2008 chartbook 121709 ahcas revisions.ppt · 2010. 1. 6. · about this chartbook this chartbook...

Prepared by: Florida Center for Medicaid and the Uninsured, The University of Florida Funded by: Florida Medicaid

Florida Medicaid Adult Enrollee Satisfaction:

A Chartbook

Comparing Managed Care Arrangements and Fee-for-Service for State FY 2006-07

2008

About This Chartbook

This Chartbook presents an analysis of adult (age 21 or older) beneficiary satisfaction with the Florida Medicaid program during the State Fiscal Year 2007 (July 1, 2006-June 30, 2007). Data were gathered by means of a telephone survey. These analyses exclude those dwelling g y p y y gin a nursing home, residents of one of the five Reform counties (Baker, Broward, Clay, Duval, and Nassau), and enrollees who have not been continuously enrolled in their plan for at least 6 months. Demographics and program satisfaction are reported for the Medicaid program overall, as well as by the type of Medicaid program or plan of the respondent. The Medicaid programs described in this report include: Medicaid Fee for Service (FFS) MediPass theprograms described in this report include: Medicaid Fee-for-Service (FFS), MediPass, the Minority Physician Network or MPN, and the Provider Service Network or PSN. MPN data are further stratified according to whether the respondents were served by NetPass or Access Health Solutions. In addition, figures for Medicaid HMOs are also presented, but since the populations were sampled differently and include residents of all Florida counties (including Reform counties), direct comparisons with the other populations cannot be made. The figures are included here for ease of reference only.

This chartbook is intended to be a graphical and easy-to-use guide for program administrators and others who are interested in understanding Medicaid enrollees’ experiences with care, and the differences between the various Medicaid programs. In the interest of brevity, many technical and scientific details regarding methodology are summarized here. A more complete description can be found in the Technical Appendix which accompanies this document. Complete survey instruments, frequencies for each item, and detailed eligibility category information may also be found in this appendix.information may also be found in this appendix.

Page 1

Table of Contents

Section 1: Introduction . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Section 3: Methods . .. . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

Section 4: Describing the Populations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

A. Demographics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

B H lth St t 36B. Health Status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36

Section 5: Experiences with Care and Satisfaction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47

A. Primary Care . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48

B S i lt C 59B. Specialty Care. . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59

C. Other Types of Care .. . . . . . . . . .. . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . 66

D. Communicating with Providers. . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .81

E Plan Administration 90E. Plan Administration. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90

Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102

Acknowledgements. . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103

Page 2

Introduction

Page 3

Florida Medicaid Includes Many Care Arrangements, including Managed Care and Fee for Service

Most Medicaid recipients are required to obtain services through managed care. Exceptions to this rule include those who are dual-enrolled in Medicare or who have other third party coverage, those who reside in a nursing facility, those who are enrolled in hospice, or those who are enrolled in Medicaid with limited benefits. These groups obtain care through the Medicaid providers of their choice on a fee-for-service (FFS) b i(FFS) basis.

The managed care arrangements available to adult Medicaid enrollees in most of the state* are the following:

• Medicaid Health Maintenance Organizations or HMOs• Medicaid Health Maintenance Organizations, or HMOs• The Medicaid Provider Access System, or MediPass• Minority Physician Networks or MPNs• The Provider Service Network or PSN

ff fAlthough each program offers substantially similar benefits packages to the enrollee, their management and administrative structures differ. Availability also differs, with enrollees in some counties having no choice but the MediPass program, while those in other counties have a choice from among up to 11 Medicaid HMOs, the MediPass program, the MPN, and the PSN. Counties offering only MediPass are generally rural and often have poorer geographic access to providers and facilities, which could negativelygenerally rural and often have poorer geographic access to providers and facilities, which could negatively influence their satisfaction with overall care.

A brief summary of each program’s structure, availability, and enrollment is given later in this section.

Large portions of this section of the chartbook are taken directly from the Florida Medicaid Summary of Services.

*Residents in the five Reform counties (Baker, Broward, Clay, Duval, and Nassau) have different managed care options. As stated previously, this report excludes residents of these five counties.

Page 4

Adult Enrollment in Medicaid Managed Care Organizations and Fee-for-Service Plans

Enrollees aged 21 years or older, continuously enrolled in plan for at least 6 months, and not residing in a nursing home.

FFS

65%

Medicaid HMO

18%

Medicaid Program/PlanEnrollment as

of June 30, 2007

FFS 361,384

MediPass 74,455

PSN

<1%

MPN: Access

MPN: NetPass 9,772

MPN: Access Health Solutions 10,188

PSN 2,506

HMO 101,064

Health

Solutions

2%MPN: NetPass

MediPass

Total 559,369

Source: Medicaid Administrative Data

2%13%

Page 5

Medicaid HMOs

Medicaid Managed Care Arrangements

The Agency for Health Care Administration (AHCA) has contracted with Health Maintenance Organizations (HMOs) throughout the state to provide Medicaid services to a defined population of enrolled Medicaid recipients. Medicaid HMOs are prepaid a fixed monthly rate (a capitation rate) per member in each of the various eligibility categories, to provide all of the covered services required by each member during the month.

As of June 2007, there were 13 Medicaid HMOs operating in the state, with a total adult (age 21+ years old) enrollment of more than 101,000 “long-term”* beneficiaries excluding those residing in a nursing home. Medicaid HMOs are available in 32 of the 67 Florida counties, and in 29 of the 62 non-Reform ,counties included in the analyses in this Chartbook. As a general rule, HMOs are offered in more urban counties, and, in many densely-populated counties, five or more HMO options are available to enrollees. Counties without an HMO are predominately rural. It is expected that individuals in these ‘No Choice’ counties might report lower overall satisfaction with care due to factors such as distance to providers and facilities The chart on the following page gives the total adult enrollment as ofproviders and facilities. The chart on the following page gives the total adult enrollment, as of September, 2007, for each HMO. It is worthy of note that 4 plans, Healthease, Staywell, Amerigroup, and United, represent 81% of the market among this population.

The maps on the following pages show HMO availability by county, and enrollment by county.

Large portions of this section of the chartbook are taken directly from the Florida Medicaid Summary of Services.

*“Long-term” beneficiaries are defined as those who had been continuously enrolled in their plan for 6 months or longer

Page 6

Medicaid Managed Care Arrangements (continued)Enrollees aged 21 years or older, continuously enrolled in plan for at least 6 months,

Total Adult % of

Vista South

Florida

2%

Healthease

23%

Staywell

22%

and not residing in a nursing home.

Plan Name Total Adult Enrollment HMO

Members

Healthease 23,445 23.2%

Staywell/WellCare 22,095 21.9%

Amerigroup 21 075 20 9%

Preferred

2%

2%

Citrus Amerigroup 21,075 20.9%

United/United Evercare 14,737 14.6%

Humana 5,759 5.7%

Buena Vista/Vista Health Plan 4,452 4.4%

Citrus

3%JMH

3%

Buena Vista

4%JMH Health Plan 2,811 2.8%

Citrus Healthcare 2,571 2.5%

Preferred Medical Plan 2,222 2.2%

Foundation/Vista S. Florida 1,897 1.9%

%

Humana

6%

TOTAL 101,064 100.0%

Enrollment figures reflect those aged 21 years and older, continuously enrolled in their plan 6 months or longer, and not residing in a nursing home.

Amerigroup

21%

United

15%

S M di id d i i t ti d t f J 2007

Note that Healthy Palm Beaches and Universal were excluded due to small number of enrollees.

Source: Medicaid administrative data for June 2007

Page 7

Number of Medicaid HMOs Operating in Each Florida County

No Medicaid HMOs

11

2

3 - 4

55 or more

Source: AHCA Managed Health Care Website, June 2007

Page 8

Medicaid Managed Care Arrangements (continued)

MediPass

The Medicaid Provider Access System, or MediPass, is a primary care case management program that is available in all 67 Florida counties. MediPass primary care providers are responsible for

idi i f th i i t’ i d f f i th i i t f thproviding or arranging for the recipient’s primary care and for referring the recipient for other necessary medical services on a 24-hour basis. MediPass providers are paid a $3 patient management fee each month for each eligible person who selects him or her as a primary care provider, plus Medicaid fee-for-service reimbursement for services that are rendered.

Ad lt ll t i M diP h 75 000 d lt l t b fi i i t t id *Adult enrollment in MediPass approaches 75,000 adult, long-term beneficiaries statewide*.

Large portions of this section of the Chartbook are taken directly from the Florida Medicaid Summary of Services.

*Excludes nursing home residents and residents of Reform counties, and includes only those continuously enrolled 6 months or longer and aged 21 and older.

Page 9

Medicaid Managed Care Arrangements (continued)

Minority Physician Networks or MPNs

The Minority Physician Network (MPN) program contracts with physician-owned organizations consisting largely of providers belonging to racial and ethnic minority groups. MPNs focus on increasing access to care and managing utilization of a historically underserved minority population. The program was initiated through contracts with two such organizations in Miami-Dade and Broward counties: NetPass and PhyTrust (now Access Health Solutions). The networks are made up of primary care providers (PCPs) who are responsible for managing care for MediPass beneficiaries.

MPNs support the primary care providers by providing administrative and utilization management services as a means of containing cost and enhancing the quality of care. PCPs are paid a $3.00 per member per month case management fee and fee-for-service reimbursement for medical services.

Since its inception, the MPN pilot project has grown from its roots in Broward, Miami-Dade, and Palm B h ti Th i th i d t t i 7 M di id i (A 4 5Beach counties. The program is now authorized to operate in 7 Medicaid service areas (Areas 4, 5, 6, 7, 9,10 and 11) which comprise 26 counties, though the MPN actually operate in only 23 of these counties, shown on the map on the following page.

Large portions of this section of the Chartbook are taken directly from the Florida Medicaid Summary of Services. Information on MPN authorized service areas from Medicaid Health Systems Development.

Page 10

Availability of Minority Physician Networks (MPNs) by County

MPNs not available

One or more MPNs available

Source: Florida Medicaid, Health Systems Development

Page 11

Medicaid Managed Care Arrangements (continued)The Provider Service Networks or PSNThe Provider Service Networks or PSN

A Provider Service Network (PSN) is an integrated health care delivery system owned and operated by Florida hospitals and physician groups. The PSN is a Medicaid managed care option for Medicaid recipients in Miami-Dade and Broward counties, and its adult enrollment exceeds 2,500 adults, long-term enrollees *enrollees.

Enrollees receive the majority of their health care services through the PSN. The following categories of recipients are eligible to enroll in a PSN:

• Low Income Families and Children (TANF)Low Income Families and Children (TANF)• Sixth Omnibus Budget Reconciliation Act (SOBRA) children• Children in Foster Care• Children in Subsidized Adoptions• Supplemental Security Income (SSI) recipients who do not receive Medicare

The PSN is paid a monthly administrative allocation payment for the management of its enrollees. PSN primary care providers are paid a monthly case management fee of $3 per member. Providers rendering services to PSN enrollees are reimbursed on a fee-for-service basis.


*Excludes nursing home dwellers and residents of Reform counties.

Page 12

Medicaid Eligibility: A Complex System of CoveragesMedicaid eligibility is a complex system that includes many categories of coverage. Eligibility categoriesMedicaid eligibility is a complex system that includes many categories of coverage. Eligibility categories vary in terms of income criteria, health criteria, age limits, benefits offered, and other criteria. To summarize, there are three basic groups who are eligible for Medicaid:

•SSI or Supplemental Security Income recipients,

TANF or Children and families and•TANF or Children and families, and,

•Aged, blind and disabled people, including people needing institutional care.

The following chart shows adult Medicaid enrollment by eligibility category.

Eligibility for Supplemental Security Income or SSI is determined by the Social Security AdministrationEligibility for Supplemental Security Income, or SSI, is determined by the Social Security Administration. All SSI recipients residing in Florida are automatically entitled to Florida Medicaid with full benefits. To be eligible for SSI, an individual must be age 65 or older or, if under age 65, must be totally and permanently disabled, and meet the SSI income and asset limits. Approximately 44% of the population surveyed for this Chartbook is made up of SSI eligibles.

