Low Income Health Program Performance Dashboard Riverside January 1, 2012 - December 31, 2013
About the Low Income Health Program The Low Income Health Program (LIHP), authorized under the 2010 Bridge to Reform 1115 Medicaid Waiver, is an optional program implemented by counties or other governmental entities, offering health care coverage to low income uninsured adults. LIHP includes two components distinguished by family income level: Medicaid Coverage Expansion (MCE) for non-elderly adults with family incomes at or below 133% of the Federal Poverty Level (FPL), and Health Care Coverage Initiative (HCCI) for non-elderly adults with family incomes from 133.01 through 200% FPL. Local LIHPs can set the income levels below the maximum allowable amount, but must operate an MCE in order to implement a new HCCI. Standard program eligibility criteria are established by the waiver Special Terms and Conditions: Resident of participating county Adult, age 19 through 64 Not eligible for Medicaid or CHIP Not pregnant US Citizen, or Legal Permanent Resident with at least 5 years in the US Income at or below 200% of the FPL (or less based on county eligibility standards) 1/1/2012-12/31/2013 LIHP Performance Dashboard - Riverside 2
About the Evaluation The UCLA Center for Health Policy Research is contracted to conduct an independent evaluation of the Low Income Health Program, as required by the Special Terms and Conditions. A primary goal of the evaluation is to provide timely feedback of evaluation findings to LIHPs and other stakeholders. The LIHP Performance Dashboard reports are produced on a quarterly basis and contain standard metrics describing program performance in enrollment and health care services. This dashboard is specific to Riverside, for the time period January 1, 2012 December 31, 2013. 1/1/2012-12/31/2013 LIHP Performance Dashboard - Riverside 3
Methods Enrollment and demographic data are used to describe the population enrolled in the program. Enrollment metrics are based on individual enrollment history records for each LIHP enrollee. Findings presented in this dashboard report are based on data submitted to UCLA as of December 31, 2013. There is a one quarter delay in reporting utilization metrics to allow sufficient time for claims processing. Future dashboard reports will include updated data on enrollment, demographics, and utilization, and will be revised to reflect retroactive changes to enrollment and utilization. All analyses contained in this report are dependent on the quality, completeness, and timeliness of data provided by LIHPs. They represent analysis conducted by the UCLA Center for Health Policy Research on the data provided by LIHPs for the purposes of the LIHP evaluation. Detailed methods are available upon request. 1/1/2012-12/31/2013 LIHP Performance Dashboard - Riverside 4
Program Facts: Riverside Implementation Date: January 1, 2012 Current Income Limit: 133% FPL New LIHP Did not participate in the Health Care Coverage Initiative, the previous waiver demonstration Suburban/Urban County in Southern California Hybrid Payor/Provider County Network includes both public and private contract providers Total Population: 2,062,000 Source: 2009 California Health Interview Survey Visit: DHCS Contract Documentation Page 1/1/2012-12/31/2013 LIHP Performance Dashboard - Riverside 5
ENROLLMENT AND DEMOGRAPHICS
Total Unduplicated Monthly Enrollment, Program-to-Date 7,996 15,277 16,331 17,489 18,696 20,465 21,854 23,042 24,117 25,248 26,088 26,732 Jan'12 Feb'12 Mar'12 Apr'12 May'12 Jun'12 Jul'12 Aug'12 Sep'12 Oct'12 Nov'12 Dec'12 Jan'13 Feb'13 Mar'13 Apr'13 May'13 Jun'13 Jul'13 Aug'13 Sep'13 Oct'13 Nov'13 Dec'13 27,251 25,186 23,192 25,230 25,947 This chart displays the number of individuals enrolled during each month of the program. This can also be interpreted as the number of member months. Total Member Months to Date: 585,089 The monthly number of enrollees is dependent on both enrollment and disenrollment. Program strategies for outreach, enrollment, and retention/redetermination, as well as the demand for care within the eligible population and other factors may influence enrollment trends. Note: Eligibility processing time is continuous, therefore enrollment data for latter months may be retroactively adjusted in the following quarter s dashboards as new data becomes available. 1/1/2012-12/31/2013 LIHP Performance Dashboard - Riverside 7 27,592 28,843 29,193 30,697 31,538 32,968 34,117
