Data and Analysis for Monitoring Health Reform in Massachusetts

Transcription

1 Data and Analysis for Monitoring Health Reform in Massachusetts State Health Access Data Assistance Center (SHADAC) Workshop Jean Yang Massachusetts Health Connector April 30 - May 1, 2012

2 Outline Overview of the Health Connector Data and Analysis to monitor health reform in MA All Payer Claims Database (APCD) initiative 2

3 Massachusetts Health Reform Enacted by state law in 2006 Expansion of subsidized coverage Medicaid expansion Creation of the Commonwealth Care program (childless adult up to 300% FPL without access to employer sponsored coverage) Establishment of the Exchange the Health Connector Merging of small and non-group market Individual mandate, employer fair share contribution 3

4 Health Connector Overview Created in 2006 by MA health reform law Quasi-public agency Health insurance exchange facilitating access to private coverage Commonwealth Care: subsidized coverage for adults up to 300% FPL without employer coverage (state/fed/enrollee $) Commonwealth Choice: unsubsidized coverage for individuals and small businesses (employer/individual $) Policymaking and appeals for individual mandate Outreach and public education Why have health insurance? Where to find it? Procurement partnerships Student health insurance, etc. 4

5 Monitoring Health Reform It is a public-private collaboration... State government: Health Connector Division of Insurance Division of Health Care Finance & Policy (DHCFP) Attorney General Inspector General Quality + Cost Council Non-profit organizations Blue Cross Blue Shield Foundation of MA Researchers / think-tanks Urban Institute University of Massachusetts Advocacy organizations 5

6 Monitoring Health Reform Data collection and analysis cover a variety of key subjects. Coverage Affordability Coverage rates Cost and cost trend ESI trend Merged market experience Effect of individual mandate Payment reform 6

7 Monitoring Health Reform Type of Data/Analysis Examples Organization Market Surveys Massachusetts Health Reform Survey BCBSMA Foundation, SHADAC, Urban Institute Massachusetts Household Health Insurance Survey DHCFP Data Collection & Public Reporting Specific Research Employers Health Insurance Survey Commonwealth Care Members Satisfaction Survey Massachusetts Health Care Key Indicators Report Massachusetts Health Care Cost Trends Report on Health Care Cost Trends and Cost Drivers Individual/Small Group Membership Report Impact of Merged Market Does Universal Coverage Improve Health? MA Health Reform: 5-Year Progress Report Status Report on Issues Related to HCR Implementation DHCFP Health Connector DHCFP DHCFP Attorney General s Office Division of Insurance DOI NBER BCBSMA Foundation Inspector General 7

8 Surveys Example: Massachusetts Household Health Insurance Survey Author: DHCFP Frequency: every other year from ; annual since 2007 Methodology: telephone, web + mail surveys Types of Data (sample) Comparing insured and uninsured population by: Age group Family income Race/ethnicity Health status Employment Etc. Type of health insurance coverage 8

9 Surveys Example: Massachusetts Household Health Insurance Survey (cont) 9

10 Surveys Example: Commonwealth Care Member Satisfaction Survey Conducted on the newly insured population The Health Connector has conducted two surveys to date Key categories Demographics Awareness & Knowledge of Commonwealth Care Satisfaction with Commonwealth Care Program Prior Health Insurance Coverage Health Status Understanding of and Satisfaction with Health Insurance Plan and Benefits Access to and Utilization of Health Care Medical Expenses and Barriers to Care Application and Enrollment Process Communications with Commonwealth Care and Satisfaction with Communications 10

11 Surveys Example: Commonwealth Care Member Satisfaction Survey (cont) Overall Satisfaction FY11 FY12 53% 44% During the past 12 months/since becoming a member, did you receive care in a hospital ER? 31% 33% 2% 2% 2% 4% 9% 14% 2% 2% FY11 FY12 28% 33% Extremely Dissatisfied Extremely Satisfied Unsure/Refuse Utilization of Health Care FY11 FY12 Visited general doctor who treats variety of illnesses 81% 82% Had a visit for check up, physical exam or preventive care 89% 86% Visited a specialist 52% 49% Taken any prescription drugs 72% 73% Were a patient in the hospital overnight 12% 13% 11

12 Surveys 12

13 Data & Reports Example: DHCFP Key Indicator Reports: Quarterly since 2008 Data on coverage, access, cost Types of Data (sample) Coverage Insured population by insurance type Enrollment by private insurer Employer coverage rates Access Residents who have a regular source of health care Utilization of essential services Cost Cost of premium Out-of-pocket spending Other Health Plan Financial Performance Acute Hospital Financial Performance Community Center Financial Performance Health Safety Net 13

14 Data & Reports Example: DHCFP Key Indicator Reports (cont) 14

15 Cost Trend Reports & Annual Hearings on Health Care Costs: Example reports: MA Health Care Cost Trends: Premium Levels and Trends in Private Health Plans: (an annual report since 2011) MA Health Care Cost Trends: Price Variation in Health Care Services (an annual report since 2011) Annual hearings regarding private and public costs and costs trends: Conducted by DHCFP These annual hearings are required by section 24 of Chapter 305 (of the Acts of 2008) Website: 15

16 Cost Trend Reports & Annual Hearings on Health Care Costs (cont) Premium Trend Unadjusted Percent Change Small Group 5.8% 2.2% Mid-size Group 5.2% 5.6% Large Group 6.1% 4.3% Premium Trend Adjusted for Benefits Percent Change Small Group 9.8% 9.5% Mid-size Group 6.1% 7.6% Large Group 6.2% 5.4% 16

17 Experience of the Merged Market 17

18 Effect of Individual Mandate 18

19 All Payer Claims Database Created under Massachusetts state legislation The vision is to establish a centralized source of claims data that includes all payers Reduces administrative redundancy of multiple data collection/ submission requirements Single source of truth Supports national health reform (e.g., risk adjustment) The APCD is configured to include 6 major files: Member eligibility Provider Product Medical claims Pharmacy claims Dental claims 19

20 All Payer Claims Database (cont) Data collection started in 2010; first data release expected in late 2012 Current effort focuses on achieving consistency in data configuration across plans and developing cross-walking capability A major operational lift; requires significant resource commitment; security and compliance is key; must have broad support from stakeholders 20

21 Summary Monitoring results of the reform is an essential requirement for success It takes broad collaboration among many stakeholders, both public and private The market must embrace as well as investing in transparency 21