Pres ca get_healthy2012aug14_sonier

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Pres ca get_healthy2012aug14_sonier

  1. 1. COVERAGE AND ACCESSJulie Sonier, Deputy DirectorState Health Access Data Assistance Center(SHADAC) at University of MinnesotaCatherine Dower, JDCenter for Health Professions at UCSF Let’s Get Healthy California Task Force
  2. 2. FRAMEWORK FOR TRACKING THEIMPACTS OF THE ACA INCALIFORNIAJulie J. Sonier, MPAState Health Access Data Assistance CenterUniversity of MinnesotaAugust 14, 2012 Let’s Get Healthy California Task Force
  3. 3. Project Background • Funded by a grant from the California HealthCare Foundation • Goal was to recommend how California can measure and monitor the impacts of the Affordable Care Act (ACA) in three areas: • Health insurance coverage • Access to health care services • Affordability and comprehensiveness of coverage • Many components of the framework we developed are relevant to monitoring coverage and access more generally Let’s Get Healthy California Task Force 3
  4. 4. Our Process• What is most important to monitor? Identify priority measures• What do we know now? Identify and compare existing data sources• Where are the gaps? Identify priorities for new/modified data collection Let’s Get Healthy California Task Force 4
  5. 5. Today’s Presentation• Considerations for selecting indicators and data sources• Overview of recommended indicators for monitoring health insurance coverage and access to care• Current availability of recommended indicators• Baseline and trends for selected indicators • Note: we did not establish benchmarks or goals Let’s Get Healthy California Task Force 5
  6. 6. CONSIDERATIONS FORSELECTING MEASURESAND DATA SOURCESLet’s Get Healthy California Task Force 6
  7. 7. Considerations for Selecting Measures• Measures that reflect major goals and provisions of the law• Outcomes rather than implementation process• Relevant/meaningful to policymakers Let’s Get Healthy California Task Force 7
  8. 8. Considerations for Recommending Data Sources• Comparability over time• Ability to do in-depth analysis (e.g., by geography, age, income, race/ethnic ity)• Population coverage – complete population of interest• Availability of benchmarks/national comparisons• Timeliness of estimates• Accessibility of data• Flexibility to adapt to changing needs – for example, to change survey content, sample size, or oversample certain populations Let’s Get Healthy California Task Force 8
  9. 9. HEALTH INSURANCECOVERAGE MEASURESLet’s Get Healthy California Task Force 9
  10. 10. Priority Measures: Coverage• Overview: % with each type of Coverage Type Data Source1 Availability coverage Employer-sponsored CHIS• In-depth topical measures: • Uninsurance Nongroup CHIS • Public coverage • ESI Public CHIS Uninsured CHIS 1 Source: California Health Interview Survey Let’s Get Healthy California Task Force 10
  11. 11. Priority Measures: Coverage Uninsurance Measures Data Source Availability• In-depth topical Point in time CHIS1 measures: • Uninsurance Uninsured at some point in CHIS the past year • Public coverage Uninsured for a year or • ESI CHIS more Reasons for uninsurance CHIS Beginning in 2014: # exempt from coverage Exchange mandate # paying tax penalty Tax records 1 Source: California Health Interview Survey Let’s Get Healthy California Task Force 11
  12. 12. Priority Measures: Coverage• In-depth topical measures: Public Coverage Measures Data Source • Uninsurance Availability • Public coverage Enrollment trend in state DHCS1, • ESI programs MRMIB2 Participation rate (% eligible CHIS3 who are enrolled) Churning/coverage DHCS, transitions (% leaving who MRMIB re-enroll within 3 months) 1 Source: Department of Health Care Services 2 Source: Managed Risk Medical Insurance Board 3 Source: California Health Interview Survey Let’s Get Healthy California Task Force 12