Trend of Monthly Enrollment and Disenrollment 35,000 30,000 25,000 Existing Enrollees Newly Enrolled Disenrolled Existing Enrollees are individuals enrolled in their local LIHP during the month prior to the specified month. New Enrollees are individuals newly enrolled in LIHP during the specified month. 20,000 15,000 10,000 5,000 0 Feb'12 Mar'12 Apr'12 May'12 Jun'12 Jul'12 Aug'12 Sep'12 Oct'12 Nov'12 Dec'12 Jan'13 Feb'13 Mar'13 Apr'13 May'13 Jun'13 Jul'13 Aug'13 Sep'13 Oct'13 Nov'13 Dec'13 Disenrolled are individuals that are no longer enrolled in the program during the month prior to the specified month. The sum of Existing Enrollees and New Enrollees is the total unduplicated monthly enrollment. Note: Eligibility processing time is continuous, therefore enrollment data for latter months may be retroactively adjusted in the following quarter s dashboards as new data becomes available. 1/1/2012-12/31/2013 LIHP Performance Dashboard - Riverside 8
Demographic Characteristics of Cumulative Unduplicated Enrollees Age and Gender 27.2% 38.6% 55 + 33% 15.1% 16.9% 50-54 16% 11.6% 10.1% 45-49 11% 8.3% 6.4% 40-44 7% 7.7% 4.2% 35-39 6% 9.4% 5.8% 30-34 8% 11.7% 9.3% 25-29 10% 9.0% 8.8% <=24 9% Male: (50.7%) Female: (49.3%) Total Cumulative Unduplicated Enrollees: 47,614 Overall Age Distribution 1/1/2012-12/31/2013 LIHP Performance Dashboard - Riverside 9
Demographic Characteristics of Cumulative Unduplicated Enrollees FPL 75.5% This exhibit displays the percent of enrollees by Federal Poverty Levels (FPLs). Current Riverside FPL Limit = 133% 3.9% 6.0% 6.1% 8.1% LIHPs may have enrollees with FPL higher than the current FPL limit due to HCCI enrollees grandfathered into the program from the previous demonstration. 0-25% 25.1-50% 50.1-75% 75.1-100% 100.1-133% 133.1-200% Total Cumulative Unduplicated Enrollees: 47,614 Note: All enrollees meet program eligibility rules, regardless of cases where data are unavailable. 1/1/2012-12/31/2013 LIHP Performance Dashboard - Riverside 10
Demographic Characteristics of Cumulative Unduplicated Enrollees Race/Ethnicity 32.5% 28.5% 27.5% 6.9% 2.2% 2.4% White African American Latino Asian/PI Other Unavailable Total Cumulative Unduplicated Enrollees: 47,614 Note: Asian includes Native Hawaiian. Other includes American Indian or Alaska Native. 1/1/2012-12/31/2013 LIHP Performance Dashboard - Riverside 11
Demographic Characteristics of Cumulative Unduplicated Enrollees Preferred Language 83.4% 16.2% English Spanish Asian/PI Languages Other Total Cumulative Unduplicated Enrollees: 47,614 Note: Classification of Languages follows the US Census guidelines. 1/1/2012-12/31/2013 LIHP Performance Dashboard - Riverside 12 0.2%
Chronic Conditions Prevalence of Diabetes, Asthma/Chronic Obstructive Pulmonary Disease (COPD), Coronary Artery Disease (CAD)/ Congestive Heart Failure (CHF), Dyslipidemia, or Hypertension among Enrollees 28.8% 16.0% 17.7% 6.4% 3.8% Diabetes Asthma/COPD CAD/CHF Dyslipidemia Hypertension Total Cumulative Unduplicated Enrollees: 47,614 1/1/2012-12/31/2013 LIHP Performance Dashboard - Riverside 13
UTILIZATION OF HEALTH SERVICES
Utilization Methods and Time Frame of Analyses UCLA utilization analyses are based on claims or encounter data provided to UCLA. Utilization metrics describe the volume of health care services paid for by LIHP and the rate of health care utilization among active and all enrollees. An active user is defined as an enrollee with at least one claim/encounter record in a given quarter. To control for variation in claims data availability and completeness, the number of active users is used as the denominator for rate calculations. Rates represent the frequency of use among users, excluding enrollees without health care service use. Emergency room and inpatient records that occur on the same or consecutive days are counted as one visit. Outpatient evaluation and management (E&M) visits include claims with the following CPT codes: 99201-99205, 99211-99215, 99241-99245, 99271-99275, 99381-99387, 99391-99397. Any outpatient E&M claims that occurred on the same day, with the same provider, are counted as one service/visit. There is a one-quarter delay in reporting utilization metrics to allow sufficient time for claims processing. The timeline below illustrates the time frame for the utilization analyses. 1/1/2012-12/31/2013 LIHP Performance Dashboard - Riverside 15
