Medicaid Reform Enrollee Satisfaction Year Two Follow-Up Survey. Volume 2: Plan Type Estimates

Transcription

1 Medicaid Reform Enrollee Satisfaction Year Two Follow-Up Survey Volume 2: Plan Type Estimates March 2011

2 Authors R. Paul Duncan, PhD Allyson G. Hall, PhD Babette Brumback, PhD Jianyi Zhang, PhD Lilliana L. Bell, MHA Lorna P. Chorba, CCNA Keva Thompson, MPH Kim Elliott, B.A. Prepared by the Department of Health Services Research, Management and Policy at the University of Florida under contract to the Agency for Health Care Administration Bureau of Medicaid Quality Management. For more information, see

3 Table of Contents Introduction and Methodology Sample and Weighting A Note on Interpreting the Tables and Statistical Significance Response Rates Summary of Major Findings Broward and Duval Rural Counties: Baker, Clay, and Nassau Broward and Duval Counties Medicaid Enrollee Satisfaction Ratings Primary Care Getting Needed Care Emergency Room Care Getting Care Quickly Communicating with Providers Helpfulness of Office Staff Rural Counties Medicaid Enrollee Satisfaction Ratings Primary Care Getting Needed Care Emergency Room Care Getting Care Quickly Communicating with Providers Helpfulness of Office Staff Discussion and Conclusion Appendix A: Survey and Sampling Methodology Instrumentation Survey Sampling Switchers Appendix B: Demographics Broward and Duval Counties Rural Counties Appendix C: Response Rates

4 Introduction and Methodology Effective July 1, 2006, the Agency for Health Care Administration (AHCA) began implementing Medicaid Reform in Broward and Duval counties. Broward County is located in the southeast section of Florida and includes the city of Fort Lauderdale. Duval County is located in the northeast section of Florida and includes the city of Jacksonville. Beginning July 1, 2007, the demonstration was expanded to include three rural counties near Duval: Baker, Clay, and Nassau. AHCA contracted with the University of Florida s Department of Health Services Research, Management and Policy to conduct a five-year evaluation of the demonstration. One component of the evaluation is an annual Consumer Assessment of Health Care Providers and Systems (CAHPS) survey of enrollees that tracks their experiences and levels of satisfaction. Three rounds of the survey (Benchmark, Year 1, and Year 2) have been conducted in Broward and Duval counties. Two rounds (Benchmark and Year 1) have been conducted in Baker, Clay, and Nassau counties. Additional details about each round of the surveys conducted are provided in Appendix A. This CAHPS Year 2 Follow-Up Survey: Volume 2 Plan Type Estimates chartbook presents plan level estimates for the Benchmark Year, Year 1, and Year 2 for Broward and Duval counties (combined) and for the Benchmark Year and Year 1 for Baker, Clay, and Nassau counties (combined). This report includes descriptions of enrollee satisfaction ratings for their health care, health plan, personal doctor, and specialists. This report includes descriptions of enrollee satisfaction ratings for their health care, health plan, personal doctor, and specialists. Respondents were asked to rate their overall satisfaction with their health plan, overall satisfaction with care, personal doctor, and specialist along a 0 10 scale with 0 representing the lowest rating and 10 representing the highest rating. Based on the approach used by the Agency for Healthcare Research and Quality (AHRQ) in its National CAHPS Benchmarking Report, the ratings were categorized into three groups, including level 1 (0 6), level 2 (7 8), and level 3 (9 10). This report also describes enrollee experiences with their primary care, getting needed care, emergency room care, getting care quickly, communicating with providers, and helpfulness of office staff. Modified versions of the CAHPS survey were used to ask enrollees about their health plan enrollment and coverage, ability to access health care, overall satisfaction and ratings of providers and health plans, experiences with providers and office staff, and health status. Sample and Weighting The population for the survey was based on AHCA Member-Month and Recipient Eligibility files. Prior to each survey, Medicaid Reform or Reform-eligible recipients (in the case of the Benchmark Survey) who were enrolled in Medicaid for at least 6 consecutive months were randomly selected to participate in the surveys. Table 1 shows the final unweighted sample sizes (total number of completed interviews) for each year. Findings from this survey are intended to provide information about the study population, which consists of the 79,985 Medicaid enrollees deemed eligible for this study. Only a sample of these enrollees was contacted. In order to calculate estimates that refer to all eligible enrollees, sampled enrollees were weighted by two factors that reflected (1) their probability of being called and (2) their estimated probability of responding given they were called. Together these two weighting factors allowed the completed interviews to reflect the sample (i.e. those who were called), and the sample to reflect the population of enrollees from which the sample was originally selected. The unweighted sample size and the weighted percentages are presented in each table. Note that the percentages in the table columns may not add up to 100 and in some instances, the percentages presented in the figures may be slightly different from those in the corresponding table due to rounding. Technical details regarding the survey and sampling methodology are provided in Appendix A. Further information on the survey instrument, statistical weighting, and disposition reports are available upon request. Demographic and health status characteristics for Broward and Duval counties combined and the rural counties (Baker, Clay, and Nassau) combined are provided in Appendix B. 1 Medicaid Reform Enrollee Satisfaction Year Two Follow-Up Survey Volume 2: Plan Type Estimates