There are five categories of eligibility for children and families that offer full benefits. By far the largest category, in terms of the number of enrollees served, is the TANF-related group, which accounts for 14% of the population surveyed for this Chartbook. This group includes low income families, including single-parent families and families with a disabled or unemployed parent. Other full benefits categories include: p p y p gMEDS (Medicaid Expansion Designated by SOBRA); Foster Care, Adoption Subsidy and Emergency Shelter; Public Medical Assistance (PMA); and Mary Brogan Breast and Cervical Cancer Program.

Medicaid programs with full benefits for aged and disabled persons who are not otherwise eligible for SSI include MEDS-AD (Medicaid for the Aged and Disabled), the Refugee Program, ICP (Institutional Care


( g ) g g (Program), Hospice, and HCBS (Home and Community Based Services).

Page 13

Adult Medicaid Enrollment by Eligibility Category, 2007Adults age 21+, not residing in one of five Reform counties (Baker, Broward,

SSI TANF Other

Adults age 21+, not residing in one of five Reform counties (Baker, Broward, Clay, Duval, Nassau), and not residing in a nursing home

46.7%

44.4%

35.6% 17.8%

41.3%14.3%

Medicaid HMO

Medicaid Overall

57.8%

40.3%

27.7%

3.9%

14.5%

55.8%

MediPass

Medicaid FFS

50.7%

56.7%

32.3%

26.9%

17.0%

16.4%

MPN: AHS

MPN: NetPass

70.0%

50.7%

15.3%

32.3%

14.7%

17.0%

0% 20% 40% 60% 80% 100%

PSN

Source: Medicaid administrative data for June 2007

0% 20% 40% 60% 80% 100%

Page 14

M th dMethods

Page 15

Medicaid HMO Data

The Medicaid HMO data presented in this Chartbook were gathered separately from the data for the other care arrangements. The Florida Center for Health Information and Policy Analysis gathered these data as part of its HMO Report Card project, and generously shared it with the authors of this report. Detailed information concerning sampling procedures and response rates for the HMO surveys can be f d i th AHCA bli ti titl d Ch i Q lit H lth Pl Fl id HMO R tfound in the AHCA publication, titled, Choosing a Quality Health Plan: Florida HMO Report.

The Medicaid HMO surveys were conducted using a different sampling frame, different versions of the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Health Plan questionnaire, and different fielding methodologies. As a result, it is not possible to make statistical comparisons between the reports from the HMO population and the otherstatistical comparisons between the reports from the HMO population and the other populations. The Medicaid HMO results are presented here for reference purposes, but statements about statistically significant differences between the HMOs and the other programs are not made.

Data for some measures were not collected for the HMO group because a different version of theData for some measures were not collected for the HMO group because a different version of the CAHPS questionnaire was used for those surveys. The HMO questionnaire consisted of the CAHPS core questions only, while the questionnaire for the other program components included CAHPS supplemental questions, as well as other non-CAHPS instruments, such as a general health status measure and a depression screener.

In terms of sampling, it should be noted that two Medicaid HMOs, Total Health Choice and Universal, were not surveyed because they enroll relatively few Medicaid beneficiaries. Together, they represent less than 1% of the total (adult and child) HMO enrollment in Medicaid. Further, Healthy Palm Beaches was not surveyed because the bulk of its enrollees are under age 21 and, therefore, not eligible for the survey. Also, note that United Healthcare Plan and United Eldercare are treated as a single entity for these purposes.

Page 16

Survey InstrumentMost data for this Chartbook were collected by means of a telephone survey of 1,877 enrollees, conducted in the Summer and Fall of 2007. For all but the HMO surveys, which were administered by AHCA separately (an additional 3,671 surveys), the survey instrument used was made up of three standardized questionnaires: The CAHPS Health Plans Survey version 4.0, the SF-12 version 2, and the PHQ-2. These standardized instruments were supplemented with questions about racial and ethnic disparities and cultural competency Complete versions of the survey instruments can be found in thedisparities and cultural competency. Complete versions of the survey instruments can be found in the technical appendix to this document.

The Consumer Assessment of Healthcare Providers and Systems (CAHPS) Health Plan Survey version 4.0 is a family of standardized survey instruments, used widely in the health care industry to assess enrollees’ satisfaction and experience with health plans. The questionnaires includes questionsassess enrollees satisfaction and experience with health plans. The questionnaires includes questions about enrollees’ experiences with primary care, specialty care, other types of care and health plan administration. Demographics and health status measures are also included. The CAHPS questionnaire used for all but the HMO surveys includes the Adult Medicaid “Core” questionnaire, as well as some supplemental questions related to chronic conditions, dental care, and prescription

di i CAHPS H lth Pl S d ti id i l ti f M di id M dimedicines. CAHPS Health Plan Surveys are used nationwide in evaluations of Medicaid, Medicare, SCHIP and commercial plans. The National CAHPS Benchmarking Database, which is a project funded by the U.S. Agency for Healthcare Research and Quality, publishes national “average” or benchmark scores for each of the types of plans.

The SF-12 (or Short Form-12) is a 12-item questionnaire to measure health-related quality of life. The SF-12 includes items measuring both physical and mental health status.

The Patient Health Questionnaire-2 (PHQ-2) is a 2-item screening tool for depression.

Page 17

Sampling and Outcome Rates

Concurrent, random samples were drawn from among enrollees in FFS, MediPass, the MPNs, and the PSN. The samples included adults (age 21+) who, at the time the sample was extracted, had been enrolled in their current care arrangement for at least 6 consecutive months, and did not reside in a nursing home. Further, residents of the five Reform counties (Baker, g (Broward, Clay, Duval and Nassau) were excluded from the sample frame. The MPN group was further stratified according to whether enrollees were served by NetPass or Access Health Solutions.

Outcome rates for all surveys were comparable to other surveys among Medicaid populations in Florida. See the technical appendix (under separate cover) for more detail.

As mentioned previously, the HMO surveys were conducted separately. The HMO sample included adults who were continuously enrolled for 6 or more months. It included residents from all 67 Florida counties, including the five Reform counties.

Page 18

Weighting

Statistical Weighting and Confidence IntervalsWeightingSurvey results for the Medicaid HMO group were statistically weighted to reflect the actual distribution of individual HMO enrollment in Florida Medicaid. The reports of each HMO’s respondents were weighted according to the actual market share that particular HMO occupied within the Medicaid program as of June, 2007. The weights were applied in order to properly reflect the relative sizes ofprogram as of June, 2007. The weights were applied in order to properly reflect the relative sizes of each HMO; companies with large enrollments should have a larger “impact” on results than those with smaller enrollments.

The Medicaid “Overall” figures reported here are also weighted to reflect the actual distribution of enrollees in the various care arrangements. The actual adult enrollment in each program as of June g p g2007 was used to calculate these weights. Again, these weights were used so that the Medicaid “overall” figure would properly represent the makeup of the Medicaid adult population. Because the FFS group represented 65% of adult Medicaid enrollment, this group’s responses were given more “weight” than those of other programs, such as the PSN, for example, which represents less than 1% of total Medicaid adult enrollment The reader should bear this in mind when reviewing the Medicaidtotal Medicaid adult enrollment. The reader should bear this in mind when reviewing the Medicaid overall figures, since any effect of the PSN or MPNs on this figure will be small.

Confidence IntervalsA confidence interval is perhaps most familiar to non-scientists as the plus-or-minus figure usuallyA confidence interval is perhaps most familiar to non scientists as the plus or minus figure usually reported in opinion poll results. Confidence intervals remind the reader that, although a single figure may be presented (e.g., 71% chose response category “A”), the actual figure for the entire population, including those who were not surveyed, may not be exactly that figure, but will fall within a range of figures below and above the given value. The confidence interval for all survey results given here will fall within a range of at most plus or minus 5% of the given value The range for some items may befall within a range of, at most, plus or minus 5% of the given value. The range for some items may be considerably smaller than ±5%.

Page 19

D ibi th P l tiDescribing the Populations

Page 20

DemographicsDemographics

Page 21

Majority of Medicaid Enrollees Surveyed are Females

Over 70% of enrollees surveyed were female, while 30% were male. This is similar to the actual gender distribution of this population in Medicaid, in which 68% are female and 32% are male*. There were significant differences between the seven Medicaid programs in terms of gender breakdown, with the PSN and MPN: Access Health Solutions being made up of slightly smaller percentages of females (61% and 64% respectively) than the other programs which were made up of 70-71% females The(61% and 64%, respectively) than the other programs, which were made up of 70 71% females. The HMO group had the largest portion of females, at 74%, though it should be noted that HMOs were not statistically compared with the other groups. (See methodology section for more information on statistical comparisons.)

M di id ll i l d l ti f th d t ifi lif i dMedicaid programs generally include a larger portion of women than men due to specific qualifying and eligibility criteria. Additionally, special coverage is provided for low-income women who are pregnant, and uninsured women who have been diagnosed with breast or cervical cancer.

*Source: Agency for Health Care Administration Frequency based on June 2007 dataSource: Agency for Health Care Administration, Frequency based on June 2007 data

Sex Medicaid Overall

Medicaid HMO

Medicaid FFS MediPass MPN:

NetPass MPN: AHS PSN

M l 29 6% 26 3% 29 4% 29 0% 29 7% 36 0% 38 9%

Reflects distribution among survey respondents.Medicaid HMO group not statistically comparable to other groups.

Male 29.6% 26.3% 29.4% 29.0% 29.7% 36.0% 38.9%

Female 70.5% 73.7% 70.6% 71.0% 70.3% 64.1% 61.1%

Sources: 1. Medicaid Beneficiary Satisfaction Survey, FY 2007, Florida Center for Medicaid & the Uninsured. 2. Medicaid HMO Surveys, FY 2007, Florida Center for Health Information and Policy Analysis

Reflects distribution among survey respondents.g p y p g p

Page 22

Gender of Enrollees Surveyed

70.5% 29.6%Medicaid Overall

Females Males

70.6%

73.7%

29.4%

26.3%

Medicaid FFS

Medicaid HMO

70.3%

71.0%

29.7%

29.0%

MPN: NetPass

MediPass

61.1%

64.1%

38.9%

36.0%

PSN

MPN: AHS

61.1% 38.9%

0% 20% 40% 60% 80% 100%


Sources: 1. Medicaid Managed Care Surveys, FY 2006 and Medicaid Fee-for-Service Surveys, FY 2006, Florida Center for Medicaid & the Uninsured. 2. Medicaid HMO Surveys, FY 2006, State Center for Health Statistics


Page 23

Medicaid Programs Differ in Terms of Age Distribution of Enrollees

Although the Medicaid program covers enrollees of all ages, including children, adolescents, and young adults, this report focuses on the adult population. The overall sample was made up of roughly 11% aged 21 to 34 years, 37% aged 35 to 64 years, and 52% aged 65 years or older. This distribution, when compared with the actual distribution in Medicaid, is slightly skewed towards older enrollees.

Among the programs, distributions were significantly different. The age distribution in the FFS population is perhaps the most distinct, with the program’s enrollment being skewed significantly toward the older groups. More than 62% of FFS enrollees were aged 65 or older, while 30% were aged 35-64, and only 8% were aged 21-34. This distribution is not unexpected, considering that FFS enrollment includes a large portion of Medicare-Medicaid dual eligibles. The PSN is also quite different comparedincludes a large portion of Medicare Medicaid dual eligibles. The PSN is also quite different compared with the other groups. The vast majority of enrollees in the PSN - more than 79% - were aged 35 to 64 years old, and a small percentage – 9% - was younger than 34 years.

M di id M di id M di id MPNAge Medicaid Overall

Medicaid HMO



18* to 34 years old 11.1% 31.4% 8.1% 21.8% 24.1% 28.1% 9.0%

35 to 64 years old 37.4% 55.1% 29.7% 68.2% 56.9% 60.0% 79.4%

65 years old or older 51 5% 13 5% 62 2% 10 0% 19 0% 12 0% 11 7%65 years old or older 51.5% 13.5% 62.2% 10.0% 19.0% 12.0% 11.7%

*The Medicaid HMO surveys included respondents aged 18-21 years old, while the surveys for the other programs only included those 21 years old or older.

Reflects distribution among survey respondentsMedicaid HMO group not statistically comparable to other groups.



