed directly to policy makers and senior administrative officials, the media and the general public. Public use tapes (with confidential identifying information removed) will be made available to qualified researchers for further analysis.

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