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Low Income Health Program Performance Dashboard

Alameda July 1, 2011 - December 31, 2013

About the Low Income Health Program

The Low Income Health Program (LIHP), authorized under the 2010 “Bridge to Reform” §1115 Medicaid Waiver, is an optional program implemented by counties or other governmental entities, offering health care coverage to low income uninsured adults. LIHP includes two components distinguished by family income level: Medicaid Coverage Expansion (MCE) for non-elderly adults with family incomes at or below 133% of the Federal Poverty Level (FPL), and Health Care Coverage Initiative (HCCI) for non-elderly adults with family incomes from 133.01 through 200% FPL. Local LIHPs can set the income levels below the maximum allowable amount, but must operate an MCE in order to implement a new HCCI. Standard program eligibility criteria are established by the waiver Special Terms and Conditions:

• Resident of participating county • Adult, age 19 through 64 • Not eligible for Medicaid or CHIP • Not pregnant • US Citizen, or Legal Permanent Resident with at least 5 years in the US • Income at or below 200% of the FPL (or less based on county eligibility standards)

2 LIHP Performance Dashboard - Alameda 7/1/2011-12/31/2013

About the Evaluation

The UCLA Center for Health Policy Research is contracted to conduct an independent evaluation of the Low Income Health Program, as required by the Special Terms and Conditions. A primary goal of the evaluation is to provide timely feedback of evaluation findings to LIHPs and other stakeholders. The LIHP Performance Dashboard reports are produced on a quarterly basis and contain standard metrics describing program performance in enrollment and health care services.

LIHP Performance Dashboard - Alameda 3 7/1/2011-12/31/2013

This dashboard is specific to Alameda, for the time period July 1, 2011 – December 31, 2013.

Methods

Enrollment and demographic data are used to describe the population enrolled in the program. Enrollment metrics are based on individual enrollment history records for each LIHP enrollee.

7/1/2011-12/31/2013 4 LIHP Performance Dashboard - Alameda

Findings presented in this dashboard report are based on data submitted to UCLA as of December 31, 2013. There is a one quarter delay in reporting utilization metrics to allow sufficient time for claims processing. Even with the one quarter delay, claims data for latter quarters may be incomplete. Future dashboard reports will include updated data on enrollment, demographics, and utilization, and will be revised to reflect retroactive changes to enrollment and utilization.

All analyses contained in this report are dependent on the quality, completeness, and timeliness of data provided by LIHPs. They represent analysis conducted by the UCLA Center for Health Policy Research on the data provided by LIHPs for the purposes of the LIHP evaluation. Detailed methods are available upon request.

Program Facts: Alameda

• Implementation Date: July 1, 2011 • Current Income Limit: 200% FPL • Legacy County

– Participated in the prior waiver as an HCCI county; transitioned to LIHP under the current waiver

– Enrollees from previous HCCI program may be grandfathered into both the MCE and HCCI components of the new program

• Suburban/Urban County in Northern California • Hybrid Payor/Provider County

– Network includes both public and private contracted providers • Total Population: 1,528,000

– Source: 2009 California Health Interview Survey • Visit: DHCS Contract Documentation Page

7/1/2011-12/31/2013 LIHP Performance Dashboard - Alameda 5

http://www.dhcs.ca.gov/provgovpart/Pages/Deliv_Alameda.aspx

ENROLLMENT AND DEMOGRAPHICS

Total Unduplicated Monthly Enrollment, Program-to-Date

7/1/2011-12/31/2013 7

This chart displays the number of individuals enrolled during each month of the program. This can also be interpreted as the number of “member months.”

Total Member Months to Date: 1,230,515

The monthly number of enrollees is dependent on both enrollment and disenrollment. Program strategies for outreach, enrollment, and retention/redetermination, as well as the demand for care within the eligible population and other factors may influence enrollment trends.

Note: Eligibility processing time is continuous, therefore enrollment data for latter months may be retroactively adjusted in the following quarter’s dashboards as new data becomes available.