Page 24

Age of Enrollees Surveyed

37.4% 51.5%11.1%Medicaid Overall

18-34 years old 35-64 years old 65 years or older

31.4%

29.7%

13.5%

8.1%

55.1%

62.2%Medicaid FFS

Medicaid HMO

24 1%

21.8%

56 9%

68.2%

19 0%

10.0%

MPN: NetPass

MediPass

28.1%

24.1%

60.0%

56.9%

12.0%

19.0%

MPN: AHS

MPN: NetPass

79.4% 11.7%9.0%

0% 20% 40% 60% 80% 100%

PSN

R fl t di t ib ti d tMedicaid HMO group not statistically comparable to other groups



Page 25

The educational attainment of Medicaid enrollees surveyed fell well-short of the state average.

Educational Attainment Below State AverageThe educational attainment of Medicaid enrollees surveyed fell well short of the state average. Among Medicaid enrollees surveyed, less than one-quarter (24%) had attained a level of education beyond high school, while 33% had graduated high school or obtained a GED as their highest level of educational attainment. Approximately 43% of those surveyed reported that they did not graduate high school or obtain a GED. These figures are in stark contrast to that of the state population as a whole The US Census Bureau estimates that 79 9% of the Florida populationpopulation as a whole. The US Census Bureau estimates that 79.9% of the Florida population aged 25 or older has attained a level of education at or above high school graduation.1 Survey data, when adjusted to compensate for the age category difference, show that only 56% of non-HMO-enrolled Medicaid beneficiaries aged 25 or older have graduated high school, and 61% of HMO-enrolled Medicaid beneficiaries aged 25 or older have graduated high school. g g g

Among the five Medicaid programs that were statistically compared, a significant difference was found on this measure. Compared with the other programs, the PSN group had the largest portion of enrollees with less than a high school diploma. More than half (50%) reported that they had not graduated high school or obtained a GED. This finding, while statistically significant, may not be large enough to be practically meaningful. 1Source: US Census Bureau, http://quickfacts.census.gov

Highest Educational Attainment Medicaid Overall

Medicaid HMO



Did not graduate high school 43.2% 36.8% 43.4% 41.7% 42.2% 44.0% 50.4%

High school graduate or GED 33.0% 36.3% 32.8% 33.4% 36.4% 36.0% 31.9%

Beyond high school 23.8% 26.8% 23.8% 24.9% 21.4% 20.0% 17.6%




Page 26

Educational Attainment of Enrollees SurveyedPercent who have graduated high school or obtained a GED:

56.8%Medicaid Overall

Percent who have graduated high school or obtained a GED:

56.6%

63.1%

Medicaid FFS

Medicaid HMO

57.8%

58.3%

MPN: NetPass

Choice

49 5%

56.0%

57.8%

PSN

MPN: AHS

et ass

49.5%

0% 20% 40% 60% 80% 100%

PSN




Page 27

Medicaid Non-Reform Population Composed of a Larger Portion of Hispanics than Florida as a Whole

Survey data suggest that the Medicaid program (exclusive of the five Reform counties) is made up of a larger percentage of Hispanics than the Florida population as a whole. Thirty-two percent of Medicaid enrollees surveyed reported being of Hispanic ethnicity, while 20% of Florida’s population overall is Hispanic.1 Medicaid administrative data show 29% of the population sampled for this Chartbook as b i f Hi i th i itbeing of Hispanic ethnicity.

Significant differences were found between the portion of Hispanics in the various program components. The MPN: NetPass and PSN groups had the highest portion of Hispanics, at 52% and 48%, respectively, while MediPass and Medicaid HMOs had the lowest portion, at 29% each.

1Source: US Census Bureau, http://quickfacts.census.gov

Hispanic or Latino Origin or Descent

Medicaid Overall

Medicaid HMO



32.3% 28.5% 32.1% 29.2% 51.8% 43.2% 47.8%




Page 28

Racial Composition Among Enrollees Surveyed: HispanicsPercent reporting Hispanic or Latino origin or descent:


Percent reporting Hispanic or Latino origin or descent:

32.1%

28.5%

Medicaid FFS

Medicaid HMO

51.8%

29.2%

MPN: NetPass

MediPass

47 8%

43.2%

51.8%

PSN

MPN: AHS

47.8%

0% 20% 40% 60% 80% 100%

PSN




Page 29

Nearly One-third of Florida Medicaid Enrollees Speak a Language Other Than English at Home and Language Varies Widely by Program

Thirty-one percent of Medicaid enrollees surveyed indicated that they spoke a language other than English in their homes. This compares with the US Census Bureau’s estimate that 23% of the Florida population as a whole speaks something other than English in the home.1 The most p p p g gcommon “other” language reported was Spanish, which was spoken at home by 28% of all those surveyed.

Significant differences were found between the reports of the various programs’ enrollees. The percentage of persons primarily speaking a language other than English in the home ranged from a g y g g g g ghigh of 49-50% in the MPN:NetPass and PSN groups to a low of 26% in MediPass. Clearly, geography is a contributing factor in these findings, since the MPNs and the PSN are offered in counties that tend to have a high percentage of Hispanic residents.1Source: US Census Bureau, http://quickfacts.census.gov

Primary Language

Spoken at Home

Medicaid Overall

Medicaid HMO



English 69.3% 69.2% 73.8% 50.5% 60.6% 51.5%

Spanish 28.3% 28.5% 24.1% 45.9% 35.6% 43.4%

Other 2.4% 2.4% 2.1% 3.5% 3.8% 5.2%

Source: Medicaid Beneficiary Satisfaction Survey, FY 2007, Florida Center for Medicaid & the Uninsured.

HMO Enrollees, who were surveyed separately, were not asked this question. Reflects distribution among survey respondents.

Page 30

Primary Language Spoken in the Home: SpanishPercent reporting that Spanish is the primary language spoken in the home:


Percent reporting that Spanish is the primary language spoken in the home:

28.5%Medicaid FFS

Medicaid HMO Question Not Asked

45.9%

24.1%

MPN: NetPass

MediPass

43 4%

35.6%

PSN

MPN: AHS

43.4%

0% 20% 40% 60% 80% 100%

PSN



Page 31

Medicaid Non-Reform Population Composed of a Smaller Portion of White Non-Hispanics than Florida as a Whole

Survey data suggest that the Medicaid (non-Reform) program is made up of a smaller percentage of Whites than the Florida population as a whole. Sixty-seven percent of Medicaid enrollees surveyed reported being White (and not multiracial), compared with 80% in the Florida population as a whole.1Note that these figures include persons of Hispanic ethnicity. (The questionnaire included separate items g p p y ( q pfor Hispanic ethnicity and race, so respondents could indicate, for example, being Hispanic and White.) When Hispanic respondents were put into a distinct race/ethnicity category, roughly 45% of survey respondents reported being White and non-Hispanic, compared with 61% in Florida as a whole. This figure is comparable to that found in Medicaid administrative data, in which 41% of Medicaid-enrolled non Reform adults were Whitenon-Reform adults were White.

Large differences were found between the programs in terms of the portion of White non-Hispanics enrolled. The FFS group was composed of the largest percentage of White non-Hispanics, at 46%, while the PSN was composed of the smallest percentage of Whites, at 4%.1Source: US Census Bureau http://quickfacts census gov1Source: US Census Bureau, http://quickfacts.census.gov

Race/Ethnicity Categories

Medicaid Overall

Medicaid HMO



Hispanic 30.9% 27.5% 30.5% 28.5% 50.0% 42.2% 46.2%

Multiracial, non-Hispanic 1.8% 1.6% 1.6% 2.9% 1.1% 2.7% 0.0%

White, non-Hispanic 44.8% 34.2% 46.1% 44.9% 24.1% 25.4% 4.3%

Black, non-Hispanic 18.7% 30.8% 18.0% 20.4% 21.4% 23.5% 45.9%

Other race, non-Hispanic 3.9% 6.0% 3.9% 3.4% 3.5% 6.2% 3.5%



Page 32

Racial Composition Among Enrollees Surveyed: White Non-Hispanics


Percent reporting their race as white (and not multiracial) and non-Hispanic:

46 1%

34.2%

Medicaid FFS

Medicaid HMO

24 1%

44.9%

46.1%

MPN N tP

MediPass Choice

Medicaid FFS

25.4%

24.1%

MPN: AHS

MPN: NetPass

4.3%

0% 20% 40% 60% 80% 100%

PSN



Page 33

Medicaid Composed of a Larger Portion of Black Non-Hispanics than Florida as a Whole

Survey data suggest that the Medicaid program is made up of a larger percentage of Blacks than the Florida population as a whole. Twenty percent of Medicaid enrollees surveyed reported being Black (and not multiracial), compared with 16% in the Florida population as a whole. Note that these figures include persons of Hispanic ethnicity. (The questionnaire included separate items for Hispanic ethnicity p p y ( q p p yand race, so respondents could indicate, for example, being Hispanic and Black.) When Hispanic respondents were put into a distinct race/ethnicity category, roughly 19% of survey respondents reported being Black and non-Hispanic. This figure is comparable to that found in Medicaid administrative data, in which 22% of Medicaid-enrolled adults were Black.

Large differences were found between the programs in terms of the portion of Black non-Hispanics enrolled. The PSN was composed of the largest percentage of Black non-Hispanics, at 46%, while the FFS group was composed of the smallest percentage of Black non-Hispanics, at 18%.1Source: US Census Bureau, http://quickfacts.census.gov

Race/Ethnicity Categories

Medicaid Overall

Medicaid HMO



Hispanic 30.9% 27.5% 30.5% 28.5% 50.0% 42.2% 46.2%

Multiracial non-Hispanic 1 8% 1 6% 1 6% 2 9% 1 1% 2 7% 0 0%Multiracial, non-Hispanic 1.8% 1.6% 1.6% 2.9% 1.1% 2.7% 0.0%

White, non-Hispanic 44.8% 34.2% 46.1% 44.9% 24.1% 25.4% 4.3%

Black, non-Hispanic 18.7% 30.8% 18.0% 20.4% 21.4% 23.5% 45.9%

Other race, non-Hispanic 3.9% 6.0% 3.9% 3.4% 3.5% 6.2% 3.5%

M di id HMO t t ti ti ll bl t th



Page 34

Racial Composition Among Enrollees Surveyed: Black, Non-Hispanics


Percent reporting their race as black (not multiracial) and non-Hispanic:

18 0%

30.8%

Medicaid FFS

Medicaid HMO

20.4%

18.0%

MediPass Choice

Medicaid FFS

23.5%

21.4%

MPN: AHS

MPN: NetPass

45.9%

0% 20% 40% 60% 80% 100%

PSN




Page 35

Health StatusHealth Status

Page 36

Majority of Medicaid Enrollees Report Being in Fair or Poor Health

Almost two-thirds of enrollees surveyed reported being in “fair” or “poor” health, while another 23% reported being in “good” health, and only 13% reported being in “very good” or “excellent” health. Although the proportion in “fair” or “poor” health is high, it is not unexpected, as the Medicaid program g p p p g , p , p gprovides coverage for a large portion of the aged and chronically ill in the state.

HMOs appear to have the lowest portion of enrollees in the “fair or poor” category and the highest portion in the “excellent or very good” category. However, these results cannot be statistically compared with those of the other program components due to methodological considerations (see methodology g g ( gysection for more details). No significant variations exist between the reports of enrollees in the various Medicaid programs that could be compared statistically (all programs except HMOs).

