Low Income Health Program Performance Dashboard Orange July 1, 2011 - September 30, 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) 7/1/2011-9/30/2013 LIHP Performance Dashboard - Orange 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 Orange, for the time period July 1, 2011 September 30, 2013. 7/1/2011-9/30/2013 LIHP Performance Dashboard - Orange 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 September 30, 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. 7/1/2011-9/30/2013 LIHP Performance Dashboard - Orange 4
Program Facts: Orange Implementation Date: July 1, 2011 Current Income Limit: 200% 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 7/1/2011-9/30/2013 LIHP Performance Dashboard - Orange 5
ENROLLMENT AND DEMOGRAPHICS
Jul'11 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 35,483 36,159 36,686 37,256 37,720 38,045 38,550 39,101 39,743 40,394 41,179 41,858 42,444 43,044 43,607 44,234 44,694 45,044 45,457 47,988 46,472 47,035 47,479 47,268 46,633 45,529 43,981 Total Unduplicated Monthly Enrollment, Program-to-Date 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: 1,143,083 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. 7/1/2011-9/30/2013 LIHP Performance Dashboard - Orange 7
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 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 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. 7/1/2011-9/30/2013 LIHP Performance Dashboard - Orange 8
Jul'11 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 Trend of Monthly Enrollment in Each Program Component, Program-to-Date 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. 7/1/2011-9/30/2013 LIHP Performance Dashboard - Orange 9
Total Cumulative Number of Enrollees in Each Program Component, Program-to-Date 39,305 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. 22,422 13,073 7,237 MCE New MCE Existing HCCI New HCCI Existing Total Cumulative Unduplicated Enrollees: 74,900 7/1/2011-9/30/2013 LIHP Performance Dashboard - Orange 10
Demographic Characteristics of Cumulative Unduplicated Enrollees Age and Gender 31.8% 44.7% 55 + 38% 13.5% 14.1% 50-54 14% 10.8% 8.7% 45-49 10% 7.8% 5.8% 40-44 7% 6.7% 4.1% 35-39 5% 8.2% 5.6% 30-34 7% 12.2% 9.2% 25-29 11% 8.9% 7.8% <=24 8% Male: (48.8%) Female: (51.2%) Total Cumulative Unduplicated Enrollees: 74,900 Overall Age Distribution 7/1/2011-9/30/2013 LIHP Performance Dashboard - Orange 11
Demographic Characteristics of Cumulative Unduplicated Enrollees FPL 35.2% This exhibit displays the percent of enrollees by Federal Poverty Levels (FPLs). 22.1% Current Orange FPL Limit = 200% 9.8% 8.4% 9.3% 13.3% 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: 74,900 Note: All enrollees meet program eligibility rules, regardless of cases where data are unavailable. 7/1/2011-9/30/2013 LIHP Performance Dashboard - Orange 12
Demographic Characteristics of Cumulative Unduplicated Enrollees Race/Ethnicity 26.7% 26.0% 27.4% 13.5% 4.4% 2.1% White African American Latino Asian/PI Other Unavailable Total Cumulative Unduplicated Enrollees: 74,900 Note: Asian includes Native Hawaiian. Other includes American Indian or Alaska Native. 7/1/2011-9/30/2013 LIHP Performance Dashboard - Orange 13
Demographic Characteristics of Cumulative Unduplicated Enrollees Preferred Language 67.7% 13.9% 16.7% 1.7% English Spanish Asian/PI Languages Other Total Cumulative Unduplicated Enrollees: 74,900 Note: Classification of Languages follows the US Census guidelines. 7/1/2011-9/30/2013 LIHP Performance Dashboard - Orange 14
Chronic Conditions Prevalence of Diabetes, Asthma/Chronic Obstructive Pulmonary Disease (COPD), Coronary Artery Disease (CAD)/ Congestive Heart Failure (CHF), Dyslipidemia, or Hypertension among Enrollees 35.8% 33.3% 20.0% 8.4% 7.2% Diabetes Asthma/COPD CAD/CHF Dyslipidemia Hypertension Total Cumulative Unduplicated Enrollees: 74,900 7/1/2011-9/30/2013 LIHP Performance Dashboard - Orange 15
