Low Income Health Program Performance Dashboard San Diego

Low Income Health Program Performance Dashboard San Diego July 1, 2011 - 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) 7/1/2011-12/31/2013 LIHP Performance Dashboard - San Diego 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 San Diego, for the time period July 1, 2011 December 31, 2013. 7/1/2011-12/31/2013 LIHP Performance Dashboard - San Diego 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. 7/1/2011-12/31/2013 LIHP Performance Dashboard - San Diego 4

Program Facts: San Diego Implementation Date: July 1, 2011 Current Income Limit: 133% FPL Legacy County Participated in the prior waiver as an HCCI county; transitioned to LIHP under the current waiver Enrollees from previous HCCI program may be grandfathered into both the MCE and HCCI components of the new program Suburban/Urban County in Southern California Payor County The county does not own or operate facilities in the provider network Total Population: 3,084,000 Source: 2009 California Health Interview Survey Visit: DHCS Contract Documentation Page 7/1/2011-12/31/2013 LIHP Performance Dashboard - San Diego 5

ENROLLMENT AND DEMOGRAPHICS

Total Unduplicated Monthly Enrollment, Program-to-Date 13,033 14,714 15,974 17,960 19,465 20,990 22,948 24,719 26,542 28,375 30,157 29,781 30,195 31,163 31,894 32,672 33,287 33,873 34,820 35,663 36,519 37,526 38,355 38,919 39,721 40,430 41,111 42,242 44,103 45,005 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: 932,156 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. 7/1/2011-12/31/2013 LIHP Performance Dashboard - San Diego 7

Trend of Monthly Enrollment and Disenrollment 50,000 45,000 40,000 35,000 30,000 25,000 20,000 15,000 10,000 5,000 0 Existing Enrollees Newly Enrolled Disenrolled Aug'11 Sep'11 Oct'11 Nov'11 Dec'11 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 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. 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. 7/1/2011-12/31/2013 LIHP Performance Dashboard - San Diego 8

Trend of Monthly Enrollment in Each Program Component, Program-to-Date 50,000 45,000 40,000 35,000 30,000 25,000 20,000 15,000 10,000 5,000 0 MCE New MCE Existing HCCI New HCCI Existing Definitions: Enrollees are classified into aid codes according to guidelines set forth in the Special Terms and Conditions. Aid codes are based on two criteria: Income: MCE: 0 to 133% FPL HCCI: above 133.01 to 200% FPL Type: Existing: enrollees whose enrollment has been effective since November 1, 2010. New: enrollees whose enrollment was not effective on November 1, 2010. This includes enrollees who were enrolled during the transition period from December 1, 2010 through June 30, 2011 when legacy counties with prior HCCI programs transitioned from HCCI to LIHP. Note: Enrollees may transition between aid codes depending on changes in income level or enrollee type. 7/1/2011-12/31/2013 LIHP Performance Dashboard - San Diego 9

Total Cumulative Number of Enrollees in Each Program Component, Program-to-Date 70,626 This chart displays the cumulative number of individuals ever enrolled to date, by aid code. A single enrollee may be counted more than once if the individual has transitioned from one aid code to another at any time. 2,032 398 248 MCE New MCE Existing HCCI New HCCI Existing Total Cumulative Unduplicated Enrollees: 72,869 7/1/2011-12/31/2013 LIHP Performance Dashboard - San Diego 10

Demographic Characteristics of Cumulative Unduplicated Enrollees Age and Gender 24.4% 36.8% 55 + 30% 14.5% 15.5% 50-54 15% 11.2% 9.8% 45-49 11% 8.9% 6.4% 40-44 8% 7.9% 4.7% 35-39 6% 10.7% 6.5% 30-34 9% 12.5% 9.9% 25-29 11% 9.9% 10.4% <=24 10% Male: (53.7%) Female: (46.3%) Total Cumulative Unduplicated Enrollees: 72,869 Overall Age Distribution 7/1/2011-12/31/2013 LIHP Performance Dashboard - San Diego 11

Demographic Characteristics of Cumulative Unduplicated Enrollees FPL 43.9% This exhibit displays the percent of enrollees by Federal Poverty Levels (FPLs). 23.0% 9.7% 10.5% 12.2% Current San Diego FPL Limit = 133% LIHPs may have enrollees with FPL higher than the current FPL limit due to HCCI enrollees grandfathered into the program from the previous demonstration. 0.7% 0-25% 25.1-50% 50.1-75% 75.1-100% 100.1-133% 133.1-200% Total Cumulative Unduplicated Enrollees: 72,869 Note: All enrollees meet program eligibility rules, regardless of cases where data are unavailable. 7/1/2011-12/31/2013 LIHP Performance Dashboard - San Diego 12

Demographic Characteristics of Cumulative Unduplicated Enrollees Race/Ethnicity 43.5% 28.8% 13.4% 13.4% 1.0% White African American Latino Asian/PI Other Total Cumulative Unduplicated Enrollees: 72,869 Note: Asian includes Native Hawaiian. Other includes American Indian or Alaska Native. 7/1/2011-12/31/2013 LIHP Performance Dashboard - San Diego 13

