2.2 Budget Line (2)—Medical Expenditure Panel Survey (MEPS)

Note: This budget line reflects AHRQ funding for the data collection and related activities conducted through the Medical Expenditure Panel Survey.

Funding Levels:

Fiscal Year 1999: $29,300,000 (Actual).
Fiscal Year 2000: $36,000,000 (Enacted).
Fiscal Year 2001: $40,850,000 (Appropriation).
Fiscal Year 2002: $48,500,000 (President's Budget).

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GPRA Goal 6: Produce and release information from MEPS on health care access, cost, use, and quality.

Strategy

AHRQ's Medical Expenditure Panel Survey collects detailed information regarding the use and payment for health care services from a nationally representative sample of Americans. No other surveys supported by the Federal Government or the private sector provide this level of detail regarding:

• The health care services used by Americans at the household level and their associated expenditures (for families and individuals).
• The cost, scope, and breadth of private health insurance coverage held by and available to the U.S. population.
• The specific services that are purchased through out-of-pocket and/or third-party payments.

This level of detail enables public and private-sector economic models to develop national and regional estimates of the impact of changes in financing, coverage, and reimbursement policy and estimates of who benefits and who bears the cost of a change in policy. No other survey provides the foundation for estimating the impact of changes on different economic groups or special populations of interest, such as the poor, elderly, veterans, the uninsured, or racial/ethnic groups.

AHRQ will continue to assess the essential components of the MEPS program—development of new, updated, or otherwise enhanced databases; creation of products for use by researchers and policymakers outside AHRQ; and facilitation of the use of MEPS-related products.

Types of Indicators

Process and output.

Use of Results by AHRQ

The results provide the Agency with a thorough review of AHRQ's data collection and development activities and release of data products and publications associated with MEPS database. AHRQ uses the results for the management of the program.

Data Issues

Many of these indicators are yes/no indicators where the data collection or product release happened as scheduled, or didn't. The evidence of successful completion of the indicators will be available on the AHRQ Web site, where products can be accessed. Other data will come from contract monitoring files. Where deadlines have been missed, the Agency determined the cause for the delays and is making the necessary corrections. Beginning with the Fiscal Year 2000 performance report, AHRQ includes the results of evaluations in Section 4.2 of the use of the MEPS products.

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GPRA Goal 6—Fiscal Year 2000 Results

Objective 6.1: Release and disseminate MEPS data and information products in timely manner for use by researchers, policy makers, purchasers, and plans. (MEPS)

Indicator 1

Core MEPS public use files (PUFs) available through Web site and CD-ROM within 9-18 months after data collection completed.

Results

The MEPS has three core data products: MEPS-HC Point-in-Time files, Insurance Component (IC) tables, and full-year expenditure files. In Fiscal Year 2000, two of these core files (point-in-time and IC) were available on the MEPS Web site and on CD-ROM within 12 months of the end of data collection. The full-year 1996 MEPS expenditure file was available on the MEPS Web site 2 years after the end of data collection. Plans are in place to reduce the time lag in producing expenditure files for future years.

Indicator 2

Specific products due in Fiscal Year 2000:

• 1999 point-in-time file.
• 1997 expenditure data available.
• 1996 full panel file available.

Results

• The 1999 point-in-time file was released in July 2000.
• The 1997 expenditure data file was complicated by data base construction difficulties, and departure of key contractor staff. It is anticipated to be released in the first quarter of 2001. However, an additional file containing 1997 insurance and demographic information was fast-tracked and released in November 2000.
• The full-year 96 MEPS-HC file was released in December 1999.
• In addition, the 1996 event files were released in January 2000.

Indicator 3

Customer satisfaction data from use of MEPS tapes and products rated at least 90%.

Results

In Fiscal Year 2000 MEPS staff conducted four workshops to help researchers use and understand the MEPS data. 143 of 159 (90%) of workshop participants indicated that they were highly satisfied with the MEPS workshop that they attended.

Indicator 4

Response time for requests received from policymakers, purchasers and plans for MEPS data tapes, analyses, and/or reports responded to within promised time frames 95% of time. (Baseline: 100% responded to within 5 days).

Results

In Fiscal Year 2000 AHRQ staff responded to 670 user requests for technical assistance. 96% of all user requests were responded to within 4 working days.

