Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Pres arm2010 june27_kenney2

502 views

Published on

Published in: Economy & Finance, Technology
  • If you want to download or read this book, copy link or url below in the New tab ......................................................................................................................... DOWNLOAD FULL PDF EBOOK here { http://bit.ly/2m6jJ5M } .........................................................................................................................
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • If you want to download or read this book, Copy link or url below in the New tab ......................................................................................................................... DOWNLOAD FULL PDF EBOOK here { http://bit.ly/2m6jJ5M } ......................................................................................................................... Download EPUB Ebook here { http://bit.ly/2m6jJ5M } ......................................................................................................................... Download Doc Ebook here { http://bit.ly/2m6jJ5M } ......................................................................................................................... .........................................................................................................................
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • Be the first to like this

Pres arm2010 june27_kenney2

  1. 1. The Effects of Medicaid Policy Changes on Adults’ Service Use Patterns in Kentucky Kent ck and Idaho Genevieve Kenney y Urban Institute James Marton Georgia State University Jennifer Pelletier Urban Institute Ariel Klein Urban Institute Jeffrey Talbert University of Kentucky AcademyHealth Annual Research Meeting June 27 2010 J 27, Funded by the State Health Access Reform Evaluation, a national program of the Robert Wood Johnson Foundation URBAN INSTITUTE PRELIMINARY FINDINGS: NOT FOR QUOTATION OR DISTRIBUTION
  2. 2. Medicaid Policy Changes Made Between 2005 to 2008 in Kentucky • KY policies introduced in July 2006: – $3-$6 copays for physician office visits p y p y – $2 copays for dental visits (# of allowable visits reduced to 1 / year) – $50 copayment for inpatient hospital stays – $1 $3 $1-$3 copayments for prescriptions (service limits on the number of prescriptions - 4 per month with a maximum of 3 brand name drugs and higher copays on brand name drugs) – 5% coinsurance (up to $6) for non-emergency use of the ER ( p ) g y • KY out-of-pocket maximums of $225 for medical services and $225 for prescriptions also put in place in July 2006 • KY increased reimbursement rates for preventive care and E&M codes in July 2007 and in January 2008 URBAN INSTITUTE PRELIMINARY FINDINGS: NOT FOR QUOTATION OR DISTRIBUTION
  3. 3. Medicaid Policy Changes Made in 2006 and 2007 in Idaho • Annual wellness exam added to adult benefit packages • Tobacco Cessation and Weight Management Preventive Health Assistance benefits become available to adults who qualify – To qualify for Tobacco benefit, adult must be a current smoker who wants to quit – To qualify for Weight Management benefit, adult must have BMI of less than 18.5 or 30 or greater. • Dental coverage for non-disabled enrollees outsourced to a managed care organization and reimbursement rates for d i ti d i b t t f adults’ services increased by an average of 3.9% URBAN INSTITUTE PRELIMINARY FINDINGS: NOT FOR QUOTATION OR DISTRIBUTION
  4. 4. Research Questions R hQ i Kentucky • Did the new 2006 primary care, dental care, inpatient stay, prescription drug, and ER copayments lead to decreases in the receipt of care? • Did the 2007 and 2008 reimbursement rate increases for evaluation and management services lead to increases in the number of physician office visits? ffi i it ? Idaho • Did the addition of an annual wellness benefit result in receipt of preventive care among adults? What are the characteristics of the ti d lt ? Wh t th h t i ti f th adults who received preventive care? • Did the tobacco cessation and weight management benefits succeed in changing beneficiary behavior? • Did the move to a managed care delivery system for dental care improve non-disabled beneficiaries’ access to dental care? URBAN INSTITUTE PRELIMINARY FINDINGS: NOT FOR QUOTATION OR DISTRIBUTION
  5. 5. Office Visits in KY – Multivariate Results • J l 2006: $3-$6 copays for office visits introduced July 2006 $3 $6 f ffi i it i t d d – We find no statistically significant change in the probability of having at least 1 office visit annually post July 2006. • Because of the reimbursement rate increases for preventive office visits in July 2007 and January 2008, we also 2008 estimated a specification with separate year dummies: – We find a very small (.35 percentage point or .4%) decline in the probability of having at least 1 office visit for fiscal year July 2006 June 2006-June 2007 (p = .033) and a small (.20 percentage point or .23%), but statistically insignificant, increase in the probability of having at least 1 office visit for fiscal year July 2007-June 2008. • Negative binomial models give similar results in terms of signs and statistical significance. URBAN INSTITUTE PRELIMINARY FINDINGS: NOT FOR QUOTATION OR DISTRIBUTION
