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Empowering Patients & Consumers to Access and

Effectively Use High-Value Care

Marcia J. Nielsen, PhD, MPHExecutive Director

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High-Value health care

Gives individuals information to make informed health care decisions

Provides comprehensive, meaningful information to providers to improve patient care

Kansas Health Policy Authority (KHPA) consumers: Purchase $2.5 billion of health care Medicaid, S-CHIP, State Employee Health Plan Tasked with coordinating health and health care for

Kansas Acknowledge that different populations have different

health needs

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Health Needs of Disabled Individuals

Extremely High Health Care Costs Health care costs for disabled consumers are 4 to 7

times those of their non-disabled peers Health insurance an absolute necessity Inadequacies of private health insurance

Lack of Personal Assistance Services (PAS), mental health parity, access to specialists

High Unemployment Nationwide, 70% of people with disabilities

unemployed; In Kansas, 46.3%* Many disincentives for disabled

persons to work * Cornell University 2006 Disability Status Report

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Empowering Kansans with Disabilities & Chronic Illness

Federal programs that work in Kansas

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Ticket to Work:Federal Initiative to Promote Employment:

Employment Services:TW-WIIA provides voucher

system for obtaining employment services (the “Ticket”)

Health Insurance: States allowed to develop Medicaid Buy-In program for individuals with disabilities and chronic illness who earn too much for traditional Medicaid

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Working Healthy Medicaid Buy-In for Disabled Kansas Workers

Provides health insurance benefits Full Medicaid coverage; personal and other services for those who

need them Medicare Part B coverage paid by Medicaid Health insurance premiums paid by individual workers

Provides greater financial security Targeted to those under 300% FPL (about $30,000 for a single

person); no premiums for those under 100% FPL Allows individuals to keep cash assets up to $15,000 Retirement accounts (no limit); Individual Development Accounts (no limit) Benefits planning Elimination of “spend-down”

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Working Healthy Progress

0

200

400

600

800

1000

1200

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J une03

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No Premium

Premium

1,040

Source: Mary Ellen Wright; Senior Manager, Working Healthy; Jean Hall, PhD, Program Evaluator, KU

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Hall, Jean; PhD; Principal Investigator; University of Kansas Center for Research on Learning Division of Adult Studies

9Hall, Jean; PhD; Principal Investigator; University of Kansas Center for Research on Learning Division of Adult Studies

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Hall, Jean; PhD; Principal Investigator; University of Kansas Center for Research on Learning Division of Adult Studies

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Hall, Jean; PhD; Principal Investigator; University of Kansas Center for Research on Learning Division of Adult Studies

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Hall, Jean; PhD; Principal Investigator; University of Kansas Center for Research on Learning Division of Adult Studies

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All expenses were adjusted using the Consumer Price Index for medical care. Each year was adjusted forward to meet 2007 prices.

Hall, Jean; PhD; Principal Investigator; University of Kansas Center for Research on Learning Division of Adult Studies

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Working Healthy is Working in Kansas Successful Employment

90.2% of original Working Healthy group is currently employed, compared to 40% of a comparison group

77% have worked at their current job for more than a year

75.5% are satisfied or very satisfied with their current employment

Appropriate Health Care Services 86.1% report they are able to get the medical services

they need Improved Quality of Life

More than half of individuals enrolled report improvements in mental health, financial status, level of independence

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Role of the Benefits Specialists Benefits Specialists:

Collect data on individual’s current benefits status Provide critical analysis of work, earning, and

resources in these benefits Provide options to individual (and support network if

appropriate) about impact of employment or increased employment on benefits

Work with staff to establish medical coverage and other benefits.

Compare and contrast Working Healthy with other available programs

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Demonstration to Maintain Independence & Employment (DMIE)

DMIE is a disability prevention program & study Goal: to determine if medical assistance (Medicaid wrap-

around) can prevent loss of employment due to a potentially disabling physical or mental impairment

Current enrollment n= 444; Began April 2006 Full time employment

Participants not currently in application process for disability Targeted to enrollees in Kansas High Risk Pool

Enrollees in KS high risk pool at a rate 8 times higher the general population

Targeted to those with significant under-insurance 91% have out-of-pocket expenses >10% of family income for

self & family

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Work Opportunities Reward Kansans (WORK): “Cash and Counseling” Opportunities

Provides more services than Medicaid buy-in Individual directs resources to their personal needs/preferences

Kansas the first state to receive approval New program under the Deficit Reduction Act (currently enrolled n=72)

Promotes employment for individuals with severe disabilities.

Developmental and physical disabilities, and traumatic brain injury

Provides Personal Services Assistive Technology and Home Modifications Independent Living Counseling

Individuals must be in “competitive

employment”

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High-Value health system for disabled individuals and workers

Value for individuals/consumers Benefits specialists promote employment by helping

individuals to navigate the complexity of various federal and state benefits

Monthly medical costs decreased significantly Cycle of poverty broken for disabled and chronically ill

through accumulation of assets Value for public/employers

Employment attainable with appropriate supports Contribution to the system through payment premiums

and payment of taxes Address workforce shortages by employing those who

want to work

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Recommendations to Promote

Employment Recognize that having a disability does not

mean someone unemployable Eliminate need to demonstrate inability to work

in order to receive health care coverage Develop comprehensive, seamless

system of health care services and supports to help those who can stay in the workforce

Promote harmony in federal/state programs

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Health System RecommendationsSignificant need for bipartisan federal

leadership: All individuals must be covered by

health insurance Consider new models of governance to

oversee private/public programs Promote coordination of care that

empowers individuals Promote value through:

Cost effectiveness analysisEvidence based medicine Leaders' Project on the

State of American Health Care

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KHPA Working Healthy Staff and University of Kansas Evaluators

Working Healthy Mary Ellen Wright, Senior

Manager Nancy Scott; Project

Coordinator Daniel Lassley; Employment

Specialist D’Ann Schlink; Support StaffDMIE Program Jennifer Telshaw; Program

Coordinator Sherry Marney; Support Staff

University of Kansas; Center for Research on Learning Division of Adult Studies

Jean P. Hall, Ph.D., Principal Investigator (jhall@ku.edu)

Noelle K. Kurth, M.S., Project Coordinator (pixie@ku.edu)

Emily Fall, Graduate Research Assistant (eledford@ku.edu)