5 Table 1: Sample Sizes for the Benchmark Year, Year 1, and Year 2 Surveys (Unweighted) Broward Duval Rural Benchmark Year 4,197 1, Year 1 4,345 1, Year 2 3,917 2,235 Note. Three rounds of the survey (the Benchmark Year, Year 1, and Year 2) were conducted in Broward and Duval (urban) counties. Two rounds (the Benchmark Year and Year 1) were conducted in Baker, Clay, and Nassau (rural) counties as indicated by the dash. Sample sizes do not sum across each year and county because the Benchmark Year surveys for the urban and rural counties are different. The demonstration was implemented in the urban counties on July 1, 2006, and implemented in the rural counties one year later. So, the Benchmark Year survey for the rural counties was fielded at the same time as the Year 1 Follow-Up survey for the urban counties. Differences in the sample sizes across the two years were due to two reasons. First, the number of plans changed and the number of enrollees in each plan changed in each year. Accordingly, a targeted number of completes that was specific to each year and each county was set. Second, the percent who responded was slightly different in each year. The intent was not to sample the exact number in each year. The Benchmark Year includes enrollees participating in HMOs, PSNs, MediPass, and fee-for-service (FFS) health care delivery systems. As part of the Reform pilot process, enrollees who were in MediPass or FFS care were required to enroll in an HMO or PSN. In the second year of the Reform pilot, many of the enrollees were required to change plans due to several of the health plans exiting the Reform counties. A separate category identified as Switchers was added in Year 2 to uniquely identify this segment of the enrollee population. Switchers could either switch across plan types or within plan types, so this category includes enrollees in both PSNs and HMOs (Appendix A). A Note on Interpreting the Tables and Statistical Significance The tables throughout this document compare the distribution in respondent ratings across three years in the case of the urban counties and two years in the case of the rural counties. The statistical significance of observed differences was assessed by a chi-square test. In essence, this approach indicates whether the distributions are different across plan type within each year. It does not assess the manner in which the distributions are different. P-values less than 0.05 indicate that there is a strong likelihood that observed differences in distributions across plan type are in fact real and not due to chance. It is noted that these samples are large; sometimes small differences can be statistically significant. Conversely, as is evident in some of the results for the rural areas, large differences may not be statistically significant. This likely is a result of a small sample size leading to increased variability in estimates. The practical and substantive importance of differences and their statistical significance is therefore open to interpretation. Response Rates The response rate refers to the ratio of people who completed the survey divided by the number of people in the sample. Three different response rates were calculated, reflecting differences in the denominator based on survey eligibility and whether an individual was actually contacted. All three response rates are presented in Table C1 in Appendix C. The Raw Response Rate is the total number of completed interviews divided by the total number of individuals eligible to participate in the survey. Raw Response Rates were calculated at 18%, 19%, and 21% for the Benchmark Year, Year 1, and Year 2 surveys, respectively for all counties The Response Rate Adjusted for Ineligibles excludes those groups that were not eligible for the survey, such as individuals who live in group quarters or telephone numbers determined to be fax/data lines, business, or other institutional telephone numbers. This ineligibility was determined after sampling and was not determined before the survey was launched. Therefore, this rate is reflective of the population under study. Response Rates Adjusted for Ineligibles for the Benchmark Year, Year 1, and Year 2 were 4, 34%, and 4 respectively, for all counties. The Cooperation Rate is a ratio of those who completed the survey divided by the number of individuals who were contacted and eligible for the study. The Cooperation Rates were 65%, 64%, and 76% for the Benchmark Year, Year 1, and Year 2 surveys respectively, for all counties. Medicaid Reform Enrollee Satisfaction Year Two Follow-Up Survey Volume 2: Plan Type Estimates 2

6 Summary of Major Findings This report compares enrollee experiences and ratings across health plan types for the Benchmark Year, Year 1, and Year 2 for Broward and Duval counties combined, and for the Benchmark Year and Year 1 for Baker, Clay, and Nassau counties combined. Broward and Duval The Benchmark Year The survey conducted during the Benchmark Year compares enrollees experiences across four different types of plan arrangements: HMO, PSN, MediPass, and FFS. Three of the 4 satisfaction ratings were statistically significantly different (health plan satisfaction, personal doctor satisfaction, and specialist satisfaction). Relative to the other plan types, lower proportions of FFS enrollees provided ratings at the highest level for health plan satisfaction and specialist satisfaction. However, the proportion giving personal doctor satisfaction was highest for the FFS enrollees compared to other enrollees. MediPass had the largest proportion of enrollees reporting health plan satisfaction and specialist satisfaction (Figure 1). Figure 1: Rating Aspects of Their Care at the Highest Level (9 10),, the Benchmark Year Survey HMO PSN MediPass FFS 69% 66% 65% 65% 57% 58% 61% 49% 74% 76% 68% 71% 67% 62% 55% 51% 4 Health Care Satisfaction Health Plan Satisfaction* Personal Doctor Satisfaction* Specialty Care Satisfaction* *p <.05 3 Medicaid Reform Enrollee Satisfaction Year Two Follow-Up Survey Volume 2: Plan Type Estimates

7 There are other statistically significant differences in enrollees reports of their experiences with care. For example, compared to other plan types, MediPass enrollees were more likely to report having a personal doctor (Table 6), to always being taken to the exam room within 15 minutes (Table 12), and to say that the doctor s office staff was always courteous and respectful (Table 18), while FFS enrollees were more likely to say it was not a problem to see a specialist (Table 8). Year 1 The Year 1 survey compares the perceptions of HMO and PSN enrollees. Statistically significant differences were noted for two items: having a personal doctor and being taken to the exam room within 15 minutes. Greater proportions of HMO enrollees reported having a personal doctor (Table 6), and always being taken to the exam room within 15 minutes compared to PSN enrollees (Table 12). Year 2 The Year 2 survey specifically identifies individuals who had to voluntarily or involuntarily switch their health plan within the past 6 months of when the survey was fielded. The addition of this group identified as Switchers was precipitated by health plan closures that occurred during 2009, requiring enrollees to enroll in other health plans. Out of 18 indicators, 9 had statistically significant differences across plan types. In all cases, Switchers had the highest proportion of enrollees providing an unfavorable rating or report. Figure 2 shows the percent of enrollees providing the highest rating (9 10) for aspects of their health care. Large proportions of enrollees provided ratings of 9 10 for their level of satisfaction with their personal doctor, regardless of plan type. In addition, across all four ratings, greater proportions of PSN enrollees provided high ratings compared to HMO enrollees or those who switched health plans. Figure 2: Rating Aspects of Their Care at the Highest Level (9 10),, Year 2 Follow-Up Survey HMO PSN Switchers 64% 57% 52% 61% 49% 72% 77% 71% 61% 69% 58% 4 Health Care Satisfaction* Health Plan Satisfaction* Personal Doctor Satisfaction* Specialty Care Satisfaction* *p <.05 Medicaid Reform Enrollee Satisfaction Year Two Follow-Up Survey Volume 2: Plan Type Estimates 4

