Mississippi Information for State Health Policy Program

Funded Proposal

Over the past decade, a growing number of states across the nation have been faced with the dilemma of having inadequate data available for health policy makers and program managers; information that is critical in the development of viable health care policies. Today in Mississippi, we are challenged by the same problem - the urgent need for integrated health statistics systems. Fragmented bits of health and related human services data are found scattered throughout many different agencies and organizations, both public and private. Most of the current health statistics systems were designed to report service statistics from facilities such as clinics and hospitals. Furthermore even within specific agencies, data systems are not necessarily integrated.

Responding to the country's needs the Robert Wood Johnson Foundation, a philanthropic organization which provides funding for selected innovative health-related projects, announced the Information for State Health Policy Initiative in January of 1991, and sent out an invitation to all states to apply for the grant by developing proposals which would strengthen each state's respective health statistics systems to support policy making and aid in program development and management.

In response to this call the governor selected 29 individuals who represented the major stakeholders in planning for data system enhancements, to form the Interagency Working Group (IWG) which was charged with the responsibility of refining the state's massive statistical needs into one workable proposal. This Interagency Working Group (IWG) had active participation from representatives of key health and human services agencies and organizations, Mississippi's judicial and legislative branches, consumer organizations and associations representing private providers.

Because improvement to the data systems infrastructure required an understanding of the policy issues for health and human services all members of the IWG were surveys to determine long and short term policy issues and their associated data needs. This information was compiled and presented to the IWG to prioritize policy issues and select a policy issue of critical importance for the state. In reviewing the work completed by the IWG, the Governor and his staff selected a focus on health care access as one of the highest and most urgent priorities for Mississippians. Access was cited as an important challenge of health care, particularly to a rural state. Furthermore it was noted that policy making aimed at enhancement of health care access requires multiple sources of data spanning many state agencies. Therefore the Mississippi proposal focused on the state's great need for health care access data and was submitted to the Foundation on August 1, 1991.

In January of 1992, Mississippi was chosen as one of the 10 states to proceed with the project and in April of 1992, Mississippi Information for State Health Policy Project (INFOSHP) - Phase I began its work under the direction of Helen Wetherbee JD, MPH, Executive Director of the Division of Medicaid. The primary objectives of Phase I of the project were to conduct a comprehensive review of information needs, identify and prioritize data systems enhancement strategies and select a specific detailed proposal to meet high priority information needs. Members of the IWG recognized that the interagency effort being used in achieving these goals would have potential long-term significance for the continued management of state's data systems. The experiences of the IWG established a precedent for a continuing working coalition of agency directors, program managers and analysts to advocate for accurate and timely data in health policy and long-term program development and management.

At the completion of Phase I work, Mississippi again successfully completed with nine other states for an additional $940,000 in grant monies to proceed with Phase II of the project - the development and actual implementation of four innovative strategies: (1) creation of a new statewide hospital discharge data set; (2) the modification and linkage of existing data bases to develop a uniform ambulatory services data set; (3) enhancing reporting from the Medicaid claims data; and (4) creation of an independent IWG-supervised entity to process, integrate and disseminate information. The IWG deemed these projects essential to laying the foundation of an integrated data infrastructure serving health and human services.

Structure and Size of IWG:

Invited Interagencies Work Group
3 Elected, 19 Executive Agencies,
15 Providers, 6 Consumer/lnterests Organizations

Issues:

Primary/Preventative Care and Access
Data Infrastructure
Medicaid Expenditures

Effected Data Systems:

Hospital Discharge (New)
Ambulatory Services (Linkage)

-Linked Community Health Centers

-Linked Health Department and Community Health Centers

-Linked Data Bases in Health Department

-Linked Birth and Death Records and Medicaid Claims

Medicaid Claims Eligibility Reporting
Birth(Linkage)
Death (Linkage)
Medicaid Data (Linkage)

Dissemination:

Reports
Public Use Tapes

Electronic Products:

Linkage Protocols
Public Use Tapes

Data Standards:

Confidentiality

Title of the Project: Mississippi Information for State Health Policy Program (MISHPP)/Phase II: Developing Health Information Resources for Mississippi

Project Director: Helen Wetherbee J.D., M.P.H. Executive Director of the Division of Medicaid will serve as Director of MISHPP. Ms. Wetherbee's extensive experience with the administration of service agencies and in designing data collection systems for agencies, as well as her legal training and service in the state are significant qualifications in leading this collaborative interagency effort.

