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Pres hsr mar5_lukanen


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Pres hsr mar5_lukanen

  1. 1. Putting Out the Welcome Mat: Targeting Outreach Under theAffordable Care ActPreliminary Findings from the 2012 MinnesotaComprehensive Health Association (MCHA) EnrolleeSurveyElizabeth Lukanen, MPHSHADAC, University of MinnesotaMN Health Services Research ConferenceSt. Paul, MNMarch 5, 2013 Funded by a grant from the Robert Wood Johnson Foundation
  2. 2. Acknowledgements• SHADAC – Lynn Blewett, SHADAC Director and Professor – Kathleen Call, Professor – Elizabeth Lukanen, Senior Research Fellow – Karen Turner, Senior Program Analyst – Heather Dahlen, PhD Student and Research Assistant• MCHA – Peggy Zimmerman-Belbeck , Director of Operations – Kirby Erickson, Executive Director• Medica – Kris Messner, Strategic Account Manager – Anton Dmytrenko, Strategic Account Executive• Support for this work was provided by a grant from the Robert Wood Johnson Foundation’s State Health Reform Assistance Network 2
  3. 3. Presentation Overview• MCHA and Health Reform• 2012 MCHA Enrollee Survey• Preliminary Results• Implications for Outreach 3
  4. 4. Minnesota Comprehensive HealthAssociation• Five Eligibility Avenues: – Loss of group coverage – Medicare ineligibility – Health-related rejection – Presumptive condition(s) – Health Coverage Tax Credit (HCTC) program• Among the longest-running and largest state high risk pools in the country – Currently, 26,000 enrollees• Premiums capped at 125% of individual market• Lifetime maximum benefit of $5,000,000• Administered by Medica Health Plan 4
  5. 5. Individuals with Preexisting Conditions andHealth Reform• The Affordable Care Act (ACA): – Prohibits pre-existing condition exclusions – Introduces premium rate restrictions in individual and small group markets – Prohibits lifetime or annual limits – 100% coverage for preventive care – Provides new coverage options • Medicaid (income ≤ 138% FPL) • Premium and cost sharing subsidies through the exchange (income 139 to 400% FPL) 5
  7. 7. 2012 MCHA Survey: Objectives• Provide information to MCHA to help transition enrollees into new ACA coverage options – Assess potential eligibility for Medicaid and exchange – Gauge enrollee familiarity with ACA changes – Collect information to inform outreach and communication strategies• Gain knowledge of how MCHA enrollees might impact risk pools – Collect information on health status, pent-up demand 7
  8. 8. Methodology• Mail survey of 5,200 MCHA enrollees – Policy holders enrolled for 12 months – Excluded children and those with Ryan White and HCTC eligibility• $2 incentive payment with survey mailing• Oversampling of low-income enrollees (used receipt of low income subsidy as proxy) and those in rural areas• Survey response rate was 50.2%• Weighting adjustments were conducted• Income imputed for 6% of cases 8
  10. 10. Enrollee General Demographics• Mean age is 52 years• Slightly more females than males (53%)• Almost 60% live in an urban area• A quarter have less than a high school education• 70% are employed or self employed• Majority report incomes above 400% FPG• 92% of enrollees report at least one chronic condition, 22% report more than four• 45% reporting being in very good/excellent health 10
  11. 11. Enrollee Experience with MCHA • More than two-thirds have been in MCHA for more than 4 years • Almost a quarter have been in MCHA for 10 years or more • 81% report being somewhat/very satisfied with their MCHA insurance coverage 11
  12. 12. Features of MCHA Coverage that areImportant to Enrollees80% 73% Rx coverage70% 67% 66% 62%60% Coverage for a specific Services50% Ability to see a specific provider 40%40% Cost of premium30% Ability to go to Mayo Clinic20% 18% 17% Low income subsidy10% HSA option0% Rated "Extremely Important" 12
  13. 13. Reasons Enrollees Would Leave MCHA Primary Reason Can no longer afford 5% premium 5% New job with Insurance 27% offer 10% Nothing would make me leave 10% My health improves and I can get in private market Turning 65 20% 23% MCHA doesnt offer benefits I need Other 13
  14. 14. Reasons Enrollees Would Remain on MCHA Primary Reason (for those who indicated nothing would make them leave) 2% Unaware of other options 4% Other companies will not cover my pre-exiting 5% 6% conditions 31% MCHA is only coverage I can find with Mayo Other companies will not cover me 14% MCHA offers benefits other plans do not Satisfied with coverage 16% 21% Other Dont know how to change plans 14
  15. 15. MCHA Enrollees Potential Eligibility forNew Coverage Options in 2014• The majority of enrollees will likely get no federal financial support for their health insurance coverage Eligibility for Financial Income as % FPG % MCHA Enrollees SupportLess than or equal to138% 9% Medicaid FPG Premium and cost-sharing 139-400% FPG 37% subsidies through the exchange Above 400% FPG 55% None 15
  16. 16. Enrollee Familiarity with Health Reform100% 1% 1% 1% 5%90% 15%80% 31%70% 24%60% No answer50% 24% Very familiar Somewhat familiar40% Somewhat unfamiliar30% 59% Very unfamiliar20% 39%10% 0% General familiarity with Familiarity with potential health reform coverage changes 16
  17. 17. Enrollees Worries About Changes UnderHealth Care Reform Self Report of Worried/Very Worried % EnrolleesHaving to pay more for premiums 91%Having to pay more for deductibles and coinsurance 89%Not being able to afford the health care services you think you need 85%Not being able to afford the prescription drugs you need 78%Having to change doctors 72%The quality of health care services you receive getting worse 70%Not being able to get the health care services you need for reasons 70%other than moneyHaving to change health plans 66% 17
  18. 18. Willingness to Enroll in a Public Program If you learned you were eligible for a public program at no cost, would you enroll? 51% 49% Yes No 18
  19. 19. Possible Outreach Methods How would you most like to receive information about coverage changes? 1% 3% 2% 2% Mail 4% Website 16% One-on-One meetings Phone number to call with questions Dont want to receive 72% information Group meetings 19
  20. 20. Implications for Outreach• The “selling” of the new coverage options needs to start now in a variety of formats• Messaging should include: – No exclusion based on pre-existing conditions – First dollar coverage for preventive services – No lifetime limits – Financial support (for those that qualify) – Information about finding insurance that covers preferred doctors and Rx 20
  21. 21. Implications for Outreach• Messaging and outreach may need to differ by: – Rural vs urban – Eligibility type (Medicaid vs exchange)• Outreach will need to address expectations about the cost of new coverage options (very difficult!)• Messaging needs to combat the negative image of “public programs”• Ideally, assistance should be specialized for this population (e.g. special training for in person assisters) 21
  22. 22. Contact Information Elizabeth Lukanen Senior Research Fellow 612.626.1537Sign up to receive our newsletter and updates at @shadac