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Objective 6.2: Facilitate use of MEPS data and associated products as tools by extramural researchers, policy makers, purchasers, and plans.

Indicator 1

Data centers operational:

• Requests for use of the centers.
• User-days at the data centers.
• Projects completed.

These are the categories AHRQ will track in the beginning of the data centers program to illustrate that the program has been established successfully and is fully operational. Baseline to be established in Fiscal Year 2001 when the data centers program begins.

Results

Due to delay in implementing a secure AHRQ LAN, opening of the data centers was deferred to January 2001.

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Objective 6.3: Modify and enhance MEPS to enable reporting on the quality of health care in America.

Indicator 1

The design decisions necessary for the expansion of MEPS databases in order to collect data that will support the National Healthcare Quality Report are completed by August 2000. The design decisions will be operationalized in the coming fiscal years.

Results

Available Data in MEPS to Support Quality of Care Analyses at the National Level. All design enhancement decisions to modify the Medical Expenditure Panel Survey (MEPS) to facilitate collecting data to inform the National Healthcare Quality report were completed by August 2000.

The Medical Expenditure Panel Survey was designed to produce national and regional annual estimates of the health care utilization, expenditures, sources of payment and insurance coverage of the U.S. civilian non-institutionalized population. The MEPS includes a survey of medical providers, to supplement the data provided by household respondents. The design of the MEPS survey permits both person based and family level estimates.

The MEPS collects data on the specific health services that Americans use, how frequently they use them, the cost of these services and how they are paid, as well as data on the cost, scope, and breadth of private health insurance held by and available to the U.S. population.

The data currently collected from MEPS will support quality of health care research directed to the following broad areas: access to care, patient/customer satisfaction, health insurance coverage, health status, health services utilization and expenditures. For the access to care measures, national estimates of the population with a usual source of care, and by site of care, can be derived from the survey in addition to estimates of the percent of families with members experiencing difficulty or delay in obtaining health care, or not receiving needed care. The survey also permits the derivation of national estimates of satisfaction with one's usual source of care and continuity of care.

Inclusion of Additional Questions in a MEPS Self Administered Questionnaire (SAQ) to Measure Quality of Care and Patient Satisfaction for Year 2000 and in a Parent Administered Questionnaire (PAQ) to Measure Parent Satisfaction With Their Children's Health Care. The selection of a core set of questions that measure quality of care and patient satisfaction was governed by the need to adopt measures that were carefully tested and validated, to insure the collection of meaningful and reliable information. Consequently, a subset of questions that were developed for the Consumer Assessments of Health Plans Study (CAHPS®) was selected for inclusion in a self-administered questionnaire (SAQ) in the MEPS to measure several dimensions of healthcare quality and patient satisfaction.

Set of medical conditions to be given special emphasis for planning the MEPS health care quality enhancements. The planned MEPS healthcare quality enhancements call for a significant household survey sample expansion of individuals with certain illnesses of national interest in terms of patient satisfaction with care received, the quality of the care and the burden of disease. The intent of this planned enhancement was to permit more focused analyses of the quality of care received for these special populations. In order to move forward with sample design analyses and MEPS questionnaire design modifications according to schedule, it was necessary to finalize the set of medical conditions that would be given special emphasis with respect to health care quality measurement and patient satisfaction.

A set of formal criteria was established to guide the decision making process regarding the selection of the set of medical conditions that were to be given special attention for implementing the planned MEPS healthcare quality enhancements. More specifically, the selection decision was based on an evaluation of conditions using the following criteria:

• Sufficient prevalence to support reliable estimates.
• Availability of diagnostic questions used in other national surveys.
• Accuracy of household reported conditions.
• Availability of evidence-based quality measures.
• Level of medical expenditures for treatment of the condition.

Based on the review of the criteria under consideration, it was recommended that the following medical conditions be given special attention for implementing MEPS healthcare quality enhancements: Diabetes, Asthma, Hypertension, Stroke, Ischemic Heart Disease, Arthritis, and COPD . It should be noted that the selection of diabetes and ischemic heart disease as targeted conditions also covers two clinical areas that are the focus of the disparities agenda (i.e., diabetes, cardiovascular disease).