8 PSN enrollees were also more likely to say it was not a problem getting a personal doctor or health care provider with whom they were happy (Figure 3), compared to HMO enrollees and those who switched plans. Figure 3: Rating of "Not a Problem" for Getting a Personal Doctor or Health Care Provider Happy With,, Year 2 Follow-Up Survey HMO PSN Switchers 85% 89% 85% "Not a Problem" Getting a Personal Doctor or Health Care Provider Happy With* *p <.05 Switchers were less likely than HMO or PSN enrollees to say that it was always easy to get an appointment with a specialist; to get the care, tests, or treatment thought needed; and to get needed advice or help when calling the doctor s office (Figure 4). Figure 4: Rating of "Always" for Specific Health Care Experiences,, Year 2 Follow-Up Survey HMO PSN Switchers 4 49% 55% 56% 53% 38% 45% 66% 71% *p <.05 Ease of Getting Specialist Appointments* Ease of Getting the Care, Tests, or Treatment Thought Needed* Ease of Getting Needed Advice or Help* 5 Medicaid Reform Enrollee Satisfaction Year Two Follow-Up Survey Volume 2: Plan Type Estimates

9 Rural Counties: Baker, Clay, and Nassau The Benchmark Year In the rural counties, the Benchmark Year survey compares the perceptions of HMO, PSN, and MediPass enrollees. FFS enrollees were not sampled in the rural areas because of the relatively small number who would qualify for Reform in the Benchmark Year. None of the differences across plan type were statistically significant. As with the urban counties, satisfaction ratings among enrollees were generally high. Year 1 Year 1 compares the experiences of enrollees in HMOs, PSNs, and those who switched their health plan in the last 6 months. Only 1 rating, health care satisfaction, had a statistically significant difference in responses across plan types. Switchers, enrollees who switched health plans, were less likely to give health care satisfaction a 9 10 compared to HMO or PSN enrollees. Figure 5: Rating Health Care Satisfaction at the Highest Level (9 10),, Year 1 Follow-Up Survey HMO PSN Switchers 4 54% 64% 48% *p <.05 Health Care Satisfaction* Medicaid Reform Enrollee Satisfaction Year Two Follow-Up Survey Volume 2: Plan Type Estimates 6

10 Broward and Duval Counties This section presents a series of tables and figures showing the distribution of survey results for each of the following select survey composites, ratings, and individual question items for Broward and Duval counties combined: Medicaid enrollee satisfaction ratings o Health care o Health plan o Personal doctor o Specialist Primary care Getting needed care Emergency room care Getting care quickly Communicating with providers Helpfulness of office staff Each table provides the results for Broward and Duval counties combined and is followed by a figure highlighting key findings. The unweighted sample sizes and the weighted percentages are shown in each table. The tests of statistical significance were calculated using the weighted data. Note that the percentages in the table columns may not add up to 100 and, in some instances, the percentages presented in the figures may be slightly different from those in the corresponding table due to rounding. 7 Medicaid Reform Enrollee Satisfaction Year Two Follow-Up Survey Volume 2: Plan Type Estimates

11 Medicaid Enrollee Satisfaction Ratings Question: Using any number from 0 10, where 0 is the worst and 10 is the best health care possible, what number would you use to rate all your health care, in the last 6 months? This measure provides an overall satisfaction rating of the health care received by Medicaid enrollees in Broward and Duval counties. Overall, the majority of respondents rated their health care at the highest level (9 10) for each of the three years. Differences in health care ratings among plan types were statistically significant within Year 2 only. The Switchers in Year 2 had the lowest percentage of individuals (57%) who rated their health care at the highest level (9 10) relative to HMO and PSN enrollees. Table 2: Health Care Satisfaction Rating (0 10), Benchmark Year Year 1 Year 2 Broward & Duval Counties HMO PSN MediPass FFS HMO PSN HMO PSN Switchers Sample Size 1,743 1, ,168 2,035 2,294 1, Level 1 (0 6) 11.5% 10.1% 9.4% 12.2% 12.3% 12.3% 13.5% 12.8% 14.4% Level 2 (7 8) 22.6% % 23.1% 28.4% 27.2% 26.4% 23.6% 28.8% Level 3 (9 10) 65.9% 64.9% 69.3% 64.7% 59.3% 60.5% % 56.8% p =.3502 p =.7714 p =.0479 Figure 6: Health Care Satisfaction Rating (0 10), Level 1 (0 6) Level 2 (7 8) Level 3 (9 10) In Year 2, a majority of enrollees (at least 57%) rated the health care they received in all plan types at the highest level (9 10). 64% 57% 4 26% 24% 14% 13% 14% 29% HMO* PSN* Switchers* *p <.05 Medicaid Reform Enrollee Satisfaction Year Two Follow-Up Survey Volume 2: Plan Type Estimates 8

12 Question: Using any number from 0 10, where 0 is the worst and 10 is the best health plan possible, what number would you use to rate your (your child s) health plan? This measure provides an overall satisfaction rating of enrollees experiences with their Medicaid health plans at the time of the survey. These results combine Broward and Duval counties enrollees experiences across plan type. Differences in the rating of their health plans were statistically significant within the Benchmark Year and Year 2. Enrollees in FFS had the lowest percentage (49%) who rated their plan at the highest level (9 10) in the Benchmark Year. The Switchers in Year 2 had the lowest percentage (49%) who rated their health plan at the highest level. Table 3: Health Plan Satisfaction Rating (0 10), Benchmark Year Year 1 Year 2 Broward & Duval Counties HMO PSN MediPass FFS HMO PSN HMO PSN Switchers Sample Size 2,205 1, ,438 2,171 2,737 2, Level 1 (0 6) 17.1% 14.6% 15.3% 22.6% 17.2% 16.6% 20.1% 14.3% 21.1% Level 2 (7 8) 25.5% 27.3% 24.1% % 25.6% 27.5% 24.7% 30. Level 3 (9 10) 57.4% % 49.4% 57.2% 57.8% 52.3% % p =.0050 p =.8926 p <.0001 In Year 2, between 49% 61% of enrollees rated their satisfaction with their health plan at the highest level (9 10). Figure 7: Health Plan Satisfaction Rating (0 10), Level 1 (0 6) Level 2 (7 8) Level 3 (9 10) 52% 61% 49% 4 28% 14% 25% 21% 3 HMO* PSN* Switchers* *p <.05 9 Medicaid Reform Enrollee Satisfaction Year Two Follow-Up Survey Volume 2: Plan Type Estimates