LIHP Performance Dashboard - Alameda

21,5

62

23,1

24

24,6

49

25,9

48

26,9

63

28,3

72

32,5

92

35,1

58

36,9

79

38,6

61

40,2

64

41,7

54

42,4

13

43,4

96

44,2

43

45,4

46

46,0

66

46,6

64

46,3

70

46,8

53

47,1

78

47,4

00

47,8

79

48,4

91

48,6

65

48,6

81

48,9

45

50,3

39

51,5

64

53,7

96

Trend of Monthly Enrollment and Disenrollment

“Existing Enrollees” are individuals enrolled in their local LIHP during the month prior to the specified month. “New Enrollees” are individuals newly enrolled in LIHP during the specified month. “Disenrolled” are individuals that are no longer enrolled in the program during the month prior to the specified month. The sum of “Existing Enrollees” and “New Enrollees” is the total unduplicated monthly enrollment.

7/1/2011-12/31/2013 8

Note: Eligibility processing time is continuous, therefore enrollment data for latter months may be retroactively adjusted in the following quarter’s dashboards as new data becomes available.


0

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Aug'

11Se

p'11

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Apr'1

2M

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Jul'1

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Existing Enrollees Newly Enrolled Disenrolled

Trend of Monthly Enrollment in Each Program Component, Program-to-Date

Definitions: Enrollees are classified into aid codes according to guidelines set forth in the Special Terms and Conditions. Aid codes are based on two criteria: Income: • MCE: 0 to 133% FPL • HCCI: above 133.01 to 200% FPL Type: • Existing: enrollees whose

enrollment has been effective since November 1, 2010.

• New: enrollees whose enrollment was not effective on November 1, 2010. This includes enrollees who were enrolled during the transition period from December 1, 2010 through June 30, 2011 when legacy counties with prior HCCI programs transitioned from HCCI to LIHP.

7/1/2011-12/31/2013 9

Note: Enrollees may transition between aid codes depending on changes in income level or enrollee type.


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MCE New MCE Existing HCCI New HCCI Existing

Total Cumulative Number of Enrollees in Each Program Component, Program-to-Date

This chart displays the cumulative number of individuals ever enrolled to date, by aid code. A single enrollee may be counted more than once if the individual has transitioned from one aid code to another at any time.

7/1/2011-12/31/2013 10

Total Cumulative Unduplicated Enrollees: 84,203


67,427

4,444

11,614

718

MCE New MCE Existing HCCI New HCCI Existing

Demographic Characteristics of Cumulative Unduplicated Enrollees – Age and Gender

7/1/2011-12/31/2013 11



10.9%

12.9%

11.2%

8.6%

9.2%

11.3%

12.8%

23.1%

Male: (53.6%)

11.5%

11.7%

8.1%

6.0%

7.1%

10.1%

13.6%

31.8%

Female: (46.4%)

11%

12%

10%

7%

8%

11%

13%

27%

<=24

25-29

30-34

35-39

40-44

45-49

50-54

55 +

Overall Age Distribution

Demographic Characteristics of Cumulative Unduplicated Enrollees – FPL

This exhibit displays the percent of enrollees by Federal Poverty Levels (FPLs). LIHPs may have enrollees with FPL higher than the current FPL limit due to HCCI enrollees grandfathered into the program from the previous demonstration.

12

Current Alameda FPL Limit = 200%

Total Cumulative Unduplicated Enrollees: 84,203 Note: All enrollees meet program eligibility rules, regardless of cases where data are unavailable.

7/1/2011-12/31/2013 LIHP Performance Dashboard - Alameda

35.6%

27.1%

6.7% 6.9%

9.4%

14.3%

0-25% 25.1-50% 50.1-75% 75.1-100% 100.1-133% 133.1-200%

Demographic Characteristics of Cumulative Unduplicated Enrollees – Race/Ethnicity


Note: Asian includes Native Hawaiian. Other includes American Indian or Alaska Native. Total Cumulative Unduplicated Enrollees: 84,203

17.9%

26.6%

15.6%

23.2%

4.4%

12.4%

White African American Latino Asian/PI Other Unavailable

Demographic Characteristics of Cumulative Unduplicated Enrollees – Preferred Language


Note: Classification of Languages follows the US Census guidelines. Total Cumulative Unduplicated Enrollees: 84,203