Self-Assessed Overall Health

Medicaid Overall

Medicaid HMO



Excellent or VeryExcellent or Very Good 12.6% 28.9% 12.2% 12.9% 17.3% 18.2% 16.3%

Good 22.9% 26.1% 22.9% 23.0% 22.9% 22.6% 18.2%

Fair or Poor 64.5% 45.1% 64.9% 64.1% 59.8% 59.2% 65.5%




Page 37

Self-Assessed Health StatusPercent describing their health as “fair” or “poor”:


64.9%

45.1%

Medicaid FFS

Medicaid HMO

59.8%

64.1%

MPN: NetPass

MediPass

59.2%

PSN

MPN: AHS

65.5%

0% 20% 40% 60% 80% 100%

PSN




Page 38

Nearly Half of Medicaid Enrollees Surveyed Report Being in “Fair” or “Poor” Mental Health

A large portion of Medicaid enrollees reported that their mental health was less than “good.” Forty-nine percent of enrollees surveyed reported being in “fair” or “poor” mental health, while another 22% reported being in “good” mental health, and 29% reported being in “very good” or “excellent” mental health. The large number of enrollees reporting that they are in “fair” or “poor” mental health is a serious concern. g p g y pMental health conditions can be more difficult to detect than physical conditions, and they can be equally debilitating. The cost of treating such conditions is high (As of 2005, 16% of Florida Medicaid prescription drug spending went toward medications to treat mental and emotional health conditions¹), but the cost of leaving them untreated may be higher. Mental and emotional health conditions can manifest themselves physically or can exacerbate existing physical conditions and those who are suffering from mental orphysically or can exacerbate existing physical conditions, and those who are suffering from mental or emotional conditions may not be able to work or function normally.²

The reports of the various Medicaid program components varied significantly on this measure, with the FFS consisting of the largest portion of enrollees in “excellent” or “very good” mental health (31%), and the smallest portion who are in “fair” or “poor” mental health (47%) The reports of the other programs weresmallest portion who are in fair or poor mental health (47%). The reports of the other programs were similar, with 22-27% reporting they were in “excellent” or “very good” mental health and 52-56% reporting they were in “fair” or “poor” mental health.¹ Source: Agency for Health Care Administration, Bureau of Medicaid Pharmacy Services, 2005

² Source: Mental Health: A Report of the Surgeon General, 1999

M di id M di id M di id MPNSelf-Assessed Mental Health Medicaid Overall

Medicaid HMO



Excellent or Very Good 29.3% 31.2% 21.6% 24.1% 24.3% 26.6%

Good 22.1% 21.5% 24.8% 20.5% 23.5% 21.3%

Fair or Poor 48.6% 47.3% 53.6% 55.5% 52.3% 52.1%



Page 39

Self-Assessed Mental Health StatusPercent describing their mental health as “fair” or “poor”:


Percent describing their mental health as fair or poor :

47.3%Medicaid FFS


55 5%

53.6%

MPN: NetPass

MediPass

52.3%

55.5%

MPN: AHS

MPN: NetPass

52.1%

0% 20% 40% 60% 80% 100%

PSN



Page 40

Depression Screening Tool Shows 46% of Medicaid Enrollees May Suffer from Moderate to Severe Depression

A striking number of Medicaid respondents scored in the range of potentially moderate to severe depression on the 2-item depression screener administered as part of this survey. Overall, 46% of Medicaid respondents had screener scores indicative of moderate to severe depression. Fifty-four p p ypercent had screener scores indicative of no depression or mild depression.

The reports of the various program components did not differ significantly on this measure.

It is important to note that depression screeners alone cannot be used to diagnose depression. However the high percentage of respondents scoring in the moderately to severely depressed range isHowever, the high percentage of respondents scoring in the moderately to severely depressed range is cause for concern, given the potential impact of depression on physical health and well being, and on health care costs.

Depression Screener Categories Medicaid Overall

Medicaid HMO


NetPassMPN: AHS PSN

No Depression or Mild Depression Probable (PHQ Score 0-2) 54.3% 55.2% 51.4% 50.3% 48.3% 50.9%

Possibility of Moderate to Severe Depression (PHQ Score 3+) 45.7% 44.8% 48.6% 49.7% 51.7% 49.1%



Page 41

Depression Screener ScoresPercent whose score on the depression screener indicated that they could be


Percent whose score on the depression screener indicated that they could be “moderately” to “severely” depressed:

44 8%Medicaid FFS


48.6%

44.8%

MediPass

Medicaid FFS

51.7%

49.7%

MPN: AHS

MPN: NetPass

49.1%

0% 20% 40% 60% 80% 100%

PSN



Page 42

Many Medicaid Enrollees Report Having Health Conditions that Interfere with their Quality of Life

Medicaid enrollees were asked several detailed questions about their health status and about existing medical conditions. Seventy-three percent of enrollees surveyed reported that their health limits them in doing moderate activities, such as moving a table or pushing a vacuum cleaner. Seventy-three percent indicated that they had a physical or mental condition that seriously interfered with their ability to work,

tt d h l d t d ti iti S t t f d t id th d dattend school or manage day-to-day activities. Seventy-seven percent of respondents said they needed or took prescription medicines.

Significant differences were found between the program components on all three of these items. The MPN: Access Health Solutions group had the lowest percentage among the program components on all three of these measures (The Medicaid HMO group had a lower percentage than MPN: AHS for thethree of these measures. (The Medicaid HMO group had a lower percentage than MPN: AHS for the prescription drug item, but the HMO figures are not statistically comparable to the other groups.)

Health Status Measure Medicaid Overall

Medicaid HMO



Health Limits Doing Moderate Activities 73.3% 74.7% 69.0% 66.7% 59.3% 69.5%

Has a Physical or Mental yCondition that Seriously Interferes with Day-to-Day Activities

72.5% 71.7% 77.4% 67.4% 65.7% 80.4%

Need or take prescription medicine 77.4% 68.9% 77.8% 77.4% 72.5% 69.0% 78.8%



Page 43

Health Conditions that Interfere with Quality of LifeAmong Medicaid enrollees surveyed, regardless of program/plan:

73 3%Health Limits

Doing Moderate

Among Medicaid enrollees surveyed, regardless of program/plan:

73.3%

Physical or Mental

Doing ModerateActivities

72.5%

Physical or MentalCondition

Interferes with Day-to-Day Activities

77.4%Needs/Takes

Prescription Drugs

0% 20% 40% 60% 80% 100%

p g



Page 44

Compared with Florida as a Whole, a Higher Percentage of Medicaid Enrollees Smoke Tobacco

Nearly one in four (25%) Medicaid-enrolled adults surveyed reported smoking tobacco on some days or every day. This compares with 21% of Florida adults overall who smoke.1 The Medicaid programs differed significantly on this measure, with a larger portion of MediPass enrollees reporting that they g y , g p p g ysmoke (36%) than in any other group. This finding is consistent with the 2006 survey of Medicaid enrollees,2 which also showed that MediPass had more smokers than the other program components surveyed. Further, the 2006 survey showed that MediPass enrollees residing in counties containing no Medicaid HMOs (these tend to be more rural counties) had a higher percentage of smokers than MediPass enrollees residing in counties with at least one Medicaid HMO (these tended to be more urbanMediPass enrollees residing in counties with at least one Medicaid HMO (these tended to be more urban counties). This finding is not unexpected, given that scientific literature has long shown an association between rural dwelling and smoking in the US.3-4

1Source: http://www tobaccofreeflorida com/english/facts/ (Linked from Florida Department of Health Website )1Source: http://www.tobaccofreeflorida.com/english/facts/ (Linked from Florida Department of Health Website.)2Source: Florida Medicaid Adult Enrollee Satisfaction: A Chartbook; Comparing Managed Care Arragnements and Fee-for-Service,

2006: Technical Supplement3Source: Doescher, MP, Jackson, E, Jerant, A, Hart, G, “Prevalence and Trends in Smoking: A National Rural Study,” The Journal of Rural

Health, Vol 22, No. 2, 112-118.4Source: Eberhardt MS, Ingram DD, Makuk DM, et al. Urban and Rural Health Chartbook. Health, United States, 2001. Hyattsville, MD:

National Center for Health Statistics; 2001: 32-35.National Center for Health Statistics; 2001: 32 35.

Self-Reported Smoking, Every Day or Some Days

Medicaid Overall

Medicaid HMO



24.6% 22.0% 36.1% 27.2% 29.5% 21.7%



Page 45

Cigarette Smoking Among Medicaid EnrolleesPercent reporting that they smoke every day or some days:


22.0%Medicaid FFS


27.2%

36.1%

MPN: NetPass

MediPass

29.5%

PSN

MPN: AHS

21.7%

0% 20% 40% 60% 80% 100%

PSN



Page 46

Experiences with Care pand Satisfaction

Page 47

Primary CarePrimary Care

Page 48

Eighty-Five Percent of Medicaid Enrollees Surveyed Report Having a Usual Source of Care

A usual source of care is a physician, nurse, or other health professional who serves as the primary health provider for an enrollee. Individuals who have a usual source of care, or a “personal doctor,” are more likely to receive preventive care than those who do not have a primary care provider.* Thus, the percentage of enrollees who report having a usual source of care is an important indicator of quality of p g p g p q ycare provided by a health program. Among Medicaid enrollees surveyed, 85% reported having a personal doctor or nurse.

Among Medicaid programs, the FFS and HMO groups appeared to have the highest percentage of beneficiaries reporting that they had a personal doctor or nurse (85%), but it is important to note that the HMO group cannot be statistically compared with the other groups due to methodology differences in the way the HMO data were obtained (see methods section for more information). The PSN group had the lowest percentage of respondents with a personal doctor (75%).

It is important for the reader to note that most Medicaid patients in managed care choose a PCP or are assigned a PCP by the system. Figures presented here are based on self-report, and, thus, are subject to faulty respondent recall, or on alternate interpretations of question intent (i.e., different interpretations of the phrase “personal doctor or nurse”).

*Source: Lambrew JM, DeFriese GH, Cary TS, Ricketts TC, Briddle AC, “The effects of having a regular doctor on access to primary care,” Medical Care, 1196, Feb; 34(2): 138-151, , , ; ( )

Enrollee Reports S/he has a Personal Doctor

Medicaid Overall

Medicaid HMO


NetPassMPN: AHS PSN

84.8% 84.9% 85.3% 83.4% 82.9% 79.1% 75.1%




Page 49

Enrollees with a Usual Source of CarePercent reporting they had a personal doctor or nurse:


Percent reporting they had a personal doctor or nurse:

85.3%

84.9%

Medicaid FFS

Medicaid HMO

82.9%

83.4%

MPN: NetPass

MediPass

75 1%

79.1%

82.9%

PSN

MPN: AHS

MPN: NetPass

75.1%

0% 20% 40% 60% 80% 100%

PSN




Page 50

Medicaid Enrollees Report Continuity in Primary Care

The term “Continuity of Care” refers to the extent to which enrollees are able to see a single health care provider over a period of time. Measuring the continuity of care that enrollees receive is an important step in describing the overall quality of care provided by any health insurance program. To this end, subjects were asked how long they had been seeing the same “personal doctor or nurse” as their primary care provider The vast majority of Medicaid enrollees (82%) reported seeing the sametheir primary care provider. The vast majority of Medicaid enrollees (82%) reported seeing the same personal doctor or nurse for at least 1 year, and a substantial portion reported seeing that PCP for 5 or more years.

The reports of the enrollees in the various care programs differed significantly in terms of length of time seeing their personal doctor or nurse. The PSN group had the largest portion of enrollees whotime seeing their personal doctor or nurse. The PSN group had the largest portion of enrollees who had been seeing their current PCPs for 5 or more years (48%), and the lowest portion who had been seeing their current PCP for less than 1 year (15%). All of the plans performed well on this measure.

Length of Time Continuously Seeing

Current PCP

Medicaid Overall

Medicaid HMO


NetPassMPN: AHS PSN

Less than 1 year 18.0% 18.0% 17.9% 17.9% 20.3% 14.6%

At least 1 year but less than 5 years 41.5% 40.1% 46.4% 51.0% 47.8% 37.5%

5 years or more 40.6% 42.0% 35.7% 31.1% 32.0% 47.9%



Page 51

Continuity of Primary CarePercent of respondents reporting that they had been seeing their personal doctor or


Percent of respondents reporting that they had been seeing their personal doctor or nurse for 1 year or longer:

82.1%Medicaid FFS


82.1%

82.1%

MediPass

Medicaid FFS

79.7%

82.1%

MPN: PhyTrust

MPN: NetPass

85.4%

0% 20% 40% 60% 80% 100%

PSN



Page 52

Medicaid Enrollees Report Relative Ease of Finding a Satisfactory PCP

Respondents who reported having switched PCPs since becoming enrolled in Medicaid (54% overall) were asked how difficult it was to find a satisfactory PCP in their plan. Overall, 65% of respondents reported it was “usually” or “always” easy to find a provider that they were “happy with.” Seventeen

t t d it “ ti ” d 17% t d it “ ”percent reported it was “sometimes” easy and 17% reported it was “never” easy.

The five plans differed significantly on this measure, with FFS and PSN enrollees reporting most favorably. In those groups, 65% to 68% of enrollees reported it was “usually” or “always” easy to find a PCP they were happy with. Among the other groups, 54% to 60% reported it was “usually” or “always”

t fi d PCP th h itheasy to find a PCP they were happy with.