13 Question: Using any number from 0 10, where 0 is the worst and 10 is the best personal doctor possible, what number would you use to rate your (your child s) personal doctor? This measure provides an overall satisfaction rating of Medicaid enrollees personal doctor or primary care provider in Broward and Duval counties by plan type at the time of the survey. Differences in the personal doctor ratings across heath plans were statistically significant for the Benchmark Year and Year 2 responses. In the Benchmark Year, the FFS enrollees had the largest percentage (76%) who rated their doctor at the highest level. The percentage of PSN enrollees who rated their personal doctor at the highest level was greater than HMO enrollees during each year of the study. Table 4: Personal Doctor Satisfaction Rating (0 10), Benchmark Year Year 1 Year 2 Broward & Duval Counties HMO PSN MediPass FFS HMO PSN HMO PSN Switchers Sample Size 1,752 1, ,252 2,087 2,454 1, Level 1 (0 6) 9.5% 7.5% 8.2% 6.7% 9.5% 7.6% 9.1% 7.1% 8.4% Level 2 (7 8) 22.6% % 17.7% 17.8% 17.1% 18.9% 16.4% 20.5% Level 3 (9 10) % 73.7% 75.6% 72.7% 75.4% % 71.1% p =.0515 p =.1377 p =.0349 Figure 8: Personal Doctor Satisfaction Rating (0 10), Level 1 (0 6) Level 2 (7 8) Level 3 (9 10) In Year 2, PSN enrollees had the largest percentage (77%) who rated their doctor at the highest level (9 10). 72% 77% 71% 4 19% 16% 9% 7% 8% HMO* PSN* Switchers* *p <.05 Medicaid Reform Enrollee Satisfaction Year Two Follow-Up Survey Volume 2: Plan Type Estimates 10

14 Question: Using any number from 0 10, where 0 is the worst and 10 is the best specialist possible, what number would you use to rate your (your child s) specialist? This measure provides an overall satisfaction rating of Medicaid Reform enrollees who saw a specialist provider in Broward and Duval counties during the 6 months prior to the time of the survey. Differences in the specialist ratings were statistically significant within the Benchmark Year and Year 2. In the Benchmark Year, MediPass enrollees had the highest percentage (67%) who rated their specialist at the highest level. In Year 2, PSN enrollees had the highest percentage (69%) who rated their specialist at the highest level. Table 5: Specialist Satisfaction Rating (0 10), Benchmark Year Year 1 Year 2 Broward & Duval Counties HMO PSN MediPass FFS HMO PSN HMO PSN Switchers Sample Size ,325 1, Level 1 (0 6) 14.6% % 13.9% 13.3% 15.2% 9.6% 18.1% Level 2 (7 8) 30.1% 23.6% 21.9% 37.6% 23.1% 22.7% 23.4% 21.8% 23.6% Level 3 (9 10) 55.3% 62.4% 67.1% 51.3% % 61.4% 68.6% 58.3% p =.0458 p =.9411 p =.0026 In Year 2, at least 58% of enrollees across plan types rated their specialist at the highest level (9 10). Figure 9: Specialist Satisfaction Rating (0 10), Level 1 (0 6) Level 2 (7 8) Level 3 (9 10) 61% 69% 58% 4 15% 23% 22% 24% 18% 1 *p <.05 HMO* PSN* Switchers* 11 Medicaid Reform Enrollee Satisfaction Year Two Follow-Up Survey Volume 2: Plan Type Estimates

15 Primary Care Question: A personal doctor is the one you (your child) would see if you (they) need a checkup, want advice about a health problem, or get sick or hurt. Do you (does your child) have a personal doctor? A primary care physician is a generalist physician, such as a pediatrician or family practice physician, who provides care to a patient at the point of first contact and takes continuing responsibility for providing the patient s care. In Medicaid Reform, all enrollees are assigned to a primary care provider; however, enrollees may not have established a relationship with their assigned primary care provider. Differences among enrollees who said that they had a personal doctor across health plans were statistically significant for the Benchmark Year and Year 1. Within the Benchmark Year, MediPass enrollees had the highest percentage who had a personal doctor (83%); while in Year 1, HMO enrollees had the highest proportion (89%). Table 6: Enrollees Who Reported Whether or Not They Had a Personal Doctor, Benchmark Year Year 1 Year 2 Broward & Duval Counties HMO PSN MediPass FFS HMO PSN HMO PSN Switchers Sample Size 2,251 2, ,730 2,430 2,859 2, Yes 77.8% 77.9% 83.3% 78.1% 89.1% % 86.2% 87.9% No 22.2% 22.1% 16.7% 21.9% 10.9% % 13.8% 12.1% p =.0059 p =.0070 p =.3369 In Year 2, between 86% 88% of all Medicaid enrollees said they had a personal doctor regardless of plan type. Figure 10: Enrollees Who Reported Whether or Not They Had a Personal Doctor, Yes No 88% 86% 88% 4 12% 14% 12% HMO PSN Switchers Medicaid Reform Enrollee Satisfaction Year Two Follow-Up Survey Volume 2: Plan Type Estimates 12

16 Getting Needed Care Question: Since you joined Medicaid, how much of a problem, if any, was it to get a personal doctor or health care provider you (for your child you) are happy with? Differences among enrollees who indicated how much of a problem it was to get a doctor or health care provider with whom they were happy were statistically significant in Year 2 only. Generally, a majority of enrollees indicated it was not a problem getting a doctor or health care provider with whom they were happy. Table 7: Problem Getting a Personal Doctor or Health Care Provider Happy With, Benchmark Year Year 1 Year 2 Broward & Duval Counties HMO PSN MediPass FFS HMO PSN HMO PSN Switchers Sample Size 1,450 1, ,759 1,811 2,198 1, A big problem 12.2% 11.9% 12.1% 16.4% 5.4% 4.9% 5.7% 3.7% 6.6% A small problem 13.2% 11.9% 14.4% 13.6% 9.1% 8.5% 8.9% 7.6% 8.6% Not a problem 74.6% 76.2% 73.5% % 86.6% 85.4% 88.7% 84.8% p =.4805 p =.7065 p =.0085 In Year 2, at least 85% of enrollees said it was not a problem finding a doctor or nurse with whom they were happy. Figure 11: Problem Getting a Personal Doctor or Health Care Provider Happy With, A big problem A small problem Not a problem 85% 89% 85% 4 6% 9% 4% 8% 7% 9% HMO* PSN* Switchers* *p < Medicaid Reform Enrollee Satisfaction Year Two Follow-Up Survey Volume 2: Plan Type Estimates