78.8%

6.7% 8.1% 6.4%

English Spanish Asian/PI Languages Other

Chronic Conditions – Prevalence of Diabetes, Asthma/Chronic Obstructive Pulmonary Disease (COPD), Coronary Artery Disease (CAD)/ Congestive Heart Failure (CHF), Dyslipidemia, or Hypertension among Enrollees



9.1%

4.4%

1.8%

12.3%

19.2%

Diabetes Asthma/COPD CAD/CHF Dyslipidemia Hypertension

UTILIZATION OF HEALTH SERVICES

Utilization Methods and Time Frame of Analyses

17

UCLA utilization analyses are based on claims or encounter data provided to UCLA. Utilization metrics describe the volume of health care services paid for by LIHP and the rate of health care utilization among “active” and all enrollees. An “active user” is defined as an enrollee with at least one claim/encounter record in a given quarter. To control for variation in claims data availability and completeness, the number of “active users” is used as the denominator for rate calculations. Rates represent the frequency of use among users, excluding enrollees without health care service use. Emergency room and inpatient records that occur on the same or consecutive days are counted as one visit. Outpatient evaluation and management (E&M) visits include claims with the following CPT codes: 99201-99205, 99211-99215, 99241-99245, 99271-99275, 99381-99387, 99391-99397. Any outpatient E&M claims that occurred on the same day, with the same provider, are counted as one service/visit. There is a one-quarter delay in reporting utilization metrics to allow sufficient time for claims processing. The timeline below illustrates the time frame for the utilization analyses.

7/1/2011-12/31/2013 LIHP Performance Dashboard - Alameda

Proportion of Enrollees Who Were “Active Users” of Health Services, by Service Type


During each time period, a proportion of the enrollees who are beneficiaries of the program will use health services. This proportion, called “active users,” varies by time period, service type, and other factors. “Non-user” enrollees are enrolled, but did not access care paid for by LIHP.

The proportion of enrollees who are “active users” is an important indicator of the demand for care and access to care. However, it may not fully represent utilization by enrollees. There may be unknown gaps in data completeness.

July 1, 2011 - September 30, 2013

Note: There is a one quarter delay in reporting utilization metrics to allow sufficient time for claims processing. Additionally, claims data for latter quarters may be incomplete and retroactively adjusted in the following quarter’s dashboards as new data becomes available. Out-of-network ER benefits are a new benefit covered under LIHP and are included in ER utilization, which may result in ER use increases across quarters.

Total Enrolled Quarter 1: 26,533 Quarter 2: 30,252 Quarter 3: 39,057 Quarter 4: 43,918 Quarter 5: 47,364 Quarter 6: 49,464 Quarter 7: 51,402 Quarter 8: 52,198 Quarter 9: 52,711

52.4% 50.6%

45.7% 44.8%

40.6% 39.3% 39.0% 39.6% 36.4%

11.2% 10.3% 9.2% 8.7% 7.9% 6.9% 6.5% 6.8% 6.5%

1.3% 1.2% 1.1% 1.0% .9% .9% .7% .8% .8%

36.0% 36.0% 33.2% 32.8%

28.8% 29.1% 29.1% 29.8%

22.1%

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60

Quarter 1 Quarter 2 Quarter 3 Quarter 4 Quarter 5 Quarter 6 Quarter 7 Quarter 8 Quarter 9

Any Service Emergency Room (ER) Inpatient (IP) Evaluation and Management (E&M)

Volume of Utilization – Emergency Room Visits, Inpatient Admissions and Evaluation & Management Visits


The total volumes of emergency room (ER), inpatient (IP) admissions, and outpatient evaluation and management (EM) visits represent the total number of services paid for by LIHP. These measures are valuable as assessments of total activity and proxy for expenditures. Total volumes of services and admissions are influenced by the number of enrollees and their characteristics and health seeking behaviors. As enrollment increases, total volumes of utilization are expected to grow.

July 1, 2011 - September 30, 2013

Note: There is a one quarter delay in reporting utilization metrics to allow sufficient time for claims processing. Additionally, claims data for latter quarters may be incomplete retroactively adjusted in the following quarter’s dashboards as new data becomes available. Out-of-network ER benefits are a new benefit covered under LIHP and are included in ER utilization, which may result in ER use increases across quarters.