Sample Enhancements. Balancing the tradeoffs between precision and cost, the design recommendation was to increase the number of PSUs for the 2001 MEPS back to 195 PSUs. This design modification has the following attractions:

• It will permit the greatest flexibility in sample selection for improving the sample yields of individuals with the targeted conditions.
• It will yield significant improvements in the precision of survey estimates relative to the current MEPS design (100 PSUs) and equivalent sample size specifications.
• It is a more appropriate design for survey estimates at the national level that are sensitive to geographic variation (e.g., State, county); the greater dispersion in the household sample should reduce the level of respondent burden in the MEPS Medical Provider Component.

MEPS design recommendation to increase the size of the 2001 sample and method of sample allocation. The planned MEPS healthcare quality enhancements call for a significant household survey sample expansion of individuals with certain illnesses of national interest in terms of quality of care and burden of disease. The intent of this planned enhancement was to permit more focused analyses of the quality of care received for these special populations and the level of satisfaction with the care received. To further improve the precision of the survey estimates beyond the gains from the increase in geographic areas, in particular for individuals with at least one of the medical conditions given special attention for implementing MEPS healthcare quality enhancements, a decision was made to increase the 2001 MEPS sample by ~3,500 households (responding for all 5 rounds of data collection) to a total sample of 13,500.

GPRA Goal 6—Fiscal Year 2001 and 2000 Indicators

Objective	Fiscal Year 2001 Indicator	Fiscal Year 2002 Indicator
Objective 6.1: Release and disseminate MEPS data and information products in timely manner for use by researchers, policymakers, purchasers, and plans. (MEPS)	In Fiscal Year 2001, 1997 Use and Expenditures, 2000 Point-in-Time, and 1998 Health Insurance and Demographics MEPS public use data files will be released. Budget: Commitment Base. Response time for requests received from policymakers, purchasers and plans for MEPS data tapes, analyses, and/or reports responded to within promised time frames 95 percent of time. Budget: Commitment Base.	Develop a method to facilitate users' custom cross tabulations of MEPS data. Budget: Commitment Base. Conduct 8 MEPS data user workshops. Budget: Commitment Base. Expand MEPS list-server participation by 20%. Budget: Commitment Base. Produce 4 Findings and at least one Chartbook. Budget: Commitment Base. Develop Frequently Asked Questions Section for MEPS Web site. Budget: Commitment Base.
Objective 6.2: Facilitate use of MEPS data and associated products as tools by extramural researchers, policymakers, purchasers, and plans.	Establish baseline for Data Center capacity.	Determine the feasibility of existing mechanisms to provide off-site access to confidential MEPS data. Budget: Commitment Base. Expand data center capacity by 10% over Fiscal Year 2001 level.
Objective 6.3: Modify MEPS to support annual reporting on quality, health care disparities, and research on long-term care in adults and children with special needs.	Data collection begins on the treatment of common clinical conditions over time for a nationally representative portion of the population in support of the National Healthcare Quality Report. LTC Measures: Have developed data use agreements (DUA) with with HCFA to assess and begin data development related to the MDS. Design MEPS over sample of adults with functional limitations and children with special needs. Produce one report related to LTC. Have developed IAA with NCHS for LTC frame development activities. Submit at least one peer-reviewed publication in the area of LTC.	Process and make available data to be included in the National Quality Report. Budget: Commitment Base. Begin data collection to support the disparities report September 2002.

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2.3 Budget line 3 - Program Support

Funding Levels

Fiscal Year 1999: $2,341,000(Actual).
Fiscal Year 2000: $2,484,000 (Enacted).
Fiscal Year 2001: $2,500,000 (Appropriation).
Fiscal Year 2002: $2,600,000 (President's Budget).

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Goal 7: Support the overall direction and management of AHRQ (PS)

This goal involves supporting the overall direction and management of AHRQ through prudent acquisition performance management, capital asset planning, personnel support and information technology planning.

Types of Indicators

Outcome indicators that document customer satisfaction with two major functions within the Agency are used.

Use of Results by AHRQ

The scores for each of the measures, in combination with the written comments received in the survey, continue to be used to improve the acquisition systems and the Intranet.

Data Issues

The data collection is accomplished through customer surveys administered to Agency staff annually.

GPRA Goal 7—Fiscal Year 2000 Results

Objective 7.1: Provide prudent planning for all capital assets.