  13. 13. Priority Measures: Coverage ESI Measures Data Source Availability• In-depth topical Percent of employers offering CEHBS2 measures: coverage Percent of workforce in firms that CEHBS • Uninsurance offer coverage • Public coverage At employers offering coverage, CEHBS • ESI1 % of employees eligible % of eligible employees who CEHBS enroll (take-up rate) Percent of families with any ESI NHIS3 offer Percent of families offered ESI NHIS with all family members enrolled Number of employers paying CEHBS penalty for not offering coverage 1 Employer Sponsored Insurance 2 Source: California Employer Health Benefits Survey 3 Source: National Health Interview Survey Let’s Get Healthy California Task Force 13
  14. 14. Priority Measures: Coverage• Health insurance exchange related measures: These measures relate to the small group insurance market, the nongroup market, and the health insurance exchange. Health Insurance Exchange Data Source AvailabilityNumber of people purchasing nongroup coverage Exchangethrough exchange (with and without subsidies)Percent of nongroup market purchasing through Exchange, insurancexchange e regulatorsNumber of employers and people with group CEHBS1, Exchangecoverage through exchangePercent of small group market purchasing through CEHBSexchange 1 Source: California Employer Health Benefits Survey Let’s Get Healthy California Task Force 14
  15. 15. Priority Measures: CoverageDistribution of insurance coverageSource: California Health Interview Survey (CHIS), 2001-2009 60% 54.9% 52.3% 53.7% 51.8% 49.6% 50% 40% 30% 21.1% 21.6% 22.5% 20.4% 18.7% 20% 14.0% 13.5% 13.2% 14.5% 14.6% 10% 5.0% 6.0% 6.0% 5.0% 6.0% 0% 2001 2003 2005 2007 2009 Employer Public Individual Uninsured Let’s Get Healthy California Task Force 15
  16. 16. Priority Measures: Coverage Uninsurance rate by county, 2009 Source: California Health Interview Survey (CHIS), 200925% 21.7%20% 14.5%15%10% 7.2%5% Let’s Get Healthy California Task Force 16
  17. 17. Priority Measures: CoverageMeasures of uninsurance Source: California Health Interview Survey (CHIS), 2001-200930%25% 21.9% 21.1% 21.2% 20.2% 19.4%20%15% 11.8% 11.3% 10.6% 10.2% 10.3%10%5%0% 2001 2003 2005 2007 2009 Uninsured all year Uninsured at some point in past year Point in time uninsured Let’s Get Healthy California Task Force 17
  18. 18. Priority Measures: CoveragePercent of employers offering health insurance coverage Sources: California Employer Health Benefits Survey, 2000-2011; Kaiser Family Foundation Employer Health Benefits Survey, 2000-2011. 90% 80% 73% 70% 71% 70% 71% 71% 70% 69% 69% 70% 67% 67% 63% 69% 68% 66% 66% 69% 60% 63% 63% 60% 61% 60% 59% 59% 50% 40% 30% 20% 10% California United States 0% 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 Let’s Get Healthy California Task Force 18
  19. 19. Priority Measures: CoverageAt employers that offer coverage: % of employees eligible, and %eligible who enrollSource: California Employer Health Benefits Survey, 2000-2011100% 88% 87% 87% 86% 86% 84% 84% 83% 83% 84% 84% 85%80% 83% 79% 79% 79% 79% 77% 80% 79% 78% 79% 75% 76%60%40%20% 0% 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 % of employees eligible % eligible who enroll Let’s Get Healthy California Task Force 19
  20. 20. Priority Measures: CoverageMed-Cal program enrollmentSource: California Department of Health Care Services 8,000,000 7,505,841 7,000,000 6,534,983 6,000,000 5,000,000 5,073,522 4,000,000 3,000,000 2,000,000 1,000,000 0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 Let’s Get Healthy California Task Force 20
  21. 21. Priority Measures: Access Use of Services Data Source• Individual Availability perspective Percent of people with a CHIS1 • Use of services usual source of care Type of place for usual • Barriers to care CHIS source of care Percent of people with a• System perspective doctor visit in the past CHIS year • Provider-based Percent of people with a MEPS- measures preventive care visit in the HC2, • Safety net past year CHIS 1 Source: California Health Interview Survey 2 Source: Medical Expenditure Panel Survey –Household Component Let’s Get Healthy California Task Force 21