Total Enrolled Quarter 1: 26,533 Quarter 2: 30,252 Quarter 3: 39,057 Quarter 4: 43,918 Quarter 5: 47,364 Quarter 6: 49,464 Quarter 7: 51,402 Quarter 8: 52,198 Quarter 9: 52,711

4,042 4,237 4,878 5,234 5,036 4,562 4,339 4,725 4,524

379 400 464 507 460 477 418 418 462

16,115

18,571

22,222

25,271

22,638 24,219

25,758 27,021

18,842

0

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Emergency Room (ER) Inpatient (IP) Evaluation and Management (E&M)

Rate of Utilization per 1,000 Enrollees – Inpatient Admissions, Emergency Room and Evaluation & Management Visits


The rates of emergency room (ER), inpatient (IP), and outpatient evaluation and management (EM) utilization per 1,000 enrollees per quarter represent standardized measures of utilization. Rates are adjusted for the level of enrollment in each quarter. Initial increases in rates of utilization may be due to pent-up demand.

July 1, 2011 - September 30, 2013


Total Member Months Quarter 1: 69,335 Quarter 2: 81,283 Quarter 3: 104,729 Quarter 4: 120,679 Quarter 5: 130,152 Quarter 6: 138,176 Quarter 7: 140,401 Quarter 8: 143,770 Quarter 9: 146,291

175 156 140 130 116 99 93 99 93

16 15 13 13 11 10 9 9 9

697 685

637 628

522 526 550 564

386

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The rates of emergency room (ER), inpatient (IP) and outpatient evaluation and management (EM) utilization per 1,000 active enrollees per quarter represent standardized measures of utilization. Rates are adjusted for the level of enrollment in each quarter amongst “active users.” Initial increases in rates of utilization may be due to pent-up demand.

July 1, 2011 - September 30, 2013


Rate of Utilization per 1,000 Active Enrollees – Inpatient Admissions, Emergency Room and Evaluation & Management Visits

Active User Member Months Quarter 1: 52,676 Quarter 2: 66,004 Quarter 3: 82,360 Quarter 4: 93,116 Quarter 5: 97,722 Quarter 6: 100,475 Quarter 7: 100,850 Quarter 8: 101,493 Quarter 9: 99,609

230 193 178 169 155 136 129 140 136

22 18 17 16 14 14 12 12 14

918

844 809 814

695 723

766 799

567

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Average Length of Inpatient Stay


Note: There is a one quarter delay in reporting utilization metrics to allow sufficient time for claims processing. Additionally, claims data for latter quarters may be incomplete and retroactively adjusted in the following quarter’s dashboards as new data becomes available.

The average number of inpatient (IP) days per admission, or “average length of stay” is the total number of IP days divided by the total number of IP visits, per quarter.

July 1, 2011 - September 30, 2013

Total Number of IP Days Quarter 1: 1,628 Quarter 2: 1,983 Quarter 3: 2,112 Quarter 4: 1,760 Quarter 5: 1,908 Quarter 6: 1,996 Quarter 7: 1,736 Quarter 8: 1,694 Quarter 9: 2,411

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Data Source: The data sources for the LIHP Performance Dashboard are from quarterly enrollment, encounter and claims data. These data are provided to UCLA by the participating LIHPs as part of the Low Income Health Program Evaluation. Data Analysts: Xiao Chen, PhD Erin Salce, MPH Natasha Purington, MS Candidate UCLA Center for Health Policy Research Completed with the support of the California Medicaid Research Institute, University of California Funded by Blue Shield of California Foundation and the California Department of Health Care Services Low Income Health Program Performance Dashboards. Analysis by the UCLA Center for Health Policy Research, April 30, 2014.

FOR MORE INFORMATION www.coverageinitiative.ucla.edu

UCLA Center for Health Policy Research 10960 Wilshire Blvd. Suite 1550

Los Angeles, CA, 90024 www.healthpolicy.ucla.edu

http://www.coverageinitiative.ucla.edu/

http://www.healthpolicy.ucla.edu/

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