  6. 6. Dental Visits, Inpatient Stays, ER use in KY – Multivariate Results • July 2006: $2 copays for dental visits introduced as well as a reduction in the number of annual allowable visits to 1 per year. p y – We find no statistically significant change in the probability of having at least 1 dental visit annually, but a statistically significant reduction in the number of annual dental visits (p < .001). – July 2006: $50 copay for inpatient stays introduced – We find a very small (.41 percentage point or 2.28%) decrease in the probability of having at least 1 inpatient stay annually (p = .002) and a statistically significant reduction in the number of annual inpatient stays (p < .001). – July 2006: 5% coinsurance (up to $6) for non-emergency use of the ER – We find a 1 percentage point (or 1.94%) increase in the probability of having at least 1 ER visit annually (p < .001) and a statistically significant increase in the number of ER visits (p < .001). URBAN INSTITUTE PRELIMINARY FINDINGS: NOT FOR QUOTATION OR DISTRIBUTION
  7. 7. Prescription use in KY – P i ti i Multivariate Results – July 2006: $1-$3 copays for prescriptions introduced (also new service limits on the number of prescriptions - 4 per month with a maximum of 3 brand name drugs) – We find no statistically significant change in the probability of having at least 1 prescription annually. – We also find that the average number of monthly generic prescriptions increases slightly (p < .001) after July 2006 (from 2.18 per month to 2.43 per month) while the average number of name brand prescriptions falls slightly (p < .001) after July 2006 (from 1.29 per month to 1.10 per month). – Increased use of generics could lead to cost savings in this large category of Medicaid p expenditure. URBAN INSTITUTE PRELIMINARY FINDINGS: NOT FOR QUOTATION OR DISTRIBUTION
  8. 8. Idaho - Descriptive Results • After moving to managed care, the share of adults who had any dental visit increased by 2.5 percentage points (from 45.5% to 48.0%). i it i db 25 t i t (f 45 5% t 48 0%) • Likewise, the share of adults who had any preventive dental visit increased by 2.4 percentage points (from 21.8% to 24.2%) i db 24 t i t (f 21 8% t 24 2%) • After introduction of the annual wellness benefit, 8.9% of adult beneficiaries b fi i i received a preventive medical check-up i a 12-month i d ti di l h k in 12 th period. Preventive care receipt is: – 10.3 percent among those who did not receive any care at an FQHC (preventive care receipt among those who did visit an FQHC may not be counted in the claims); – Higher among women than men (11.6% vs. 1.7%): – Higher among adult TANF recipients than SSI recipients (11.4% vs. 7.2%). 7 2%) – Rates also vary by region in the state, ranging from 5.6% to 15.6%. URBAN INSTITUTE PRELIMINARY FINDINGS: NOT FOR QUOTATION OR DISTRIBUTION
  9. 9. Idaho- Personal Health Assistance Benefits Results • Overall, participation in the personal health assistance benefits appears low: in 2009, about 1000 people were in the weight management benefit and 360 people were in the tobacco cessation benefit but do not know size of eligible pool • The state conducted a survey of participants, which resulted in 56 respondents y p p , p to the weight management survey and 39 respondents to the tobacco cessation survey – While the sample sizes are very small, the majority of respondents reported that small they gained/lost weight as intended on the weight management program (88%, 95% C.I. 76%-95%) – F Fewer respondents reported successfully quitting smoking as a result of their d t t d f ll itti ki lt f th i participation in the tobacco cessation program (20%, 95% C.I. 10%-38%)—other information on the survey suggests that this could relate to fact that the benefit only covers 7 weeks of tobacco cessation drugs while the full treatment is 12 weeks. URBAN INSTITUTE PRELIMINARY FINDINGS: NOT FOR QUOTATION OR DISTRIBUTION
  10. 10. Idaho- Multivariate Results • DD estimates indicate that non-disabled adults are 5.4 5 4 percentage points more likely to have an annual i lik l h l dental visit after introduction of managed care and 2.0 2 0 percentage points more likely to have received a preventive dental visit after introduction of managed care • Simple pre-post models without the use of a pre post comparison group found results in the same direction URBAN INSTITUTE PRELIMINARY FINDINGS: NOT FOR QUOTATION OR DISTRIBUTION
  11. 11. Limitations • Inaccuracies in coding practices in the claims data may understate the extent of preventive care received • Can not assess extent to which copays are being collected in KY • Not controlling for possibly confounding changes in case mix or service delivery system with a simple pre-post design • Length of post period may not allow sufficient time for impacts to be felt p cs o e • No information available on content of care being provided URBAN INSTITUTE PRELIMINARY FINDINGS: NOT FOR QUOTATION OR DISTRIBUTION
