COVERAGE AND ACCESS. Julie Sonier, Deputy Director State Health Access Data Assistance Center (SHADAC) at University of Minnesota

Transcription

1 COVERAGE AND ACCESS Julie Sonier, Deputy Director State Health Access Data Assistance Center (SHADAC) at University of Minnesota Catherine Dower, JD Center for Health Professions at UCSF Let s Get Healthy California Task Force

2 FRAMEWORK FOR TRACKING THE IMPACTS OF THE ACA IN CALIFORNIA Julie J. Sonier, MPA State Health Access Data Assistance Center University of Minnesota August 14, 2012 Let s Get Healthy California Task Force

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 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 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 CONSIDERATIONS FOR SELECTING MEASURES AND DATA SOURCES Let s Get Healthy California Task Force 6

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 Considerations for Recommending Data Sources Comparability over time Ability to do in-depth analysis (e.g., by geography, age, income, race/ethnicity) 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 HEALTH INSURANCE COVERAGE MEASURES Let s Get Healthy California Task Force 9

10 Priority Measures: Coverage Overview: % with each type of coverage Coverage Type Data Availability Source 1 In-depth topical measures: Employer-sponsored CHIS 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 Priority Measures: Coverage Uninsurance Measures Data Availability Source In-depth topical measures: Uninsurance Public coverage ESI Point in time CHIS 1 Uninsured at some point in the past year Uninsured for a year or more CHIS CHIS Reasons for uninsurance CHIS Beginning in 2014: # exempt from coverage mandate Exchange # paying tax penalty Tax records 1 Source: California Health Interview Survey Let s Get Healthy California Task Force 11

12 Priority Measures: Coverage In-depth topical measures: Uninsurance Public coverage ESI Public Coverage Measures Enrollment trend in state programs Data Availability Source DHCS 1, MRMIB 2 Participation rate (% eligible who are enrolled) CHIS 3 Churning/coverage transitions (% leaving who re-enroll within 3 months) DHCS, MRMIB 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 Priority Measures: Coverage In-depth topical measures: Uninsurance Public coverage ESI 1 ESI Measures Percent of employers offering coverage Percent of workforce in firms that offer coverage At employers offering coverage, % of employees eligible % of eligible employees who enroll (take-up rate) Percent of families with any ESI offer Percent of families offered ESI with all family members enrolled Data Availability Source CEHBS 2 CEHBS CEHBS CEHBS NHIS 3 NHIS 1 Employer Sponsored Insurance 2 Source: California Employer Health Benefits Survey 3 Source: National Health Interview Survey Number of employers paying penalty for not offering coverage CEHBS Let s Get Healthy California Task Force 13

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 Number of people purchasing nongroup coverage through exchange (with and without subsidies) Percent of nongroup market purchasing through exchange Number of employers and people with group coverage through exchange Percent of small group market purchasing through exchange Data Availability Exchange Source Exchange, insurance regulators CEHBS 1, Exchange CEHBS 1 Source: California Employer Health Benefits Survey Let s Get Healthy California Task Force 14

15 Priority Measures: Coverage Distribution of insurance coverage Source: California Health Interview Survey (CHIS), % 50% 54.9% 51.8% 52.3% 53.7% 49.6% 40% 30% 20% 10% 0% 21.1% 21.6% 22.5% 20.4% 18.7% 14.6% 14.0% 13.5% 13.2% 14.5% 5.0% 6.0% 6.0% 5.0% 6.0% Employer Public Individual Uninsured Let s Get Healthy California Task Force 15

16 Priority Measures: Coverage Uninsurance rate by county, 2009 Source: California Health Interview Survey (CHIS), % 20% 21.7% 15% 14.5% 10% 7.2% 5% Let s Get Healthy California Task Force 16

17 Priority Measures: Coverage Measures of uninsurance 30% Source: California Health Interview Survey (CHIS), % 20% 21.9% 21.1% 20.2% 19.4% 21.2% 15% 11.8% 10.6% 10.2% 10.3% 11.3% 10% 5% 0% Uninsured all year Uninsured at some point in past year Point in time uninsured Let s Get Healthy California Task Force 17