Ease of Finding a PCP that Subject was "Happy With"

Medicaid Overall

Medicaid HMO


NetPassMPN: AHS PSN

Never 17.8% 16.2% 24.6% 18.4% 17.9% 13.5%

Sometimes 17.4% 16.2% 20.8% 25.4% 22.6% 21.1%

Usually 14.8% 14.5% 15.9% 12.9% 16.8% 8.1%

Always 50.0% 53.1% 38.7% 43.3% 42.6% 57.3%



Page 53

Ease of Finding a Satisfactory PCPPercent of respondents reporting that it was “usually” or “always” easy to find a


Percent of respondents reporting that it was usually or always easy to find a personal doctor in Medicaid that they were “happy with”:

67.6%Medicaid FFS


56 2%

54.6%

MPN: NetPass

MediPass

65 4%

59.4%

56.2%

MPN: AHS

MPN: NetPass

65.4%

0% 20% 40% 60% 80% 100%

PSN



Page 54

More Than Three-Quarters of Medicaid Enrollees Rate Their Choice of Doctors as “Good,” “Very Good,” or “Excellent”

Respondents who reported having changed PCPs since switching to Medicaid were asked to rate the number of PCPs they had to choose from in their health plan. Overall, 44% of respondents rated the choice as “excellent” or “very good,” while 34% rated it as “good,” and 22% rated the choice as “fair” or “ ”“poor.”

There was a significant difference between the Medicaid plans on this measure, with the PSN group reporting most favorably. Forty-one percent of PSN enrollees rated the choice of doctors in their plan as “excellent,” a figure which exceeds the next highest figure by 11%. The MPN: AHS group and the M diP t d l t f blMediPass group reported least favorably.

Rating of the Number ofRating of the Number of Doctors to Choose From in

Health Plan

Medicaid Overall

Medicaid HMO


NetPassMPN: AHS PSN

Excellent 22.1% 23.7% 23.1% 16.3% 30.1% 18.4% 40.9%

Very Good 21.8% 18.6% 22.5% 20.5% 12.0% 16.1% 18.2%

Good 34.1% 32.1% 36.4% 25.3% 30.1% 30.5% 28.7%

Fair 13.3% 15.5% 11.6% 19.5% 17.5% 22.4% 9.4%

Poor 8.7% 10.1% 6.4% 18.4% 10.4% 12.6% 2.8%




Page 55

Ratings of the Number of Doctors to Choose From

P t f d t h t d their h i f d t “ ll t” “ d”


Percent of respondents who rated their choice of doctors as “excellent” or “very good”:

45.6%

42.3%

Medicaid FFS


42 1%

36.8%

MPN: NetPass

MediPass

59 1%

34.5%

42.1%

MPN: AHS

MPN: NetPass

59.1%

0% 20% 40% 60% 80% 100%

PSN




Page 56

Most Medicaid Enrollees Rate their PCP Highly

Respondents who reported that they had a personal doctor were asked to rate their doctor on a scale of 0 to 10, with 0 being the “worst personal doctor possible” and 10 being the “best personal doctor possible.” Overall, most Medicaid respondents rated their doctors very highly, with 72% giving their doctor a rating of 9 or 10. This compares favorably with figures from Medicaid-enrolled adults

ti id i hi h 60% t d th i d t t 9 10 * Th Fl id M di id fi l d thnationwide, in which 60% rated their doctor at 9 or 10.* The Florida Medicaid figure also exceeds the commercial plan national average, which was 63%. The mean rating of doctors was 8.89 for Florida Medicaid respondents overall.

There was a significant difference in the ratings of respondents from the different Medicaid programs, with PSN respondents rating the doctors most favorably among all of the programs Eighty onewith PSN respondents rating the doctors most favorably among all of the programs. Eighty-one percent of PSN enrollees rated their doctors at 9 or 10, and the mean rating was 9.17. The MPN: NetPass group also rated doctors highly, and was the only other program whose respondents ranked their personal doctors above 9. *Source: 2007 CAHPS Health Plan Survey Chartbook, National CAHPS Benchmarking Database

Rating of Personal Doctor (Scale 0-10)

Medicaid Overall

Medicaid HMO


NetPassMPN: AHS PSN

0 to 6 10.4% 17.5% 9.8% 12.9% 9.5% 14.8% 7.0%

7 to 8 17 6% 19 9% 17 5% 18 3% 15 2% 22 7% 12 2%

y , g

7 to 8 17.6% 19.9% 17.5% 18.3% 15.2% 22.7% 12.2%

9 to 10 72.0% 62.6% 72.7% 68.8% 75.3% 62.6% 80.7%

Mean Rating of Personal Doctor 8.89 ± 0.89 8.26 ± 0.86 8.93 ± 1.86 8.69 ± 2.17 9.05 ± 1.74 8.44 ± 2.28 9.17 ± 1.82

fM di id HMO t t ti ti ll bl t th



Page 57

Ratings of Personal DoctorScale: 0 to 10 where 0 is the “worst personal doctor possible” and 10 is the “bestScale: 0 to 10 where 0 is the worst personal doctor possible and 10 is the best personal doctor possible.”

17 6%10 4% 72 0%Medicaid Overall

0 to 6 7 to 8 9 to 10

17.5% 19.9%

17.6%10.4% 72.0%

62.6%Medicaid HMO

Medicaid Overall

12.9%

9.8%

18.3%

17.5%

68.8%

72.7%

MediPass

Medicaid FFS

14.8%

9.5%

22.7%

15.2% 75.3%

62.6%MPN: AHS

MPN: NetPass

7.0% 12.2% 80.7%

0% 20% 40% 60% 80% 100%

PSN




Page 58

Specialty CareSpecialty Care

Page 59

Enrollees’ Ease In Getting Specialist Appointments Varies Greatly Among Programs

Respondents who reported that they had tried to make an appointment to see a specialist physician in the 6 months prior to the interview (46%) were asked how difficult it had been to get that appointment. Their responses varied significantly. Overall, 63% reported it was “always” easy to get the appointments. This is a favorable finding, considering that the national CAHPS average for Medicaid adults is 45% reporting it “ l ” t t i t t f i lt * A th 14% f d t i di t d itit was “always” easy to get appointments for specialty care*. Another 14% of respondents indicated it was “usually” easy to get appointments with specialists, and 23% reported it was “sometimes” or “never” easy. So, while the majority of respondents in Medicaid reported relative ease in getting appointments to see specialists, a sizable minority – 23% - reported that they frequently had difficulty.

The reports of the Medicaid plans differed significantly on this measure with the FFS population reportingThe reports of the Medicaid plans differed significantly on this measure, with the FFS population reporting most favorably by far. Roughly two-thirds (66%) of FFS respondents reported it was “always” easy to see a specialist in Medicaid, and another 15% reported it was “usually” easy. Nineteen percent reported it was “never” or “sometimes” easy to see a specialist in Medicaid. The reports of the other program groups were similar, with 45-54% indicating it was “always” easy to get specialist appointments and 34-41% reporting it was “sometimes” or “never” easy.

*Source: 2007 CAHPS Health Plan Survey Chartbook, National CAHPS Benchmarking Database

Easy to Get Appointments with Specialists

Medicaid Overall

Medicaid HMO


NetPassMPN: AHS PSN

Never or Sometimes 23.4% 38.8% 19.3% 39.1% 37.3% 41.3% 34.3%

Usually 13.8% 16.5% 14.6% 10.7% 9.2% 13.4% 11.6%

Always 62.8% 44.7% 66.1% 50.3% 53.6% 45.4% 54.1%




Page 60

Ease of Seeing a SpecialistQ. In the last 6 months, how often was it easy to get appointments with specialists?Q. In the last 6 months, how often was it easy to get appointments with specialists?

76 6% 23 4%Medicaid Overall

Usually or Always Sometimes or Never

61.2%

76.6% 23.4%

38.8%Medicaid HMO

Medicaid Overall

61.0%

80.7%

39.1%

19.3%

MediPass

Medicaid FFS

58.8%

62.8% 37.3%

41.3%MPN: AHS

MPN: NetPass

65.7% 34.3%

0% 20% 40% 60% 80% 100%

PSN




Page 61

Enrollees’ Experiences Getting Specialist Appointments Vary by Program

Respondents who reported that they had tried to make an appointment to see a specialist physician in the 6 months prior to the interview (46%) were asked about reasons why they may have experienced difficulties in getting that appointment. Respondents were able to give multiple reasons why they may have experienced difficulty. Overall, the most common reasons had to do with the specialist network. Fifty-nine percent of respondents overall listed reasons related to the network’s comprehensiveness or geographic proximity of the providers in the network as factors in their difficulty getting specialist appointments. Thirty-nine percent of respondents indicated that they had difficulty getting plan authorization or had difficulty finding needed plan information on their choice of specialists. Thirty-one percent of respondents said that they had difficulty getting an appointment with a specialist due to the specialist’s schedule or limited availability. Seventeen percent indicated they had difficulty getting a referral from their primary care provider.

There were differences between programs in the reasons given for having difficulty getting appointments with specialists. p g g g y g g pp pFor the FFS, MediPass, and MPN groups, the most common reasons had to do with the specialist network or choice of specialists (55-73%), while for the PSN group, the most common reasons had to do with health plan administration (52%)–specifically, that plan authorization was delayed (34%).

Reasons Subjects Had Difficulty Getting Medicaid Medicaid Medicaid MediPass MPN: MPN: PSNDifficulty Getting

Appointments with Specialists Overall HMO FFS MediPass NetPass AHS PSN

Difficulty getting referral from PCP 17.2% 19.0% 11.9% 8.5% 18.1% 22.4%

Difficulty with plan administration/availability ofadministration/availability of information 38.9% 34.5% 50.0% 50.7% 51.1% 52.2%

Specialist Network/Choice of Specialists Insufficient 59.3% 55.2% 72.6% 67.6% 58.5% 43.3%

Specialist's Schedule 31.4% 31.0% 34.5% 28.2% 21.3% 26.9%



Page 62

Reasons for Difficulty Getting Specialist AppointmentsPercent of respondents indicating difficulty getting appointments with specialistsPercent of respondents indicating difficulty getting appointments with specialists due to various factors:

Difficulty Getting Referral

38 9%

17.2%

Difficulty with PlanAdministration or

Difficulty Getting Referralfrom PCP

59.3%

38.9%

Specialist Network/Choiceof Specialists Insufficient

Administration orInformation Availability

31.4%Specialist's Schedule

of Specialists Insufficient

0% 20% 40% 60% 80% 100%



Page 63

Medicaid Enrollees Rate their Specialist Doctors Highly

Respondents who reported that they had seen a specialist doctor in the 6 months prior to interview were asked to rate their specialist on a scale of 0 to 10, with 0 being the “worst specialist possible” and 10 being the “best specialist possible.” Overall, most Medicaid respondents rated their specialists very highly, with 70% giving their specialist doctor a rating of 9 or 10. This compares favorably with figures f M di id ll d d lt ti id i hi h 60% t d th i i li t d t t 9 10 * Thfrom Medicaid-enrolled adults nationwide, in which 60% rated their specialist doctor at 9 or 10.* The Florida Medicaid figure also exceeds the nationwide average for commercial insurance consumers, in which 61% rated their specialists at a 9 or 10.* The mean rating of specialists was 8.78 for Florida Medicaid respondents overall.

There was a significant difference in the ratings of respondents from the different Medicaid programs, with PSN respondents rating the doctors most favorably among all of the programs. Seventy-five percent of PSN enrollees rated their specialists at 9 or 10, and the mean rating was 9.00. The PSN was the only program in which the mean specialist rating was at or above 9.*Source: 2007 CAHPS Health Plan Survey Chartbook National CAHPS Benchmarking Database

Rating of Specialist Doctor (Scale 0-10)

Medicaid Overall

Medicaid HMO


NetPassMPN: AHS PSN

0 to 6 10.3% 17.2% 10.1% 11.0% 10.6% 14.1% 10.0%


7 to 8 19.6% 19.4% 19.2% 21.5% 20.1% 18.1% 15.4%

9 to 10 70.2% 63.5% 70.8% 67.6% 69.4% 67.8% 74.6%

Mean Rating of Specialist 8.78 ± 0.93 8.33 ± 0.82 8.79 ± 2.00 8.73 ± 2.16 8.83 ± 1.88 8.68 ± 2.12 9.00 ± 1.80




Page 64

Rating of Specialist DoctorsScale: 0 to 10 where 0 is the “worst specialist possible” and 10 is the “bestScale: 0 to 10 where 0 is the worst specialist possible and 10 is the best specialist possible.”