17 Question: In the last 6 months, how much of a problem, if any/how often was it easy to get appointments for you (your child) with specialists? The differences among enrollees who reported how often it was easy to get an appointment with a specialist within the last 6 months were statistically significant in the Benchmark Year and Year 2. In the Benchmark Year, HMOs had the highest number of respondents who said that it was a big problem to make an appointment with a specialist. In Year 2, PSN enrollees were more likely to report that it was always easy to see a specialist compared to HMO enrollees or enrollees who switched plans. Table 8: How Much of a Problem to See Specialist,, the Benchmark Year Survey Benchmark Year Broward & Duval Counties HMO PSN MediPass FFS Sample Size A big problem 27.5% 21.1% 22.4% 20.1% A small problem 20.6% 21.7% 21.6% 14.4% Not a problem 51.9% 57.2% % p =.0383 Ease of Getting Specialist Appointments,, Year 2 Follow-Up Survey Year 1 Year 2 Broward & Duval Counties HMO PSN HMO PSN Switchers Sample Size 1, Never 15.4% 11.6% 13.6% 11.1% 18.6% Sometimes % 20.7% % Usually 18.1% 18.6% % 14.4% Always 45.4% 47.1% 48.6% 54.8% 38.5% p =.3346 p =.0019 The question and response structure was different for the Benchmark Year compared to both Year 1 and Year 2. Across Years 1 and 2, between 11% 19% of enrollees said it was never easy to get an appointment with a specialist. Figure 12: Ease of Getting Specialist Appointments, Never Sometimes Usually Always 49% 55% 4 14% 21% 17% 11% 29% 19% 14% 14% 38% HMO* PSN* Switchers* *p <.05 Medicaid Reform Enrollee Satisfaction Year Two Follow-Up Survey Volume 2: Plan Type Estimates 14

18 Question: In the last 6 months, how often was it easy to get the care, tests, or treatment you thought you (your child) needed through your (their) health plan? Findings were statistically significantly different in Year 2 only. In that year, between 45% 56% of enrollees said it was always easy to get the care, tests, or treatment they thought they needed within the last 6 months. Table 9: How Much of a Problem if any to get Care, Tests, or Treatment Thought Needed,, the Benchmark Year Survey Benchmark Year Broward & Duval Counties HMO PSN MediPass FFS Sample Size A big problem 13.1% 11.7% 10.5% 13.6% A small problem 17.8% 19.8% 17.3% 21.8% Not a problem 69.1% 68.5% 72.2% 64.7% p =.6900 Ease of Getting the Care, Tests, or Treatment Thought Needed,, Year 2 Follow-Up Survey In Year 2, PSN enrollees had the lowest percentage reporting that it was never easy to get the care, tests, or treatment, compared to Switchers who had the highest percentage. Year 1 Year 2 Broward & Duval Counties HMO PSN HMO PSN Switchers Sample Size 1,724 1,187 1,036 1, Never 9.3% 7.5% 9.7% 7.1% 13.7% Sometimes 17.6% 16.8% 21.2% 18.8% 24.2% Usually 20.8% 17.7% 16.3% 18.1% 17.4% Always 52.3% % 56.1% 44.8% p =.1066 p =.0026 The question and response structure was different for the Benchmark Year compared to both Year 1 and Year 2. Figure #: 13: Ease of of Getting Care, the Care, Tests, Tests, Treatment or Treatment Thought Thought Needed, Needed, by Plan Type, Broward By Plan Type, and Duval Broward Counties, and Duval Year Counties 2 Follow-Up Survey Never Sometimes Usually Always 53% 56% 45% % 24% 16% 19% 18% 17% 14% 7% HMO* PSN* Switchers* *p < Medicaid Reform Enrollee Satisfaction Year Two Follow-Up Survey Volume 2: Plan Type Estimates

19 Emergency Room Care Question: In the last 6 months, how many times did you go to an emergency room to get care for yourself? Many emergency room visits are not for life threatening conditions and are often avoidable. High numbers of emergency room visits may indicate a lack of access to primary care or poorly managed chronic conditions such as diabetes or congestive heart failure. There were no statistically significant differences in enrollee responses across health plans within any of the years regarding their use of the emergency room. Across all three years, over 5 of the enrollees in any given plan did not visit the emergency room in the 6 months prior to the survey. Table 10: Emergency Room Visits Within 6 Months, Benchmark Year Year 1 Year 2 Broward & Duval Counties HMO PSN MediPass FFS HMO PSN HMO PSN Switchers Sample Size , None 60.5% 62.1% 59.5% 56.7% 57.2% 53.6% 59.6% 55.5% 50.9% % 33.9% 37.4% 40.3% 38.9% 39.8% 37.7% 39.7% or more 2.2% % 3.9% 6.6% 2.7% 4.9% 3.1% p =.6737 p =.0926 p =.1972 This question was included in both the adult and child questionnaires in the Benchmark Year and only included in the adult questionnaire in Year 1 and Year 2. For consistency and comparison in reporting, data from those who responded on behalf of children were excluded from the Benchmark Year. In Year 2, less than 5% of enrollees reported making 5 or more emergency room visits. Figure 14: Emergency Room Visits Within 6 Months, None or more 4 55% 38% 4 51% 46% 3% 5% 3% HMO PSN Switchers Medicaid Reform Enrollee Satisfaction Year Two Follow-Up Survey Volume 2: Plan Type Estimates 16