  22. 22. Priority Measures: Access Barriers to Care Data Source Availability• Individual Percent of people who forgo MEPS- perspective needed care HC1 MEPS- • Use of services Reasons for forgone care HC • Barriers to care Percent of people not able to MEPS- get an appointment with a HC, doctor in a timely way CHIS*2• System perspective Percent of people who had • Provider-based difficulty finding a provider that NHIS3, measures would accept new patients CHIS* • Primary care • Safety net • Specialty care Percent of people who had difficulty finding a provider that CHIS*, would accept their insurance NHIS** • Primary care *Requires new data collection • Specialty care **Not able to distinguish between primary and specialty care 1 Source: Medical Expenditure Panel Survey –Household Component 2 Source: California Health Interview Survey 3 Source: National Health Interview Survey Let’s Get Healthy California Task Force 22
  23. 23. Priority Measures: Access Provider-Based Measures Data Source Availability• Individual perspective Percent of physicians accepting Medical new patients, by payer • Use of services Board of • Primary care CA* • Barriers to care • Specialty care Percent of physicians Medical participating in public programs Board of• System perspective • Primary care CA* • Specialty care • Provider-based measures Emergency room visit rates OSHPD1 • Safety net Ambulatory care sensitive OSHPD hospital admissions Preventable/avoidable OSHPD emergency room visits *Requires new data collection 1 Source: Office of Statewide Health Planning and Development Let’s Get Healthy California Task Force 23
  24. 24. Priority Measures: Access• Individual perspective Safety Net Data Source • Use of services Availability • Barriers to care Volume and type of services OSHPD1, provided by safety net clinics counties*• System perspective • Provider-based Uncompensated care OSHPD* measures • Safety net County indigent care volume Counties* and cost *Requires new data collection 1 Source: Office of Statewide Health Planning and Development Let’s Get Healthy California Task Force 24
  25. 25. Priority Measures: AccessPercent of people with a usual source of careSource: California Health Interview Survey, 2001-2009 90% 87.6% 87.5% 87.8% 85.8% 80% 70% 60% 50% 40% 30% 20% 10% 0% 2001 2003 2005 2009 Let’s Get Healthy California Task Force 25
  26. 26. Priority Measures: Access Percent of people without a usual source of care Source: California Health Interview Survey, 200930% 22%20% 14%10% 9%0% Let’s Get Healthy California Task Force
  27. 27. Priority Measures: AccessType of place for usual source of careSource: California Health Interview Survey, 2001-200980% 70%70% 67% 64% 61%60%50%40%30% 23% 23% 18%20% 16%10% 14% 12% 13% 12% 0% 2001 2003 2005 2009 Doctors office Community/Government clinic No usual source Let’s Get Healthy California Task Force 27
  28. 28. Priority Measures: AccessPercent of people with a doctor visit in the past yearSource: California Health Interview Survey, 2001-2009 90% 83.0% 83.2% 83.5% 82.7% 80% 70% 60% 50% 40% 30% 20% 10% 0% 2003 2005 2007 2009 Let’s Get Healthy California Task Force 28
  29. 29. Priority Measures: Access Ambulatory care sensitive hospital admissions based on AHRQ prevention quality indicators (PQIs) Example: Short-term Complications of Diabetes (PQI 1) & Uncontrolled Diabetes (PQI 14) Source: California Office of Statewide Health Planning and Development , 2009 Let’s Get Healthy California Task Force 29
  30. 30. Stakeholder Feedback• CHCF solicited stakeholder feedback on the framework through a series of 6 stakeholder meetings in Feb. 2012• Response to the framework was largely positive• Key coverage and access issues identified by stakeholders: • “Drill-down” is very important (e.g., by geography, race/ethnicity, large vs small employers) • Understanding who remains uninsured and why is a top priority • Need for better measures of access: • Providers accepting Medi-Cal • Consider broadening the definition of provider beyond physicians Let’s Get Healthy California Task Force 30

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