AHRQ included this objective in the plan because we understood we needed to acknowledge this requirement. However, the Agency has no capital assets and didn't include any indicators.

Result

Not Applicable.

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Objective 7.2: Maintain acquisition performance management system to ensure: (1) timely completion of transactions, (2) vendor and customer satisfaction, and (3) efficient and effective use of resources.

Indicator 1

Internal customer satisfaction rated at minimum of 4.5/5. Baseline in Fiscal Year 1999 - 4.4/5.

Results

Internal customer satisfaction rated at minimum of 4.2/5. (Did not meet target). The last survey conducted by the DCM was Fiscal Year 1998. No survey was conducted in Fiscal Year 1999. Due to a significant change in Program personnel and no formal training or workshops conducted by DCM this fiscal year, the target goal fell short by .3 percentage points. DCM will review its current policies and procedures to identify weaknesses that can be improved and will result in a level of satisfaction that will achieve the internal customer goal and provide our customers with quality service.

Indicator 2

External customer satisfaction rated at 4.5/5. Baseline in Fiscal Year 1999 - 4.0/5.

Results

External customer satisfaction rated at 4.6/5.

Indicator 3

Customer satisfaction survey results assessed and used to implement changes to improve and enhance services.

Results

A study of the procurement planning process has been conducted. The implementation of the improvements outlined in the report will enhance the services provided by contract staff. A plan for identifying improvements as a result of the customer/vendor satisfaction survey was submitted December 15, 2000 with implementation to follow.

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Objective 7.3: Continued enhancement and expansion of Agency intranet site to ensure staff have immediate access to all current information. The site covers Agency administrative and operational processes, procedures, and policies. It also covers information on ongoing health care research as well as results and findings from all the research supported by the Agency.

Indicator 1

Customer satisfaction rated at minimum of 3.5/4. Baseline in Fiscal Year 1999 - 3.1/4.

Results

Internal customer satisfaction rated at 3.2/5.0. Our original target was 3.5 out of 4. When the survey was conducted the base was changed to 5. The change in the base, from 4 to 5, makes comparing this target to the original goal more difficult. However, the lower satisfaction rate did surprise staff. Based on the comments and feedback of this survey, AHRQ has made a variety of large scale changes to the Intranet to improve and enhance services, and increase customer satisfaction. These changes are outlined in the next measure.

Indicator 2

Demonstration through customer satisfaction surveys that the daily work of staff has been facilitated by the intranet.

Results

Use of AHRQ's Intranet facilitated work economies to agency staff in the following manner:

• The AMIS application data base can be queried for information via the Intranet.
• Individual Centers/Offices have home pages for sharing and disseminating information with the rest of AHRQ staff.
• The Intranet provides a single source location for linking Agency data and program information to all AHRQ employees.
• Many AHRQ related publication are now available on-line via Intranet access.

Indicator 3

Assessment of customer satisfaction surveys and use of such surveys to implement changes to improve and enhance services as necessary.

Results

The use of customer satisfaction surveys are extremely beneficial to AHRQ, providing the necessary feedback to implement process improvements. The general and specific feedback coming from these surveys have helped AHRQ redesign and redirect our efforts to facilitate the varied needs of our many customers.

GPRA Goal 7— Fiscal Year 2001 and 2002 Indicators

Objective	Fiscal Year 2001 Indicator	Fiscal Year 2002 Indicator
Objectives 7.1, 7.2, 7.3: (Discontinued). Objective 7.4: Establish and maintain a secure Agency computer network infrastructure.	Preliminary policies and procedures for reducing security risks will be developed by the end of Fiscal Year 2001. Initial criteria for reporting security incidents will be established by the end of Calendar Year 2001. Initial procedures for responding to security incidents will be established by the end of Calendar Year 2001. Implementation of a Secure Phase 1 LAN for analysis of intramural research and survey data will be completed by end of Fiscal Year 2001. Implementation of a Phase 1 firewall, intrusion detection and virus control system will be in place by end of Calendar Year 2001. Initial security awareness training will begin by end of Calendar Year 2001.	Perform initial tests, (periodically, beginning in second quarter of Fiscal Year 2002) to evaluate the preliminary policies and procedures.

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Note: "Commitment Base" identifies budgeted projects and initiatives started in past years and still continuing.

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