20 Getting Care Quickly Question: In the last 6 months, when you called during regular office hours, how often did you get the help or advice you (your child) needed? Differences among enrollees across heath plans who said that they got the help or advice they needed were statistically significant in Year 2. In general, over of enrollees reported always getting the help or advice needed. Table 11: Getting Needed Help or Advice When They Called the Doctor s Office During Office Hours, In Year 2, enrollees categorized as Switchers had the lowest percentage who reported they always received the help or advice they needed compared to HMO and PSN enrollees. Benchmark Year Year 1 Year 2 Broward & Duval Counties HMO PSN MediPass FFS HMO PSN HMO PSN Switchers Sample Size 1,065 1, ,680 1,074 1,322 1, Never 5.6% 4.4% 5.7% 4.1% 6.7% 4.2% 6.8% 4.8% 5.9% Sometimes 17.7% 15.9% 14.8% % 14.6% 16.2% 12.8% 17.4% Usually % 15.2% 17.3% 16.2% 15.4% 11.5% 11.5% 16.5% Always 62.7% 62.2% 64.3% 66.7% 64.5% 65.7% 65.5% % p =.3223 p =.1303 p =.0040 Figure 15: Getting Needed Help or Advice When They Called the Doctor's Office During Office Hours, Never Sometimes Usually Always 65% 71% 4 16% 12% 13% 11% 7% 5% 6% 17% 17% HMO* PSN* Switchers* *p < Medicaid Reform Enrollee Satisfaction Year Two Follow-Up Survey Volume 2: Plan Type Estimates

21 Question: In the last 6 months, how often were you (your child) taken to the exam room within 15 minutes of your (your child s) appointment? There were statistically significant differences across health plans by response category for how often enrollees were taken to the exam room within 15 minutes of their appointment for the Benchmark Year and Year 1. Within the Benchmark Year, MediPass enrollees had the highest percentage who reported they always received care quickly (31%), and in Year 1 HMO enrollees (3) had the highest percentage. Table 12: Exam Room Within 15 Minutes, Benchmark Year Year 1 Year 2 Broward & Duval Counties HMO PSN MediPass FFS HMO PSN HMO PSN Switchers Sample Size 1,717 1, ,915 1,938 2,124 1, Never % 26.1% 26.8% 25.7% 30.7% 28.9% 26.9% 32.9% Sometimes 27.1% 26.5% 24.7% 26.9% 27.9% % 27.3% 27.2% Usually 15.3% 15.6% 18.3% 20.9% 16.7% 16.3% 16.1% 16.6% 14.9% Always 23.5% 24.9% 30.9% 25.3% 29.7% % 29.3% 25. p =.0040 p =.0357 p =.1154 Figure 16: Exam Room Within 15 Minutes, Never Sometimes Usually Always More than 25% of enrollees across health plans in Year 2 said they were always taken to an exam room in 15 minutes. 4 33% 29% 29% 26% 27% 27% 29% 27% 16% 17% 15% 25% HMO PSN Switchers Medicaid Reform Enrollee Satisfaction Year Two Follow-Up Survey Volume 2: Plan Type Estimates 18

22 Communicating with Providers Question: In the last 6 months, how often did your (your child s) personal doctor listen carefully to you? Studies have shown that when patients have positive interpersonal relationships with their doctors, their overall satisfaction and rates of compliance are high. Across the three years, the majority of enrollees (over 88%) reported their personal doctor either usually or always listened carefully to them. However, there were no statistically significant differences in enrollee responses across health plans within any of the years. Table 13: How Often Personal Doctor Listened Carefully to Enrollee, Benchmark Year Year 1 Year 2 Broward & Duval Counties HMO PSN MediPass FFS HMO PSN HMO PSN Switchers Sample Size 1,752 1, ,810 1,827 2,022 1, Never 2.9% 1.7% % 1.6% 1.7% % Sometimes 8.9% 7.8% 8.8% 8.9% 5.8% 6.1% 6.9% 4.6% 6.7% Usually 11.2% 13.5% % % 7.1% 7.3% 9.6% Always % 80.2% 76.5% 83.8% 85.3% 84.3% 86.1% 82.1% p =.1411 p =.3074 p =.0684 At least 82% of enrollees in Year 2 said their personal doctor always listened carefully to them. Figure 17: How Often Personal Doctor Listened Carefully to Enrollee, Never Sometimes Usually Always 84% 86% 82% 4 7% 7% 7% 1 2% 2% 5% 7% 2% HMO PSN Switchers 19 Medicaid Reform Enrollee Satisfaction Year Two Follow-Up Survey Volume 2: Plan Type Estimates

23 Question: In the last 6 months, how often did your (your child s) personal doctor explain things in a way that was easy to understand? The overall majority of Medicaid enrollees (over 77%) stated their doctor always explained things in a way that was easy for them to understand. There was a statistically significant difference among health plans for this question in Year 2, with enrollees in PSNs having the highest percentage of always responses. Table 14: How Often Personal Doctor Explained Things in a Way That was Easy to Understand, Benchmark Year Year 1 Year 2 Broward & Duval Counties HMO PSN MediPass FFS HMO PSN HMO PSN Switchers Sample Size 1,751 1, ,815 1,824 2,019 1, Never 5.5% 4.4% % 2.3% 2.5% 2.8% 1.9% 2.2% Sometimes 8.5% 8.2% 8.5% 8.2% 6.5% 6.6% 7.2% 4.8% 7.2% Usually 8.9% 10.3% 9.1% 10.8% 11.1% 8.8% % 10.9% Always 77.1% 77.1% 79.4% 78.1% 80.1% % p =.1961 p =.2768 p =.0428 Figure 18: How Often Personal Doctor Explained Things in a Way That was Easy to Understand, Never Sometimes Usually Always In Year 2, at least of enrollees said their personal doctor always explained their health care to them in a way that was easy to understand. 81% 83% 4 *p <.05 7% 9% 1 11% 3% 5% 7% 2% 2% HMO* PSN* Switchers* Medicaid Reform Enrollee Satisfaction Year Two Follow-Up Survey Volume 2: Plan Type Estimates 20