19 6%10.3% 70 2%Medicaid Overall

0 to 6 7 to 8 9 to 10

10.1%

17.2%

19.2%

19.4%

19.6%10.3%

70.8%

70.2%

63.5%

Medicaid FFS

Medicaid HMO

Medicaid Overall

10.6%

11.0%

20.1%

21.5%

69.4%

67.6%

MPN: NetPass

MediPass

10.0%

14.1%

15.4%

18.1% 67.8%

74.6%PSN

MPN: AHS

0% 20% 40% 60% 80% 100%




Page 65

Other Types of CareOther Types of Care

Page 66

Medicaid Enrollees Report Getting Urgent Care in a Timely Fashion

Respondents were asked if, in the 6 months prior to the interview, they had experienced an illness or injury requiring immediate medical attention. Those who reported affirmatively (46%) were asked if they had gotten that care as soon as they wanted it. Sixty-five percent of Medicaid enrollees overall reported that they “always” got the care as soon as they wanted it It is worthy of note that this figurereported that they always got the care as soon as they wanted it. It is worthy of note that this figure compares favorably with national CAHPS averages for Medicaid and commercial plans. Nationally, only 56% of adult Medicaid enrollees reported that they “always” got such care as soon as they wanted it, while 60% of commercial plan enrollees reported getting such care as soon as they wanted it.* Among Florida Medicaid survey respondents, 17% reported that they “usually” got care for illnesses or injuries as soon as desired, and 14% percent reported that they “sometimes” did. Four percent reported they “never” got that care as soon as they felt necessary.

The reports of the seven Medicaid plans differed significantly on this measure, but the difference was too small to be of practical significance.

Got Immediate Care for Illness or Injury as Soon as Desired

Medicaid Overall

Medicaid HMO


NetPassMPN: AHS PSN

Never 4.1% 4.0% 3.7% 5.9% 7.5% 3.3% 3.7%


Never 4.1% 4.0% 3.7% 5.9% 7.5% 3.3% 3.7%

Sometimes 13.9% 22.6% 14.0% 11.8% 15.0% 22.1% 19.1%

Usually 16.7% 15.2% 17.1% 17.1% 10.2% 9.7% 6.2%

Always 65.3% 58.2% 65.2% 65.3% 67.4% 64.9% 71.0%




Page 67

Getting Urgent Care QuicklyPercent reporting that they “always” got an appointment for urgent care as quickly


Percent reporting that they always got an appointment for urgent care as quickly as they wanted:

58.2%

65.2%Medicaid FFS

Medicaid HMO

65.3%

67 4%MPN: NetPass

MediPass

67.4%

64.9%MPN: AHS

MPN: NetPass

71.0%

0% 20% 40% 60% 80% 100%

PSN




Page 68

Medicaid Enrollees Report Satisfaction with Timeliness of Non-Urgent Care

Respondents were asked if, in the 6 months prior to the interview, they had made an appointment for non-urgent health care. The 75% who reported affirmatively were asked if they had gotten that care as soon as they wanted it. Sixty-six percent of Medicaid enrollees overall reported that they “always” got the care as soon as they wanted it This figure compares quite favorably with national CAHPS reports*the care as soon as they wanted it. This figure compares quite favorably with national CAHPS reports , which show 51% of adult Medicaid enrollees, 53% of adult commercial enrollees, and 63% of Medicare enrollees reporting that they “always” got such care as soon as they wanted it. Among Florida Medicaid survey respondents, 18% reported that they “usually” got non-urgent care as soon as desired, and 12% reported that they “sometimes” did. Four percent reported they “never” got that care as soon as they felt necessary.

Among programs, the Medicaid HMO group had the lowest portion (71%) of respondents indicating that they “usually” or “always” got an appointment as soon as they wanted it, and the FFS group had the highest portion at 86%. The 5 non-HMO plans did not differ significantly on this measure, but the HMO

t d t ti ti ll ith th th 5group was not compared statistically with the other 5 programs.

Got Appointment for Non-Urgent Care as Soon as Desired

Medicaid Overall

Medicaid HMO


NetPassMPN: AHS PSN

Never 3 9% 4 7% 3 7% 4 9% 2 7% 4 9% 4 8%


Never 3.9% 4.7% 3.7% 4.9% 2.7% 4.9% 4.8%

Sometimes 12.1% 24.8% 10.7% 16.8% 16.6% 20.1% 18.9%

Usually 17.8% 17.8% 18.8% 14.0% 13.5% 13.5% 10.4%

Always 66.3% 52.8% 66.8% 64.2% 67.2% 61.5% 65.9%




Page 69

Getting Non-Urgent Care QuicklyPercent reporting that they “always” got an appointment for routine care as quickly


p g y y g pp q yas they wanted:

68.0%

52.8%

Medicaid FFS

Medicaid HMO

64.2%

68.0%

MPN N tP

MediPass

Medicaid FFS

61.5%

67.2%

MPN: AHS

MPN: NetPass

65.9%

0% 20% 40% 60% 80% 100%

PSN




Page 70

Seventy Percent of Medicaid Enrollees Report Receiving Appointments for Non-Urgent Care Within One Week

More than seventy percent of Medicaid enrollees reported that, when they needed non-urgent care, they received that care within one week of calling for an appointment. Thirteen percent reported waiting between 1 and 2 weeks for the appointment, and 17% reported waiting longer than 2 weeks. Responses on this survey question were cross-referenced with those from the question regarding satisfaction with wait times for non-urgent appointments. Of th h t d iti l th 2 k f i t t 69% t d th t th “ ll ”Of those who reported waiting longer than 2 weeks for an appointment, 69% reported that they “usually” or “always” got appointments as soon as desired. This suggests that many of those patients who waited 2 weeks or longer for an appointment may have intentionally booked these appointments weeks in advance, and, thus, were satisfied with their wait times.

The reports of the program components varied significantly on this measure The MPN: NetPass group reportedThe reports of the program components varied significantly on this measure. The MPN: NetPass group reported most favorably, with 77% of respondents indicating that they received non-urgent care within one week of calling for an appointment. The FFS and MediPass groups also reported favorably, with 70-71% receiving and appointment within one week. The PSN group reported least favorably, with 43% reporting that they received an appointment within one week, and 48% reporting that they waited longer than 2 weeks. It should be noted that among PSN respondents who waited longer than 2 weeks 73% indicated that they “usually” or “always” gotamong PSN respondents who waited longer than 2 weeks, 73% indicated that they usually or always got appointments as soon as desired, again suggesting that the appointments may have intentionally been booked far in advance.

Days Waiting Between Making an Appointment and Seeing a Medicaid

O llMedicaid

HMOMedicaid

FFS MediPass MPN: N tP

MPN: AHS PSNan Appointment and Seeing a

Provider Overall HMO FFS MediPass NetPass AHS PSN

0 to 7 days 70.2% 70.0% 71.2% 77.4% 67.0% 43.1%

8 to 14 days 13.0% 13.2% 12.8% 7.7% 10.7% 9.0%

15 days or longer 16.8% 16.7% 16.0% 14.9% 22.3% 48.0%



Page 71

Days Waiting for Routine Care AppointmentsPercent reporting that they got an appointment for routine care within one week:


Percent reporting that they got an appointment for routine care within one week:

70.0%Medicaid FFS


77 4%

71.2%

MPN: NetPass

MediPass

67.0%

77.4%

MPN: AHS

MPN: NetPass

43.1%

0% 20% 40% 60% 80% 100%

PSN



Page 72

Large Portion of Medicaid Enrollees Report Visiting ERs

Respondents were asked if, in the 6 months prior to the interview, they had visited an emergency room (ER) to get treatment for themselves. While most Medicaid respondents (66%) indicated that they had not, more than one-third (34%) indicated that they had visited an ER, with 16% indicating they had made 2 or more visits. It is important to note that these figures are based on self-report. It may be difficult for respondents to recall whether a particular ER visit occurred during the 6 month time framedifficult for respondents to recall whether a particular ER visit occurred during the 6 month time frame referenced in the question, and, thus, the number of visits reported for this time period could be an inflated figure.

The number of ER visits did not differ significantly by plan.

ER Visits in 6 Months Prior to Interview

Medicaid Overall

Medicaid HMO


NetPassMPN: AHS PSN

None 65.9% 66.9% 62.1% 63.7% 61.4% 63.5%

1 17.9% 17.9% 18.3% 20.1% 16.2% 15.4%

2 or more 16.1% 15.2% 19.6% 16.2% 22.5% 21.2%



Page 73

ER Visits in 6 Months Prior to InterviewQ. In the last 6 months, how many times did you go to an emergency room to get

65 9% 17 9% 16 1%Medicaid Overall

No Visits One Visit Two or More Visits

Q. In the last 6 months, how many times did you go to an emergency room to get care for yourself?

%

65.9%

%

17.9% 16.1%

%M di id FFS

Medicaid HMO

Medicaid Overall

Question Not Asked

62.1%

66.9%

18.3%

17.9% 15.2%

19.6%MediPass

Medicaid FFS

61.4%

63.7%

16.2%

20.1%

22.5%

16.2%

MPN: AHS

MPN: NetPass

63.5% 15.4% 21.2%

0% 20% 40% 60% 80% 100%

PSN



Page 74

Illness Prevention Often Discussed with Medicaid Patients

Respondents were asked how often they had discussed illness prevention with their doctor or health care provider in the 6 months prior to interview. Fifty-four percent of Medicaid enrollees overall indicated that they “usually” or “always” discussed preventive care with the health care provider, while 24% indicated that they “sometimes” did, and 22% indicated that they “never” discussed illness prevention in the 6 months prior to interviewprevention in the 6 months prior to interview.

The Medicaid programs differed significantly on this measure, with the PSN group reporting most favorably. Nearly half (48%) of PSN enrollees indicated that they “always” discussed illness prevention with their health care provider, and another 12% indicated that they “usually” did. The reports of the other programs ranged from 38-40% indicating that they “always” discussed illnessreports of the other programs ranged from 38 40% indicating that they always discussed illness prevention and 12-18% indicating that they “usually” did.

Discussed Illness Prevention with Doctor in Last 6 Months

Medicaid Overall

Medicaid HMO


NetPassMPN: AHS PSN

Never 22.2% 23.1% 18.3% 21.3% 21.4% 21.5%Never 22.2% 23.1% 18.3% 21.3% 21.4% 21.5%

Sometimes 23.7% 22.5% 29.7% 21.3% 25.9% 18.6%

Usually 15.6% 16.3% 12.1% 17.7% 13.9% 11.5%

Always 38.5% 38.1% 39.9% 39.7% 38.7% 48.4%



Page 75

Illness Prevention Discussed with Medicaid PatientsPercent reporting that they “always” or “usually” discussed illness prevention with

38 5% 15 6% 22 2%23 7%Medicaid Overall

Always Usually Sometimes Never

Percent reporting that they always or usually discussed illness prevention with their health provider in the 6 months prior to interview.

38.5% 15.6% 22.2%23.7%

Medicaid HMO

Medicaid Overall

Question Not Asked

39.9%

38.1%

12.1%

16.3%

18.3%

23.1%

29.7%

22.5%

MediPass

Medicaid FFS

38.7%

39.7%

13.9%

17.7%

21.4%

21.3%21.3%

25.9%MPN: AHS

MPN: NetPass

48.4% 11.5% 21.5%18.6%

0% 20% 40% 60% 80% 100%

PSN



Page 76

Most Medicaid Enrollees Report Few Problems Getting Care, Tests, or Treatment

Respondents who reported needing care, tests, or treatment in the 6 months prior to the interview (47%) were asked how difficult it was to get the needed care. Overall, 53% of respondents reported it was “always” easy to get that care in Medicaid, and 19% reported it was “usually” easy. Nineteen

t f d t t d it “ ti ” d 9% t d it “ ”percent of respondents reported it was “sometimes” easy and 9% reported it was “never” easy. These figures compare favorably with national Medicaid figures compiled by the National CAHPS Benchmarking Database*, in which only 48% of Medicaid-enrolled adults reported it was “always” easy to get care through their plan.

Th fi l did t diff i ifi tl thiThe five plans did not differ significantly on this measure.