Proportion of Enrollees Who Were Active Users of Health Services, by Service Type January 1, 2012 - September 30, 2013 60 50 40 30 20 10 0 Any Service Emergency Room (ER) Inpatient (IP) Evaluation and Management (E&M) 46.1% 21.1% 11.7% 49.7% 34.6% 12.7% 54.4% 36.2% 17.7% 52.6% 34.9% 16.2% During each time period, a proportion of the enrollees who are beneficiaries of the program will use health services. This proportion, called active users, varies by time period, service type, and other factors. Non-user enrollees are enrolled, but did not access care paid for by LIHP. The proportion of enrollees who are active users is an important indicator of the demand for care and access to care. However, it may not fully represent utilization by enrollees. There may be unknown gaps in data completeness. Total Enrolled Quarter 1: Not Yet Implemented Quarter 2: Not Yet Implemented Quarter 3: 16,699 Quarter 4: 20,492 Quarter 5: 24,400 Quarter 6: 26,944 Quarter 7: 30,576 Quarter 8: 28,829 Quarter 9: 32,327 Note: There is a one quarter delay in reporting utilization metrics to allow sufficient time for claims processing. Additionally, claims data for latter quarters may be retroactively adjusted in the following quarter s dashboards as new data becomes available. Out-of-network ER benefits are a new benefit covered under LIHP and are included in ER utilization, which may result in ER use increases across quarters. 46.5% 22.5% 1/1/2012-12/31/2013 LIHP Performance Dashboard - Riverside 16 53.0% 25.9% 13.8% 14.3% 3.8% 4.3% 4.0% 3.9% 3.4% 4.0% 50.3% 24.6% 13.1% Quarter 1 Quarter 2 Quarter 3 Quarter 4 Quarter 5 Quarter 6 Quarter 7 Quarter 8 Quarter 9 2.9%
Volume of Utilization Emergency Room Visits, Inpatient Admissions and Evaluation & Management Visits January 1, 2012 - September 30, 2013 18000 16000 14000 12000 10000 Emergency Room (ER) Inpatient (IP) Evaluation and Management (E&M) 15,655 15,683 12,936 12,537 12,063 11,047 The total volumes of emergency room (ER), inpatient (IP) admissions, and outpatient evaluation and management (EM) visits represent the total number of services paid for by LIHP. These measures are valuable as assessments of total activity and proxy for expenditures. Total volumes of services and admissions are influenced by the number of enrollees and their characteristics and health seeking behaviors. 8000 6000 4000 2000 0 5,528 2,641 728 3,726 6,414 6,317 5,988 6,026 6,139 1,025 1,119 1,236 1,200 1,354 1,105 Quarter 1 Quarter 2 Quarter 3 Quarter 4 Quarter 5 Quarter 6 Quarter 7 Quarter 8 Quarter 9 As enrollment increases, total volumes of utilization are expected to grow. Total Enrolled Quarter 1: Not Yet Implemented Quarter 2: Not Yet Implemented Quarter 3: 16,699 Quarter 4: 20,492 Quarter 5: 24,400 Quarter 6: 26,944 Quarter 7: 30,576 Quarter 8: 28,829 Quarter 9: 32,327 Note: There is a one quarter delay in reporting utilization metrics to allow sufficient time for claims processing. Additionally, claims data for latter quarters may be retroactively adjusted in the following quarter s dashboards as new data becomes available. Out-of-network ER benefits are a new benefit covered under LIHP and are included in ER utilization, which may result in ER use increases across quarters. 1/1/2012-12/31/2013 LIHP Performance Dashboard - Riverside 17