  12. 12. Policy Implications • Our general finding in Kentucky is very little or no impact of the modest copayments on utilization across several categories of service--small impacts on office visits and prescriptions; Without knowing underlying cause of the observed patterns, can not fully understand implications • Adults in Idaho Medicaid have very low levels of preventive care receipt, y p p, indicating that physicians and beneficiaries may be missing opportunities for counseling on prevention and chronic disease management. • The Beha ioral PHA benefits in Idaho have low enrollment to date and are not Behavioral ha e lo structured in a way that can be expected to achieve widespread behavior change. • Need to invest in data systems: track progress with respect to preventive care receipt; examine content of care; and assess extent to which beneficiaries are receiving appropriate follow-up care for problems that are diagnosed URBAN INSTITUTE PRELIMINARY FINDINGS: NOT FOR QUOTATION OR DISTRIBUTION
  13. 13. Genevieve Kenney Senior Fellow The Urban Institute (202) 261-5568 JKenney@urban.org JK @ b www.urban.org www.healthpolicycenter.org URBAN INSTITUTE
  14. 14. Motivation • Idaho and Kentucky introduced policy changes aimed at: – increasing emphasis on and access to wellness and prevention services – Controlling Medicaid cost growth – encouraging more effective use of state Medicaid M di id resources and greater involvement of d t i l t f Medicaid beneficiaries in their health care URBAN INSTITUTE PRELIMINARY FINDINGS: NOT FOR QUOTATION OR DISTRIBUTION
  15. 15. • Kentucky Sample Kentucky We use administrative claims and enrollment data from Kent ck se administrati e Medicaid to build a dataset consisting of all full fiscal years of coverage between 2005-2008 for non-institutionalized, non-elderly adult enrollees ( g (aged 19-64). ) • In building this dataset, we excluded person-months with missing values for key variables, such as demographics or eligibility category, and the person-months representing dual coverage. We drop full years of coverage h i d l d f ll f in which there was a mid-year switch in the category of eligibility or in the benefit package. • We also exclude enrollees in Louisville-region counties, because all Medicaid enrollees in those counties are enrolled in a capitated managed care plan ( p (Passport). Roughly 16% of our full fiscal y p ) g y years of coverage g represent Passport coverage. • We are left with 341,367 full fiscal y , years of FFS Medicaid coverage g generated by 164,209 unique individuals. URBAN INSTITUTE PRELIMINARY FINDINGS: NOT FOR QUOTATION OR DISTRIBUTION
  16. 16. Kentucky Analyses • Descriptive analysis of receipt of care across several different service categories (any office visits, any dental visits, any inpatient stays, any prescription use, and any ER visits) after the introduction of the i ti d i it ) ft th i t d ti f th copays. • Logistic regression analysis with marginal effects to examine the impact of the KY reforms on the probability of the receipt of any care over a 12-month period across the different service categories with controls for age, race, gender, and geographic location. • Count models are also estimated to examine the impact of the KY reforms on the annual number of visits across the different service categories. t i URBAN INSTITUTE PRELIMINARY FINDINGS: NOT FOR QUOTATION OR DISTRIBUTION
  17. 17. Idaho Sample • We use administrative claims and enrollment data from Idaho Medicaid to build a dataset consisting of all full years of coverage between 2004-2008 for non-institutionalized, non-elderly adult b t 2004 2008 f i tit ti li d ld l d lt enrollees (aged 19-64). • I building this dataset, we excluded person-months with missing In b ildi thi d t t l d d th ith i i values for key variables, such as demographics or eligibility category, and the person-months representing dual coverage. We also exclude e o ees w o ece ved a t e ca e enrollees who received all their care at a Federally Qualified Health ede a y Qua ed ea t Center (FQHC) due to the absence of claims data for these providers (about 8.5% of the sample). • We have 52,346 person-years in the physician visit dataset and 52,245 person-years in the dental visit dataset. URBAN INSTITUTE PRELIMINARY FINDINGS: NOT FOR QUOTATION OR DISTRIBUTION
  18. 18. Idaho Analyses • Case study analyses to assess policy changes included key stakeholder interviews with current and former Medicaid officials, providers, provider associations, associations and advocacy groups and a small state survey of participants in the tobacco cessation and weight management benefits • Descriptive analysis of receipt of any preventive visit after introduction of p y p yp policy changes • Descriptive analysis of receipt of any dental visit and any preventive dental visit before and after implementation of policy changes isit polic • Logistic regression analysis with marginal effects of receipt of any dental visit and any preventive dental visit over a 12 month period with controls for age, 12-month race, gender, FQHC use, and geographic location using disabled population as a comparison group (Difference in differences estimate) URBAN INSTITUTE PRELIMINARY FINDINGS: NOT FOR QUOTATION OR DISTRIBUTION

×