How Often was it Easy to Get Care, Tests, or Treatment

Through Health Plan

Medicaid Overall

Medicaid HMO


NetPassMPN: AHS PSN

Never 9 1% 12 5% 7 2% 15 2% 13 6% 17 2% 8 7%

y , g

Never 9.1% 12.5% 7.2% 15.2% 13.6% 17.2% 8.7%

Sometimes 19.4% 22.6% 19.2% 20.6% 18.8% 19.1% 22.0%

Usually 18.8% 21.2% 19.2% 18.1% 16.2% 13.4% 12.7%

Always 52.7% 43.7% 54.5% 46.1% 51.3% 50.3% 56.7%




Page 77

Ease of Getting Care, Tests, or TreatmentPercent of respondents reporting that it was “usually” or “always” easy to get


needed care, tests, or treatment:

73.7%

64.9%

Medicaid FFS

Medicaid HMO

67.5%

64.2%

MPN: NetPass

MediPass

63.7%

PSN

MPN: AHS

MPN: NetPass

69.4%

0% 20% 40% 60% 80% 100%

PSN




Page 78

Most Medicaid Enrollees Report No Problems Getting Prescriptions Through Medicaid

Medicaid enrollees were asked if they got any new prescriptions for medication or needed to refill any prescriptions in the 6 months prior to the interview. Seventy-eight percent of respondents overall responded affirmatively. Those who reported that they did get a new prescription or a refill were asked “how often it was easy” to get this prescription through Medicaid. Most respondents (90%) reported it was “ ll ” “ l ” hil 7% i di t d it “ ti ” d 2% i di t d it “ ”“usually” or “always” easy, while 7% indicated it was “sometimes” easy and 2% indicated it was “never” easy to get their prescriptions through Medicaid.

There was a statistically significant difference between the programs on this measure, though the nature and practical significance of the difference is difficult to discern. Although the PSN and FFS groups have the highest number of respondents indicating that it was “always” easy to get prescriptions these twothe highest number of respondents indicating that it was always easy to get prescriptions, these two programs also had the two highest percentage of respondents indicating it was “never” easy to get prescriptions. It is possible that the experiences of enrollees vary considerably in these programs. Policy implications are difficult to predict, given this variability in reported experience.

How Often Was it Easy to Get Prescription

Medicaid Overall

Medicaid HMO


NetPassMPN: AHS PSN

Never 2.4% 2.4% 2.1% 1.6% 2.1% 3.0%

Sometimes 7.4% 6.6% 10.5% 13.7% 10.6% 10.0%

Usually 13.2% 12.8% 15.4% 12.9% 13.6% 4.4%

Always 77.1% 78.3% 72.0% 71.8% 73.6% 82.7%



Page 79

Obtaining Prescription Drugs Through MedicaidQ. In the last 6 months, how often was it easy to get your prescription medicine from your health plan?

Always Usually or Sometimes Never

78 3%

77.1%

19 4%

20.6% 2.4%

2 4%Medicaid FFS

Medicaid HMO

Medicaid Overall

Question Not Asked

71.8%

72.0%

78.3%

26.6%

25.9%

19.4% 2.4%

2.1%

1.6%MPN: NetPass

MediPass

Medicaid FFS

82.7%

73.6%

71.8%

14.4%

24.2%

26.6%

3.0%

2.1%

1.6%

PSN

MPN: AHS

MPN: NetPass

0% 20% 40% 60% 80% 100%



Page 80

Communicating with ProvidersCommunicating with Providers

Page 81

Medicaid Enrollees Report that Most Medicaid Providers Communicate Well

Respondents were asked a series of questions about whether their Medicaid providers communicated well with them. The vast majority of respondents indicated that their providers did communicate well. Eighty-seven percent indicated that their provider “usually” or “always” explained things so that they could understand. Eighty-nine percent indicated that their doctor “usually” or “always” listened carefully to them. Ninety two percent said that their doctor “usually” or “always” showed respect for what they said and 90%Ninety-two percent said that their doctor usually or always showed respect for what they said, and 90% indicated that their doctor spent enough time with them. Responses to these three questions were cross-referenced to show that 77% of Medicaid respondents overall indicated that their provider “usually” or “always” performed all four of these tasks.

The Medicaid programs differed significantly on these measures. The HMO and MPN: AHS groups had theThe Medicaid programs differed significantly on these measures. The HMO and MPN: AHS groups had the lowest percentages of respondents reporting favorably on these measures individually. Recall, however, that the performance of the HMO group cannot be statistically compared with that of the other groups in this report (see methods section for more information).

Doctor "Usually" or Medicaid Medicaid Medicaid MediPass MPN: MPN: AHS PSN"Always"... Overall HMO FFS MediPass NetPass MPN: AHS PSN

Explained Things So That Subject Could Understand 86.8% 82.6% 86.4% 88.2% 90.3% 84.4% 88.3%

Listened Carefully to Subject 89.0% 83.8% 89.5% 86.4% 92.2% 85.7% 93.3%j

Showed Respect for What Subject Said 91.6% 85.8% 92.4% 88.7% 87.9% 86.4% 90.9%

Spent Enough Time With Subject 89.8% 80.0% 91.3% 83.8% 85.6% 82.5% 86.1%




Page 82

Medicaid Providers Communicate WellCombines responses from four questions. Percent of respondents reporting that providers “usually” or “always” performed the following functions:

•“Explained things so that they (as a patient) could understand,”•“Listened carefully,” •“Showed respect for what they said,” and“S t h ti ” ith th•“Spent enough time” with them.

72.0%

76.7%

Medicaid HMO

Medicaid Overall

74.8%

77.3%

72.0%

MediPass

Medicaid FFS

Medicaid HMO

68.3%

75.0%

MPN: AHS

MPN: NetPass

76.8%

0% 20% 40% 60% 80% 100%

PSN




Page 83

Some Medicaid Enrollees Report Language Barriers in Communicating with Providers

Medicaid enrollees were asked whether, in the 6 months prior to interview, they had experienced difficulty communicating with their health provider due to speaking a different language than the provider. Overall, 83% of respondents indicated that they “never” experienced difficulty, while 7% indicated they “sometimes” did, and 1% indicated they “usually” did. Nine percent of respondents indicated that they , y y p p y“always” had difficulty communicating with their doctor due to language barriers. When cross-referenced with the survey question about the respondent’s primary language, results show that 18% of those whose primary language is something other than English reported that they “usually” or “always” had difficulty communicating with their provider due to language differences, compared with 7% among those whose primary language was Englishwhose primary language was English.

There were no statistically significant differences between the Medicaid programs on this measure.

Experienced DifficultyExperienced Difficulty Communicating With Doctor Due to Speaking Different Languages

Medicaid Overall

Medicaid HMO


NetPassMPN: AHS PSN

Never 82.9% 83.4% 81.1% 82.5% 80.7% 78.1%

Sometimes 6 7% 6 5% 7 4% 7 0% 8 8% 7 0%Sometimes 6.7% 6.5% 7.4% 7.0% 8.8% 7.0%

Usually 1.4% 1.4% 1.1% 1.6% 0.9% 2.1%

Always 9.0% 8.7% 10.4% 9.0% 9.7% 12.8%



Page 84

Language Barriers

P t f d t i di ti th t th “ ll ” “ l ” h d diffi ltPercentage of respondents indicating that they “usually” or “always” had difficulty communicating with a doctor or other health provider because they spoke different languages:

10.4%

Medicaid HMO

Medicaid Overall

Question Not Asked

10.1%

11.5%MediPass

Medicaid FFS

10.6%

10.6%MPN: AHS

MPN: NetPass

14.9%

0% 20% 40% 60% 80% 100%

PSN



Page 85

Most Medicaid Enrollees Report Being Involved in Health Care Decision Making and Agreeing with Providers on Health Care Management

Patients who feel that they are involved in their health care decision making are more likely to be satisfied with their care.* When asked how often they were involved in their health care decision making, most Medicaid enrollees surveyed (79%) said that they were “usually” or “always” involved. Among Medicaid program components, there was no significant difference on this measure.

Enrollees were also asked how often it was “easy” to get health care providers to agree with them on the best way to manage their health care. Again, the vast majority of enrollees (81%) reported that it was “usually” or “always” easy. There was a significant difference in the program components on this measure, with MediPass, FFS, and MPN: NetPass reporting most favorably, and the PSN and MPN: AHS reporting least favorably.least favorably.*Source: Kaplan SH, Greenfield S, Gondek B, et al, “Characteristics of physicians with participatory decision-making styles,” Annual of Internal Medicine, 1996, 124: 497-504.

Patient Involvement in Health Care Decision Making

Medicaid Overall

Medicaid HMO


NetPassMPN: AHS PSN

How Often was Subject as Involved as He/She Wanted in Health Care Decisions

Never or Sometimes 20.6% 21.5% 15.4% 17.7% 25.9% 24.5%

Usually or Always 79.4% 78.5% 84.6% 82.4% 74.1% 75.5%

How Often was it Easy to Get Heath Providers to Agree with Subject on Management of Health Conditions

Never or Sometimes 19.1% 19.2% 17.5% 19.8% 26.8% 24.0%

Usually or Always 80.9% 80.8% 82.5% 80.2% 73.3% 76.0%U y y 80 9% 80 8% 8 5% 80 % 3 3% 6 0%



Page 86

Patient Involvement in Health Care Decision Making and Agreement with Providers on Health Care Management

Percent who reported that they were “usually” or “always” as involved as they wanted to be in health care decision making

Percent who reported that it was “usually” or “always” easy to get health providers to agree with them on management of health conditions

80.9%79.4%

Medicaid HMO

Medicaid Overall

Questions Not Asked

agree with them on management of health conditions

80.8%

84.6%

78.5%

MediPass Choice

Medicaid FFS

Medicaid HMO Questions Not Asked

80.2%

82.5%

74.1%

82.4%

MPN: AHS

MPN: NetPass

MediPass Choice

76.0%

73.3%

75.5%

0% 20% 40% 60% 80% 100%

PSN

MPN: AHS

0% 20% 40% 60% 80% 100%



Page 87

Most Medicaid-Enrolled Smokers Report Being Advised by Health Providers to Quit

Smoking has been identified as a major public health risk, so tobacco control has been targeted as a major goal of Healthy People 2010. Medicaid enrollees were asked how often they smoked tobacco, if at all. Overall, 25% reported that they smoked, with the MediPass group having a larger portion of smokers than any other group, at 36%. y g p,

Those who smoked were asked several questions about their health providers’ advice about smoking cessation in the 6 months prior to the interview. Three percent of these respondents indicated that they had no health care visits at all in the 6 months prior to interview. But of those who did have at least one visit, 71% overall indicated that they had been advised to stop smoking during at least one visit. There y p g gwere no significant differences between the programs on any of these measures.

Tobacco Smoking and Cessation Advice

Medicaid Overall

Medicaid HMO


NetPassMPN: AHS PSN

Enrollees Who Report Smoking Tobacco "Some Days" or "Every Day" 24.6% 22.0% 36.1% 27.2% 29.5% 21.7%

Number of Health Care Visits During Which Enrollee was Advised to Quit Smoking

None 29.2% 27.8% 34.1% 20.2% 28.6% 24.6%

One or More 70.8% 72.2% 65.9% 79.8% 71.4% 75.4%



Page 88

Some Medicaid Programs Have More Smokers Than OthersPercentage of enrollees who report smoking tobacco “some days” or “every day”Percentage of enrollees who report smoking tobacco “some days” or “every day” in the 6 months prior to interview:

24 6%Medicaid Overall 24.6%

Medicaid HMO

Medicaid Overall

Question Not Asked

36.1%

22.0%

MediPass

Medicaid FFS

29.5%

27.2%

MPN: AHS

MPN: NetPass

21.7%

0% 20% 40% 60% 80% 100%

PSN



Page 89

Plan AdministrationPlan Administration

Page 90

Florida Medicaid Enrollees More Often Successful in Getting Help from Customer Service Compared With National Average Enrollees who reported that they had tried to get help or information from customer service in the 6 months prior to interview (28% of enrollees overall) were asked how often the customer service department gave them the help they needed. Fifty percent overall indicated that customer service “always” gave them the help they needed. This figure compares favorably with the 48% of Medicaid enrolled adults nationally who

t d th t th “ l ” t th h l th d d d th 46% f i l h lth i lreported that they “always” got the help they needed, and the 46% of commercial health insurance plan enrollees who reported that they “always” got the help they needed.* Twelve percent reported that they “usually” got needed help from customer service, and 22% reported that they “sometimes” got help. Fifteen percent of respondents indicated that they “never” got the help they needed from customer service. There was no significant difference between the plans on this measure.g p

It is important to note that the CAHPS survey question asks about “your health plan’s customer service,” and, thus, does not differentiate well between Florida Medicaid’s customer service department and individual health plans’ or provider groups’ customer service lines.