Chronic Conditions Prevalence of Diabetes, Asthma/Chronic Obstructive Pulmonary Disease (COPD), Coronary Artery Disease (CAD)/ Congestive Heart Failure (CHF), Dyslipidemia, or Hypertension among Enrollees 28.7% 20.9% 15.7% 8.4% 5.9% Diabetes Asthma/COPD CAD/CHF Dyslipidemia Hypertension Total Cumulative Unduplicated Enrollees: 72,869 7/1/2011-12/31/2013 LIHP Performance Dashboard - San Diego 14

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. 7/1/2011-12/31/2013 LIHP Performance Dashboard - San Diego 16

Proportion of Enrollees Who Were Active Users of Health Services, by Service Type July 1, 2011 - September 30, 2013 80 70 60 50 40 30 20 10 0 72.7% 53.3% Any Service Emergency Room (ER) Inpatient (IP) Evaluation and Management (E&M) 67.7% 66.7% 50.7% 49.5% 63.6% 65.1% 46.1% 46.1% 63.4% 63.3% 63.9% 63.2% 45.0% 46.2% 46.0% 45.7% 12.7% 11.6% 12.6% 12.7% 13.8% 12.9% 13.2% 12.8% 12.9% 8.1% 6.8% 6.4% 5.9% 5.7% 5.4% 5.4% 5.3% 5.2% Quarter 1 Quarter 2 Quarter 3 Quarter 4 Quarter 5 Quarter 6 Quarter 7 Quarter 8 Quarter 9 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: 16,941 Quarter 2: 22,133 Quarter 3: 27,261 Quarter 4: 32,665 Quarter 5: 34,355 Quarter 6: 36,755 Quarter 7: 39,669 Quarter 8: 42,445 Quarter 9: 44,833 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. 7/1/2011-12/31/2013 LIHP Performance Dashboard - San Diego 17

Volume of Utilization Emergency Room Visits, Inpatient Admissions and Evaluation & Management Visits July 1, 2011 - September 30, 2013 100000 90000 80000 70000 60000 50000 40000 30000 20000 10000 0 21,264 Emergency Room (ER) Inpatient (IP) Evaluation and Management (E&M) 26,286 32,630 34,886 72,572 74,090 3,056 3,643 4,851 6,064 7,038 7,053 7,608 7,912 8,625 1,630 1,758 2,067 2,254 2,326 2,329 2,505 2,682 2,775 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. As enrollment increases, total volumes of utilization are expected to grow. Total Enrolled Quarter 1: 16,941 Quarter 2: 22,133 Quarter 3: 27,261 Quarter 4: 32,665 Quarter 5: 34,355 Quarter 6: 36,755 Quarter 7: 39,669 Quarter 8: 42,445 Quarter 9: 44,833 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. 7/1/2011-12/31/2013 LIHP Performance Dashboard - San Diego 18 85,973 72,422 90,868 Quarter 1 Quarter 2 Quarter 3 Quarter 4 Quarter 5 Quarter 6 Quarter 7 Quarter 8 Quarter 9

Rate of Utilization per 1,000 Enrollees Inpatient Admissions, Emergency Room and Evaluation & Management Visits July 1, 2011 - September 30, 2013 3000 2500 2000 Emergency Room (ER) Inpatient (IP) Evaluation and Management (E&M) 2,410 2,335 2,226 2,248 1,893 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. 1500 1,459 1,350 1,319 1,185 1000 500 0 210 187 196 206 226 212 213 207 213 112 90 84 77 75 70 70 70 69 Quarter 1 Quarter 2 Quarter 3 Quarter 4 Quarter 5 Quarter 6 Quarter 7 Quarter 8 Quarter 9 Total Member Months Quarter 1: 43,721 Quarter 2: 58,415 Quarter 3: 74,209 Quarter 4: 88,313 Quarter 5: 93,252 Quarter 6: 99,832 Quarter 7: 107,002 Quarter 8: 114,800 Quarter 9: 121,262 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. 7/1/2011-12/31/2013 LIHP Performance Dashboard - San Diego 19

Rate of Utilization per 1,000 Active Enrollees Inpatient Admissions, Emergency Room and Evaluation & Management Visits July 1, 2011 - September 30, 2013 3000 2500 2000 1500 1,612 Emergency Room (ER) Inpatient (IP) Evaluation and Management (E&M) 2,744 2,722 2,624 2,509 2,191 1,498 1,478 1,331 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. 1000 500 0 232 208 220 231 254 239 243 239 258 124 100 94 86 84 79 80 81 83 Quarter 1 Quarter 2 Quarter 3 Quarter 4 Quarter 5 Quarter 6 Quarter 7 Quarter 8 Quarter 9 Active User Member Months Quarter 1: 39,575 Quarter 2: 52,633 Quarter 3: 66,227 Quarter 4: 78,640 Quarter 5: 82,982 Quarter 6: 88,573 Quarter 7: 93,989 Quarter 8: 99,179 Quarter 9: 100,150 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. 7/1/2011-12/31/2013 LIHP Performance Dashboard - San Diego 20

Average Length of Inpatient Stay July 1, 2011 - September 30, 2013 10 9 8 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. 7 6 5 5.1 5.5 5.0 5.0 5.1 5.3 5.3 4.9 4 3 2 1 0 2.8 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: 4,573 Quarter 2: 9,005 Quarter 3: 11,416 Quarter 4: 11,253 Quarter 5: 11,672 Quarter 6: 11,982 Quarter 7: 13,195 Quarter 8: 14,211 Quarter 9: 13,647 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. 7/1/2011-12/31/2013 LIHP Performance Dashboard - San Diego 21

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