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. 7/1/2011-9/30/2013 LIHP Performance Dashboard - Orange 17
Proportion of Enrollees Who Were Active Users of Health Services, by Service Type July 1, 2011 - June 30, 2013 70 60 50 40 30 20 10 0 Any Service Emergency Room (ER) Inpatient (IP) Evaluation and Management (E&M) 61.6% 62.9% 63.5% 62.9% 60.8% 59.3% 59.0% 59.9% 50.7% 52.6% 53.6% 53.5% 50.7% 49.0% 48.5% 51.3% 12.5% 11.3% 11.9% 11.9% 12.4% 11.5% 11.4% 10.0% 5.2% 4.9% 5.0% 4.9% 4.8% 4.8% 4.8% 4.3% Quarter 1 Quarter 2 Quarter 3 Quarter 4 Quarter 5 Quarter 6 Quarter 7 Quarter 8 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: 39,017 Quarter 2: 40,554 Quarter 3: 42,399 Quarter 4: 44,207 Quarter 5: 46,112 Quarter 6: 47,493 Quarter 7: 49,295 Quarter 8: 50,121 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. 7/1/2011-9/30/2013 LIHP Performance Dashboard - Orange 18
Volume of Utilization Emergency Room Visits, Inpatient Admissions and Evaluation & Management Visits July 1, 2011 - June 30, 2013 70000 60000 50000 40000 30000 20000 10000 0 Emergency Room (ER) Inpatient (IP) Evaluation and Management (E&M) 63,344 59,549 61,336 56,348 50,126 49,262 44,112 44,649 6,871 6,600 7,129 7,641 8,198 7,777 7,909 7,088 2,479 2,393 2,558 2,562 2,712 2,769 2,921 2,697 Quarter 1 Quarter 2 Quarter 3 Quarter 4 Quarter 5 Quarter 6 Quarter 7 Quarter 8 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: 39,017 Quarter 2: 40,554 Quarter 3: 42,399 Quarter 4: 44,207 Quarter 5: 46,112 Quarter 6: 47,493 Quarter 7: 49,295 Quarter 8: 50,121 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. 7/1/2011-9/30/2013 LIHP Performance Dashboard - Orange 19
Rate of Utilization per 1,000 Enrollees Inpatient Admissions, Emergency Room and Evaluation & Management Visits July 1, 2011 - June 30, 2013 1600 1400 1200 1000 Emergency Room (ER) Inpatient (IP) Evaluation and Management (E&M) 1,281 1,309 1,333 1,358 1,298 1,222 1,185 1,197 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. 800 600 400 200 0 190 175 182 186 191 174 170 150 69 64 65 62 63 62 63 57 Quarter 1 Quarter 2 Quarter 3 Quarter 4 Quarter 5 Quarter 6 Quarter 7 Quarter 8 Total Member Months Quarter 1: 108,328 Quarter 2: 113,021 Quarter 3: 117,394 Quarter 4: 123,431 Quarter 5: 129,095 Quarter 6: 133,972 Quarter 7: 139,917 Quarter 8: 141,782 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. 7/1/2011-9/30/2013 LIHP Performance Dashboard - Orange 20
Rate of Utilization per 1,000 Active Enrollees Inpatient Admissions, Emergency Room and Evaluation & Management Visits July 1, 2011 - June 30, 2013 1600 1400 1200 1000 800 Emergency Room (ER) Inpatient (IP) Evaluation and Management (E&M) 1,461 1,453 1,423 1,380 1,387 1,415 1,314 1,272 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. 600 400 200 0 222 194 196 197 202 185 182 168 80 70 70 66 67 66 67 64 Quarter 1 Quarter 2 Quarter 3 Quarter 4 Quarter 5 Quarter 6 Quarter 7 Quarter 8 Active User Member Months Quarter 1: 93,020 Quarter 2: 101,907 Quarter 3: 109,007 Quarter 4: 116,142 Quarter 5: 121,908 Quarter 6: 126,243 Quarter 7: 130,108 Quarter 8: 126,636 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. 7/1/2011-9/30/2013 LIHP Performance Dashboard - Orange 21
Average Length of Inpatient Stay July 1, 2011 - June 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 5.0 5.0 5.1 4.7 4.9 4.8 4.8 4.3 4 3 2 1 0 Quarter 1 Quarter 2 Quarter 3 Quarter 4 Quarter 5 Quarter 6 Quarter 7 Quarter 8 Total Number of IP Days Quarter 1: 69 Quarter 2: 64 Quarter 3: 65 Quarter 4: 62 Quarter 5: 63 Quarter 6: 62 Quarter 7: 63 Quarter 8: 57 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. 7/1/2011-9/30/2013 LIHP Performance Dashboard - Orange 22
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, December 31, 2013. 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