*Source: 2007 CAHPS Health Plan Survey Chartbook National CAHPS Benchmarking Database

How Often did Health Plan's Customer Service Give Information or Help Needed

Medicaid Overall

Medicaid HMO


NetPassMPN: AHS PSN

Never 15.4% 11.2% 14.3% 19.5% 15.3% 17.4% 9.4%

Source: 2007 CAHPS Health Plan Survey Chartbook, National CAHPS Benchmarking Database

Sometimes 22.3% 23.9% 21.4% 25.2% 21.6% 25.7% 31.8%

Usually 12.2% 16.7% 13.3% 8.1% 12.6% 12.8% 7.5%

Always 50.1% 48.1% 51.0% 47.2% 50.5% 44.0% 51.4%




Page 91

Getting Information and Help from Customer Service

Always Usually Sometimes Never

Q. In the last 6 months, how often did your health plan’s customer service give you the information or help you needed?

16.7%

12.2%

23.9%

22.3%

11.2%

15.4%50.1%

48.1%Medicaid HMO

Medicaid Overall

8.1%

13.3%

25.2%

21.4%

19.5%

14.3%51.0%

47.2%MediPass

Medicaid FFS

12.8%

12.6%

25.7%

21.6%

17.4%

15.3%50.5%

44.0%MPN: AHS

MPN: NetPass

7.5% 31.8% 9.4%51.4%

0% 20% 40% 60% 80% 100%

PSN




Page 92

Most Medicaid Enrollees Report Receiving Help with Care Coordination

The coordination of care has been shown to be an important element of patient satisfaction with care, as patients can easily become frustrated with telephoning doctors for referrals and assuring that test results are shared among their many providers. Thus, Medicaid enrollees were asked whether or not they had received help coordinating their care. More than two-thirds (68%) of respondents reported that they had

i d h l f th i h lth l d t ’ ffi li ireceived help from their health plan, doctor’s office, or clinic.

The reports of the five plans did not vary significantly, with figures for the plans ranging from 61-73% indicating that they received assistance with care coordination.

Subject Received Help with Coordinating Care from Health Plan,

Medicaid Overall

Medicaid HMO


NetPassMPN: AHS PSNg ,

Doctor's Office, or ClinicOverall HMO FFS NetPass AHS

Yes 68.4% 68.7% 68.0% 63.5% 61.3% 73.3%

No 31.6% 31.3% 32.0% 36.5% 38.7% 26.7%



Page 93

Coordination of Care


Percent of respondents who indicated they had received assistance with coordinating care:

68 7%Medicaid FFS

Medicaid HMO

Medicaid Overall

Question Not Asked

68.7%

68.0%

63 5%MPN N tP

MediPass

Medicaid FFS

63.5%

61.3%MPN: AHS

MPN: NetPass

73.3%

0% 20% 40% 60% 80% 100%

PSN



Page 94

Most Respondents Received Help with Care Coordination from their Doctor’s Office or Clinic

Respondents who reported that they received assistance with coordinating their health care (68%) were asked for more information about who had helped them. A list of possible responses was read to the respondent, and for each, the respondent was asked whether or not that resource had provided assistance to them. The majority of respondents (82%) indicated that their doctor’s office or clinic had helped them, while 44% indicated that someone from their health plan has provided assistance. Friends and family members p p ywere also indicated as resources that provided assistance (30%), as were other organizations (16%).

The five Medicaid programs differed significantly in the percentage of people indicating that they received help from their doctor’s office. When compared with the other health program, fewer people in the two MPN groups reported receiving coordination of care help from their doctor’s office. Roughly 67% of enrollees in the MPN: AHS group and 73% of the MPN: NetPass group indicated that they received help from their doctor’s office, compared with 78-83% among the other programs. The programs also differed significantly in the percentage of respondents who reported receiving care coordination from their health plan. Sixty percent of respondents from the PSN group reported that their health plan provided coordination of care assistance for them. This figure was by far the highest among the five plans, with the other plans ranging from 41-44%. g y g g p , p g g

Who helped the patient with care coordination?

Medicaid Overall

Medicaid HMO


NetPassMPN: AHS PSN

Someone from health plan 43.5% 43.4% 44.1% 41.4% 40.6% 60.0%

Someone from doctor's office or clinic 82.0% 82.4% 83.1% 72.7% 67.0% 78.2%

Someone from another organization 16.3% 15.4% 19.9% 18.2% 18.9% 20.9%

A friend or family member 29.8% 29.4% 31.6% 33.3% 29.3% 22.7%



Page 95

Coordination of Care Services Provided by Doctor’s Offices and Health Plans

Percent of respondents indicating that they had received help with care coordination from their doctor’s office or from their health plan in the 6 months prior to interview:

43.5%82.0%

Medicaid HMO

Medicaid Overall

Health Plan Doctor's Office or Clinic

Question Not Asked

44.1%

43.4%83.1%

82.4%

MediPass

Medicaid FFS


40.6%

41.4%

78 2%

67.0%

72.7%

MPN: AHS

MPN: NetPass

60.0%78.2%

0% 20% 40% 60% 80% 100%

PSN



Page 96

Florida Medicaid Enrollees Rate their Health Care a “9” or “10” More Often than National Medicaid Average

Respondents who had at least one medical visit in the 6 months prior to interview were asked to rate all of their health care on a scale of 0 to 10, with 0 being the “worst health care possible” and 10 being the “best health care possible.” Overall, 48% of Medicaid respondents rated their health care at a 9 or 10 Thi f bl ith fi f M di id ll d d lt ti id i hi h 46%10. This compares favorably with figures from Medicaid-enrolled adults nationwide, in which 46% rated their health care at 9 or 10.* The Florida Medicaid figure is equal to the figure from commercial plan enrollees nationwide. The mean rating of health care was 7.92 for Florida Medicaid respondents overall.

There was a significant difference in the ratings of respondents from the different Medicaid programs, with PSN respondents rating their health care most favorably among all of the programs. Fifty-nine percent of PSN enrollees rated their health care at 9 or 10, and the mean rating was 8.29.


Rating of Health Care(Scale 0-10)

Medicaid Overall

Medicaid HMO


NetPassMPN: AHS PSN

0 to 6 22.5% 23.9% 21.4% 27.4% 21.1% 24.6% 19.0%

7 to 8 30.0% 28.2% 30.3% 29.6% 28.9% 23.8% 22.2%

y , g

9 to 10 47.6% 48.0% 48.3% 43.0% 50.0% 51.7% 58.8%

Mean Rating of Health Care in Last 6 Months 7.92 ± 1.06 7.76 ± 0.86 7.97 ± 2.31 7.65 ± 2.41 8.00 ± 2.37 7.86 ± 2.55 8.29 ± 2.31




Page 97

Rating of Health Care in the Last 6 MonthsScale: 0 to 10 where 0 is the “worst health care possible” and 10 is the “best healthScale: 0 to 10 where 0 is the worst health care possible and 10 is the best health care possible.”


0 to 6 7 to 8 9 to 10

23.9%

22.5%

28.2%

30.0% 47.6%

48.0%Medicaid HMO

Medicaid Overall

27.4%

21.4%

29.6%

30.3%

43.0%

48.3%

MediPass

Medicaid FFS

24.6%

21.1%

23.8%

28.9% 50.0%

51.7%MPN: AHS

MPN: NetPass

19.0% 22.2% 58.8%

0% 20% 40% 60% 80% 100%

PSN




Page 98

Florida Medicaid Enrollees Rate their Health Plans a “9” or “10” More Often than Private Health Plan Enrollees

Respondents who had at least one health care visit or procedure in the 6 months prior to interview were asked to rate their health plan on a scale of 0 to 10, with 0 being the “worst health plan possible” and 10 being the “best health plan possible.” Overall, 56% of Medicaid respondents rated their health

l t 9 10 Thi f bl ith fi f M di id ll d d lt ti id iplan at a 9 or 10. This compares favorably with figures from Medicaid-enrolled adults nationwide, in which 51% rated their health care at 9 or 10.* The Florida Medicaid figure also exceeds the figure from commercial plan enrollees nationwide, in which 40% of them rated their plan at a 9 or 10.* The mean rating of health care was 8.07 for Florida Medicaid respondents overall.

There was a significant difference in the ratings of respondents from the different Medicaid programs, with PSN respondents rating their health care most favorably among all of the programs. Seventy-one percent of PSN enrollees rated their health care at 9 or 10, and the mean rating was 8.73. *Source: 2007 CAHPS Health Plan Survey Chartbook, National CAHPS Benchmarking Database

Rating of Health Plan(Scale 0-10)

Medicaid Overall

Medicaid HMO


NetPassMPN: AHS PSN

0 to 6 20.9% 22.9% 19.9% 25.9% 21.6% 23.4% 12.0%

7 to 8 22.9% 27.7% 22.6% 25.3% 19.4% 18.5% 16.8%

9 to 10 56.2% 49.4% 57.5% 48.8% 59.0% 58.1% 71.1%

Mean Rating of Health Plan 8.07 ± 1.17 7.76 ± 0.88 8.15 ± 2.57 7.71 ± 2.70 8.19 ± 2.38 7.93 ± 2.77 8.73 ± 2.14




Page 99

Rating of Health Plan in the Last 6 MonthsScale: 0 to 10 where 0 is the “worst health plan possible,” and 10 is the “best healthScale: 0 to 10 where 0 is the worst health plan possible, and 10 is the best health plan possible.”


0 to 6 7 to 8 9 to 10

22.9%

20.9%

27.7%

22.9% 56.2%

49.4%Medicaid HMO

Medicaid Overall

25.9%

19.9%

25.3%

22.6%

48.8%

57.5%

MediPass

Medicaid FFS

23.4%

21.6%

18.5%

19.4% 59.0%

58.1%MPN: AHS

MPN: NetPass

12.0% 16.8% 71.1%

0% 20% 40% 60% 80% 100%

PSN




Page 100

Glossary

Page 101

AHCA A f H lth C Ad i i t ti

GLOSSARY

AHCA: Agency for Health Care Administration

CAHPS: Consumer Assessment of Healthcare Providers and Systems

FFS: Fee-for-Service

HMO: Health Maintenance Organization

MPN: Minority Physician Network

MPN: AHS: Access Health Solutions

Outcome Rate: A general or “umbrella” term used in survey research to describe the portion of completed interviews to attempted interviews or possible interviews. There are different types of outcome rates, including response rates, cooperation rates, and contact rates.

PCP: Primary Care ProviderPCP: Primary Care Provider

PHQ-2: Patient Health Questionnaire. A short questionnaire used as a preliminary screen for depression.

PSN: Provider Service Network

SF-12: 12 Item Short-Form Health Survey. A 12-item scale used to assess the health status of respondents.

SSI: Supplemental Security Income

TANF: Temporary Assistance for Needy Families

Page 102

Acknowledgments

Page 103

CHARTBOOK TEAM

Chartbook teamFlorida Center for Medicaid & the Uninsured

Authors: Heather Steingraber, Research Coordinator

Technical Assistance: Chris Mallison and Jianyi Zhang, PhD

Center Director: R. Paul Duncan, PhD

Funded by: The Agency for Health Care AdministrationFunded by: The Agency for Health Care AdministrationProject Officers: Cliff Schmidt, MPA, AHC Administrator

Danni Atkins, RN, BSN, CLNC, Government Analyst IIOffice of Research Contracts and Evaluations

Agency Staff: Susan Dilmore PMP Bureau ChiefAgency Staff: Susan Dilmore, PMP, Bureau Chief Medicaid Quality Management

Dyke Snipes, Deputy Secretary for Medicaid

S i l Th k t Bill D hl d Th Fl id C t f H lth I f tiSpecial Thanks to: Bill Dahlem and The Florida Center for Health Information and Policy Analysis for providing survey data from Medicaid HMOs

Page 104

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