18 Priority Measures: Coverage Percent of employers offering health insurance coverage Sources: California Employer Health Benefits Survey, ; Kaiser Family Foundation Employer Health Benefits Survey, % 80% 70% 60% 50% 69% 70% 71% 70% 69% 68% 66% 66% 71% 71% 70% 67% 67% 63% 63% 60% 61% 59% 73% 59% 69% 69% 63% 60% 40% 30% 20% 10% California United States 0% Let s Get Healthy California Task Force 18

19 Priority Measures: Coverage At employers that offer coverage: % of employees eligible, and % eligible who enroll Source: California Employer Health Benefits Survey, % 80% 60% 88% 87% 87% 84% 84% 86% 86% 83% 83% 84% 84% 85% 83% 79% 79% 79% 79% 75% 77% 80% 79% 78% 76% 79% 40% 20% 0% % of employees eligible % eligible who enroll Let s Get Healthy California Task Force 19

20 Priority Measures: Coverage Med-Cal program enrollment Source: 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, Let s Get Healthy California Task Force 20

21 Priority Measures: Access Individual perspective Use of services Barriers to care Use of Services Percent of people with a usual source of care Type of place for usual source of care Data Availability Source CHIS 1 CHIS System perspective Provider-based measures Safety net Percent of people with a doctor visit in the past year Percent of people with a preventive care visit in the past year CHIS MEPS- HC 2, CHIS 1 Source: California Health Interview Survey 2 Source: Medical Expenditure Panel Survey Household Component Let s Get Healthy California Task Force 21

22 Priority Measures: Access Individual perspective Use of services Barriers to care System perspective Provider-based measures Safety net Barriers to Care Percent of people who forgo needed care Reasons for forgone care *Requires new data collection **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 Percent of people not able to get an appointment with a doctor in a timely way Percent of people who had difficulty finding a provider that would accept new patients Primary care Specialty care Percent of people who had difficulty finding a provider that would accept their insurance Primary care Specialty care Data Availability Let s Get Healthy California Task Force 22 Source MEPS- HC 1 MEPS- HC MEPS- HC, CHIS* 2 NHIS 3, CHIS* CHIS*, NHIS**

23 Priority Measures: Access Individual perspective Use of services Barriers to care System perspective Provider-based measures Safety net Provider-Based Measures Percent of physicians accepting new patients, by payer Primary care Specialty care Percent of physicians participating in public programs Primary care Specialty care Data Availability Source Medical Board of CA* Medical Board of CA* Emergency room visit rates OSHPD 1 Ambulatory care sensitive hospital admissions Preventable/avoidable emergency room visits OSHPD OSHPD *Requires new data collection 1 Source: Office of Statewide Health Planning and Development Let s Get Healthy California Task Force 23

24 Priority Measures: Access Individual perspective Use of services Barriers to care Safety Net Data Availability Source System perspective Provider-based measures Safety net Volume and type of services provided by safety net clinics Uncompensated care County indigent care volume and cost OSHPD 1, counties* OSHPD* Counties* *Requires new data collection 1 Source: Office of Statewide Health Planning and Development Let s Get Healthy California Task Force 24

25 Priority Measures: Access Percent of people with a usual source of care Source: California Health Interview Survey, % 87.6% 87.5% 87.8% 85.8% 80% 70% 60% 50% 40% 30% 20% 10% 0% Let s Get Healthy California Task Force 25

26 30% Priority Measures: Access Percent of people without a usual source of care Source: California Health Interview Survey, % 22% 14% 10% 9% 0% Let s Get Healthy California Task Force

27 Priority Measures: Access Type of place for usual source of care Source: California Health Interview Survey, % 70% 70% 67% 64% 61% 60% 50% 40% 30% 20% 16% 18% 23% 23% 10% 12% 13% 12% 14% 0% Doctor's office Community/Government clinic No usual source Let s Get Healthy California Task Force 27

28 Priority Measures: Access Percent of people with a doctor visit in the past year Source: California Health Interview Survey, % 80% 70% 60% 50% 40% 30% 20% 10% 83.2% 83.5% 83.0% 82.7% 0% Let s Get Healthy California Task Force 28

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 Stakeholder Feedback CHCF solicited stakeholder feedback on the framework through a series of 6 stakeholder meetings in Feb 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