24 Question: In the last 6 months, how often did your (your child s) personal doctor show respect for what you had to say? The majority of all Medicaid enrollees stated their doctor always showed respect for what they had to say (over 79%). In Year 2, the differences across health plans for this question were statistically significant, with enrollees in PSNs having the highest percentage of always responses relative to HMO enrollees and Switchers. Table 15: How Often Personal Doctor Showed Respect, Benchmark Year Year 1 Year 2 Broward & Duval Counties HMO PSN MediPass FFS HMO PSN HMO PSN Switchers Sample Size 1,752 1, ,807 1,824 2,021 1, Never % 2.1% 1.8% 1.4% 1.3% % Sometimes 7.5% 6.3% 7.7% 9.2% 3.8% 3.8% 5.4% 3.3% 4.9% Usually 8.2% % 9.7% 8.2% 6.1% 5.5% 4.6% 6.1% Always 81.3% % 79.3% 86.7% 88.7% 88.1% % p =.2623 p =.2278 p =.0238 In Year 2, at least 88% of enrollees said their personal doctor always showed respect for what they had to say. Figure 19: How Often Personal Doctor Showed Respect, Never Sometimes Usually Always 88% 9 88% 4 5% 6% 1% 2% 3% 5% 5% 6% 1% HMO* PSN* Switchers* *p < Medicaid Reform Enrollee Satisfaction Year Two Follow-Up Survey Volume 2: Plan Type Estimates

25 Question: In the last 6 months, how often did your (your child s) personal doctor spend enough time with you (your child)? Overall, the majority of enrollees believed their personal doctor either usually or always spent enough time with them (over ). There were no statistically significant differences in responses across health plans for each year. Table 16: How Often Personal Doctor Spent Enough Time, Benchmark Year Year 1 Year 2 Broward & Duval Counties HMO PSN MediPass FFS HMO PSN HMO PSN Switchers Sample Size 1,740 1, ,793 1,816 2,011 1, Never 4.7% 4.4% 4.3% 3.6% 3.8% 3.1% 3.9% 3.5% 3.6% Sometimes % 13.3% 13.4% 13.3% 11.8% 12.1% 11.1% 11.2% Usually 14.6% 17.6% 12.2% 14.9% % 13.7% 12.6% 15.3% Always 65.7% 64.6% 70.2% 68.1% 67.9% 71.6% 70.3% 72.8% 69.9% p =.1723 p =.2418 p =.7221 Figure 20: How Often Personal Doctor Spent Enough Time, Never Sometimes Usually Always In Year 2, between 7 73% of enrollees said their personal doctor always spent enough time with them. 7 73% % 14% 11% 13% 11% 4% 4% 4% 15% HMO PSN Switchers Medicaid Reform Enrollee Satisfaction Year Two Follow-Up Survey Volume 2: Plan Type Estimates 22

26 Question: In the last 6 months, how often did you have a hard time speaking with or understanding a doctor or other health providers because you spoke different languages? Language barriers have been found to negatively impact quality of care and this is particularly salient in the state of Florida. There were no statistically significant differences across health plans in reports of language difficulties. Overall, less than 1 of enrollees reported always having a problem understanding a doctor because of language difficulties. Table 17: Difficult Communication Due to Language, Benchmark Year Year 1 Year 2 Broward & Duval Counties HMO PSN MediPass FFS HMO PSN HMO PSN Switchers Sample Size , Never 77.8% 74.6% 71.8% 80.8% 73.9% 71.8% 71.7% 77.1% 70.4% Sometimes 14.9% 14.9% % 14.6% % 11.8% 16.5% Usually 1.5% 4.2% 1.5% 1.8% 3.6% 2.7% 2.9% 3.2% 3.7% Always 5.8% 6.3% 8.6% 7.2% 7.9% 9.5% 10.2% 7.9% 9.4% p =.4536 p =.4952 p =.5520 This question was included in both the adult and child questionnaires in the Benchmark Year and only included in the adult questionnaire in Year 1 and Year 2. For consistency and comparison in reporting, data from those who responded on behalf of children were excluded from the Benchmark Year. In Year 2, over 7 of enrollees indicated that they never had difficulty communicating with their providers due to language barriers, regardless of plan type. Figure 21: Difficult Communication Due to Language, Never Sometimes Usually Always 72% 77% % 17% 1 12% 8% 9% 3% 3% 4% HMO PSN Switchers 23 Medicaid Reform Enrollee Satisfaction Year Two Follow-Up Survey Volume 2: Plan Type Estimates

27 Helpfulness of Office Staff Question: In the last 6 months, how often did office staff at a doctor s office or clinic treat you (and your child) with courtesy and respect? Medicaid enrollees perception of their doctor s office respectfulness was high for the duration of the study period. There was a statistically significant difference in enrollees experiences in the Benchmark Year, with a greater percentage of MediPass enrollees reporting always being treated with courtesy and respect compared to FFS, PSN, and HMO enrollees. Table 18: Office Staff Courteous and Respectful, Benchmark Year Year 1 Year 2 Broward & Duval Counties HMO PSN MediPass FFS HMO PSN HMO PSN Switchers Sample Size 1,752 1, ,975 1,962 2,170 1, Never % 2.4% 1.2% 2.5% 2.5% 2.7% 2.5% 2.9% Sometimes 8.9% 5.9% 5.3% 7.2% 8.1% 7.2% 6.9% 7.1% 6.9% Usually 8.8% 10.5% 8.1% 10.4% 8.5% 8.1% 6.7% 6.8% 9.3% Always 79.2% 80.4% 84.2% 81.2% 80.9% 82.3% 83.7% 83.6% 80.9% p =.0054 p =.7907 p =.5715 Figure 22: Office Staff Courteous and Respectful, Never Sometimes Usually Always In Year 2, between 81% 84% of enrollees believed their doctor s office staff always treated them with courtesy and respect. 84% 84% 81% 4 7% 7% 7% 7% 7% 3% 2% 3% HMO PSN Switchers 9% Medicaid Reform Enrollee Satisfaction Year Two Follow-Up Survey Volume 2: Plan Type Estimates 24