Structure and Process: The Interagency Working Group (IWG) of MISHPP will provide continuing oversight to staff at the Division of Medicaid in the Office of the Governor as they implement an interagency collaborative work plan for four data projects. These projects are: creation of a new statewide hospital discharge data set; the modification and linkage of existing data bases to develop a uniform ambulatory services data set; enhancing reporting from the Medicaid claims data; and creation of an independent IWG-supervised entity to process, integrate and disseminate information. The IWG deemed these projects essential to laying the foundation of an integrated data infrastructure serving health and human services. Each project will be staffed by a project manager responsible for daily operations. Staff will develop a Project Implementation Plan for each project with a schedule of tasks, personnel, process review and data analysis and outcome reporting. The IWG will review Implementation Plans and as project implementation proceeds, evaluate project process and outcomes through routine reports. As data sets are collected and analysis completed, reports will be reviewed to assure content and format are useful. IWG will meet during the year to review project progress. MISHPP staff will be assisted at these meetings by Dr. Greer Sullivan, Program Development Consultant who has extensive experience in linking and analyzing administrative data in a variety of health services settings. As health care reform mandates are announced by the federal government, as agencies and organizations modify data systems/policy priorities/program management, as trends in state morbidity and mortality statistics vary, MISHPP staff will report these changes to-theIWG to evaluate the need to modify the Comprehensive Data Enhancement Plan. MISHPP staff will be using nominative group techniques to reach consensus on modifications to the Plan. MISHPP process therefore retains the IWG role in Phase II not only in oversight for project development, data analysis and information dissemination but maintains an on-going review of policy priorities and designation of information needs.

Short and long-term health policy issues to be addressed. The data projects respond to four priority areas within MISHPP's broad policy focus on health care access: enhance access to and utilization of inpatient care; enhance effective coordination of preventive and primary ambulatory care; enhance utilization of Medicaid funds; and strengthen data infrastructure for enhanced retrieval and analysis of information about access to health and human services.

The plan for implementing data system improvements. 1. Hospital Discharge Data Set (HDDS). Conduct feasibility studies of legal, financial and technical issues inherent to an HDDS and develop support among the major stakeholders in these data for legislative implementation. Robert Wood Johnson Foundation support is especially critical for the developmental stage of this strategy because the state lacks funding for a thorough exploration and resolution of these issues. Early and substantial state support will be required to institutionalize this data system in the third year of Phase II. 2. Ambulatory Data Set. Conduct a multi-phase process including: develop a uniform data set (UDS) among community health centers; enhance basic Mississippi State Department of Health (MSDH) Patient Information Management System (PIMS) functions with software to conduct analyses that link client data across programs within MSDH; link vital records with Medicaid claims data; and link the CHCs' UDS with MSDH PIMS, Medicaid claims, hospital discharge files and vital records. 3. Medicaid Utilization Reporting: Take advantage of the Division of Medicaid's purchase of MEDSTAT Decision Support System, a user-friendly software package that integrates Mississippi Medicaid Information System (MMIS) claims files and provides on-line access to these files for rapid preparation of analytical reports. Staff support will facilitate rapid dissemination of MEDSTAT reports to the IWG to survey for alternative analytic output and format options. Staff will facilitate exploration of linkage with CHC/MSDH UDS. 4. The Information Center: Build support for continuation of MISHPP operations beyond grant funding in an independent state-funded Center. Staff will prepare a report on options available for institutionalization of the operations in the form of an Information Center. These options will be developed based on experiences in other states. Issues of location, confidentiality, governance, and technical and staff support will be presented to the IWG for review and discussion. MISHPP development of management and policy-relevant information over first two grant years will build support among IWG members and in Legislature. IWG members will be the key players in convincing the Legislature to institutionalize such a Center and appoint the IWG as its policy advisory governing board.

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