Rate of Utilization per 1,000 Enrollees Inpatient Admissions, Emergency Room and Evaluation & Management Visits January 1, 2012 - September 30, 2013 800 700 600 500 400 Emergency Room (ER) Inpatient (IP) Evaluation and Management (E&M) 685 681 603 459 438 419 424 The rates of emergency room (ER), inpatient (IP), and outpatient evaluation and management (EM) utilization per 1,000 enrollees per quarter represent standardized measures of utilization. Rates are adjusted for the level of enrollment in each quarter. Initial increases in rates of utilization may be due to pent-up demand. 300 200 100 0 200 197 279 243 238 230 55 54 49 47 48 52 Quarter 1 Quarter 2 Quarter 3 Quarter 4 Quarter 5 Quarter 6 Quarter 7 Quarter 8 Quarter 9 Total Member Months Quarter 1: Not Yet Implemented Quarter 2: Not Yet Implemented Quarter 3: 39,604 Quarter 4: 56,650 Quarter 5: 69,013 Quarter 6: 78,068 Quarter 7: 75,629 Quarter 8: 78,769 Quarter 9: 88,733 Note: There is a one quarter delay in reporting utilization metrics to allow sufficient time for claims processing. Additionally, claims data for latter quarters may be retroactively adjusted in the following quarter s dashboards as new data becomes available. Out-of-network ER benefits are a new benefit covered under LIHP and are included in ER utilization, which may result in ER use increases across quarters. 1/1/2012-12/31/2013 LIHP Performance Dashboard - Riverside 18 208 37
Rate of Utilization per 1,000 Active Enrollees Inpatient Admissions, Emergency Room and Evaluation & Management Visits January 1, 2012 - September 30, 2013 1000 900 800 700 600 500 Emergency Room (ER) Inpatient (IP) Evaluation and Management (E&M) 870 849 739 538 538 520 537 The rates of emergency room (ER), inpatient (IP) and outpatient evaluation and management (EM) utilization per 1,000 active enrollees per quarter represent standardized measures of utilization. Rates are adjusted for the level of enrollment in each quarter amongst active users. Initial increases in rates of utilization may be due to pent-up demand. 400 300 200 100 0 257 251 348 298 282 269 263 71 69 61 58 56 60 47 Quarter 1 Quarter 2 Quarter 3 Quarter 4 Quarter 5 Quarter 6 Quarter 7 Quarter 8 Quarter 9 Active User Member Months Quarter 1: Not Yet Implemented Quarter 2: Not Yet Implemented Quarter 3: 30,807 Quarter 4: 44,601 Quarter 5: 55,325 Quarter 6: 63,650 Quarter 7: 63,728 Quarter 8: 67,281 Quarter 9: 70,005 Note: There is a one quarter delay in reporting utilization metrics to allow sufficient time for claims processing. Additionally, claims data for latter quarters may be retroactively adjusted in the following quarter s dashboards as new data becomes available. Out-of-network ER benefits are a new benefit covered under LIHP and are included in ER utilization, which may result in ER use increases across quarters. 1/1/2012-12/31/2013 LIHP Performance Dashboard - Riverside 19
Average Length of Inpatient Stay January 1, 2012 - September 30, 2013 10 9 8 7 7.2 The average number of inpatient (IP) days per admission, or average length of stay is the total number of IP days divided by the total number of IP visits, per quarter. 6 5 4.6 4.8 4.9 4.9 5.3 4.5 4 3 2 1 0 Quarter 1 Quarter 2 Quarter 3 Quarter 4 Quarter 5 Quarter 6 Quarter 7 Quarter 8 Quarter 9 Total Number of IP Days Quarter 1: Not Yet Implemented Quarter 2: Not Yet Implemented Quarter 3: 5,268 Quarter 4: 4,738 Quarter 5: 5,323 Quarter 6: 5,998 Quarter 7: 5,824 Quarter 8: 7,162 Quarter 9: 5,003 Note: There is a one quarter delay in reporting utilization metrics to allow sufficient time for claims processing. Additionally, claims data for latter quarters may be retroactively adjusted in the following quarter s dashboards as new data becomes available. 1/1/2012-12/31/2013 LIHP Performance Dashboard - Riverside 20
Data Source: The data sources for the LIHP Performance Dashboard are from quarterly enrollment, encounter and claims data. These data are provided to UCLA by the participating LIHPs as part of the Low Income Health Program Evaluation. Data Analysts: Xiao Chen, PhD Erin Salce, MPH Natasha Purington, MS Candidate UCLA Center for Health Policy Research Completed with the support of the California Medicaid Research Institute, University of California Funded by Blue Shield of California Foundation and the California Department of Health Care Services Low Income Health Program Performance Dashboards. Analysis by the UCLA Center for Health Policy Research, April 30, 2014. FOR MORE INFORMATION www.coverageinitiative.ucla.edu UCLA Center for Health Policy Research 10960 Wilshire Blvd. Suite 1550 Los Angeles, CA, 90024 www.healthpolicy.ucla.edu