28 Question: In the last 6 months, how often was office staff at a (your child s) doctor s office or clinic as helpful as you thought they should be? There were no statistically significant differences for enrollees across health plans in each year of the pilot regarding how helpful the office staff was to them. Overall, over 7 of enrollees said their doctor s office staff was always helpful. Table 19: Office Staff Helpful, Benchmark Year Year 1 Year 2 Broward & Duval Counties HMO PSN MediPass FFS HMO PSN HMO PSN Switchers Sample Size 1,754 1, ,970 1,965 2,168 1, Never 3.9% 3.2% % 3.1% 2.6% 2.8% 3.1% 2.9% Sometimes 12.4% 12.3% 10.5% 14.2% % 12.4% 10.2% 13.5% Usually 13.9% 14.5% 14.5% 13.1% 13.4% 12.9% 11.1% 10.6% 12.1% Always 69.8% % 71.5% 71.5% 73.7% 76.1% 71.5% p =.1271 p =.7962 p =.2874 In Year 2, at least 72% of enrollees said their doctor s office staff was always helpful to them. Figure 23: Office Staff Helpful, Never Sometimes Usually Always 74% 76% 71% 4 12% 11% 14% 1 11% 12% 3% 3% 3% HMO PSN Switchers 25 Medicaid Reform Enrollee Satisfaction Year Two Follow-Up Survey Volume 2: Plan Type Estimates

29 Rural Counties The demonstration pilot was expanded to the rural counties on July 1, 2007; one year after it was first implemented in Broward and Duval counties. This section presents a series of tables and figures showing the distribution of survey results for each of the following select survey composites, ratings, and individual question items for Baker, Clay, and Nassau counties combined (often referred to as rural counties ): Medicaid enrollee satisfaction ratings o Health care o Health plan o Personal doctor o Specialist Primary care Getting needed care Emergency room care Getting care quickly Communicating with providers Helpfulness of office staff This analysis reflects enrollees experiences and levels of satisfaction during the first half of the demonstration pilot in the rural counties. Each table provides results for the rural demonstration counties of Baker, Clay, and Nassau combined and is followed by a figure highlighting key findings. The unweighted sample sizes and the weighted percentages are shown in each table. The tests of statistical significance were calculated based on the weighted data. Note that the percentages in the table columns may not add up to 100 and, in some instances, the percentages presented in the figures may be slightly different from those in the corresponding table due to rounding. Medicaid Reform Enrollee Satisfaction Year Two Follow-Up Survey Volume 2: Plan Type Estimates 26

30 Medicaid Enrollee Satisfaction Ratings Question: Using any number from 0 10, where 0 is the worst and 10 is the best health care possible, what number would you use to rate all your health care in the last 6 months? This measure provides an overall satisfaction rating of the health care received by all types of health care providers by Medicaid Reform enrollees in Baker, Clay, and Nassau counties at the time of the survey. Overall, the majority of respondents in the rural counties rated their health care at the highest level (9 10) for the Benchmark Year and Year 1 except for Switchers in Year 1. Differences in health care ratings among plan types were statistically significant within Year 1 only with PSN enrollees most likely to provide the highest satisfaction rating. Table 20: Health Care Satisfaction Rating (0 10), In Year 1, nearly half of enrollees in all plan types (at least 48%) rated the health care they received at the highest level (9 10). Benchmark Year Year 1 Rural Counties HMO PSN MediPass HMO PSN Switchers Sample Size Level 1 (0 6) 16.3% 14.1% 13.3% 16.9% 9.5% 14.1% Level 2 (7 8) 24.8% 23.2% 31.1% 28.7% 26.8% 37.5% Level 3 (9 10) 58.9% 62.7% 55.6% 54.4% 63.7% 48.4% p =.3622 p =.0411 Figure 24: Health Care Satisfaction Rating (0 10), Level 1 (0 6) Level 2 (7 8) Level 3 (9 10) 64% 54% 48% 4 29% 27% 38% 17% 1 14% HMO* PSN* Switchers* * p < Medicaid Reform Enrollee Satisfaction Year Two Follow-Up Survey Volume 2: Plan Type Estimates

31 Question: Using any number from 0 10, where 0 is the worst and 10 is the best health plan possible, what number would you use to rate your (your child s) health plan? For the health plan ratings in the rural counties, neither the differences within the Benchmark Year nor the Year 1 responses were statistically significant. Overall, approximately 45% 57% of respondents in the rural counties rated their health plan at the highest level (9 10). Table 21: Health Plan Satisfaction Rating (0 10), Benchmark Year Year 1 Rural Counties HMO PSN MediPass HMO PSN Switchers Sample Size Level 1 (0 6) % 25.4% 16.1% 20.3% Level 2 (7 8) 27.3% 32.5% 29.5% 29.2% 27.3% 31.4% Level 3 (9 10) 49.8% 50.5% % 56.6% 48.3% p =.5705 p =.0833 Figure 25: Health Plan Satisfaction Rating (0 10), Level 1 (0 6) Level 2 (7 8) Level 3 (9 10) In Year 1, between 45% 57% of respondents in the rural counties rated their health plan at the highest level (9 10). 45% 57% 48% 4 25% 29% 27% 16% 31% HMO PSN Switchers Medicaid Reform Enrollee Satisfaction Year Two Follow-Up Survey Volume 2: Plan Type Estimates 28

32 Question: Using any number from 0 10, where 0 is the worst and 10 is the best personal doctor possible, what number would you use to rate your (your child s) personal doctor? This measure provides an overall satisfaction rating of Medicaid Reform enrollees personal doctor or primary care provider in Baker, Clay, and Nassau counties at the time of the survey. Differences in the personal doctor ratings for enrollees in the rural counties were not statistically significant within plan types for either the Benchmark Year or Year 1. Overall, more than 64% of enrollees rated their satisfaction with their personal doctor at the highest level (9 10). Table 22: Personal Doctor Satisfaction Rating (0 10), Benchmark Year Year 1 Rural Counties HMO PSN MediPass HMO PSN Switchers Sample Size Level 1 (0 6) 10.3% % 10.6% 8.9% 11.7% Level 2 (7 8) 20.1% 19.8% 22.8% 22.6% % Level 3 (9 10) 69.7% 72.2% 66.1% 66.8% 73.1% 64. p =.6496 p =.5095 In Year 1, at least 64% of enrollees in the rural counties rated their satisfaction with their personal doctor at the highest level (9 10). Figure 26: Personal Doctor Satisfaction Rating (0 10), Level 1 (0 6) Level 2 (7 8) Level 3 (9 10) 67% 73% 64% 4 23% 11% 9% 18% 12% 24% HMO PSN Switchers 29 Medicaid Reform Enrollee Satisfaction Year Two Follow-Up Survey Volume 2: Plan Type Estimates