evaluating medicaid reform in florida: early findings
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Evaluating Medicaid Reform in Florida: Early Findings. Presented by: Allyson Hall, PhD On behalf of the UF MRE Team AcademyHealth: State Health Policy Interest Group Meeting June 7, 2008. More Choices for Beneficiaries HMOs and PSNs Customized benefit packages - PowerPoint PPT PresentationTRANSCRIPT
Evaluating Medicaid Reform in Florida: Early FindingsPresented by: Allyson Hall, PhD
On behalf of the UF MRE Team
AcademyHealth: State Health Policy Interest Group Meeting
June 7, 2008
What’s New?
• More Choices for Beneficiaries• HMOs and PSNs• Customized benefit packages• Opt-out to employer-sponsored plans
• Choice Counseling
• Enhanced Benefit Accounts Program
• Risk-adjusted Rates
• Low-income Pool
Evaluation
The UF evaluation examines whether or not Reform achieves its stated objectives including:
– the establishment of Health Plans and Networks, and related processes to manage and deliver health care to enrollees;
– development of a process for enrollees to choose the plan they prefer;
– improved health care processes; – better health outcomes; – improved enrollee satisfaction; and– predictability in costs/expenditures
Evaluating Medicaid Reform in Florida: UF Evaluation Team
Administration
Paul Duncan (Principal Investigator)[email protected]
Lilly Bell (Project Manager)[email protected]
Florida Advisory Committee
Technical Advisory Committee
Organizational Analyses
Christy Lemak (Investigator)
Amy Yarbrough (Investigator)
Fiscal Analyses
Jeffrey Harman (Investigator)
Quality of Care, Outcomes, and
Enrollee Experience Analyses
Allyson Hall (Investigator)
Rada Dagher (Investigator)
Low-Income Pool Analyses
Niccie McKay (Investigator)
Organizational AnalysesChristy Lemak and Amy Yarbrough
Key Informant Interviews • Health plans and networks
– 15 organizations; 58 interviews (3 rounds)
• AHCA (Tallahassee and Area offices)– 59 one-hour interviews (3 rounds)
• Legislators• Other stakeholders
– Interested parties survey (45 responses + 8 follow-up interviews)
– Community forums (attended 8 focus groups + 7 additional interviews)
Implementation Went Well
• Almost 200,000 enrollees in 5 counties with very few bumps in the road
• How? Why?– Leadership, Resources, Communication– A New Way of Working Together– Continuous Improvement Process
Some Elements Appear to Work Well or Show Strong Potential
• More Choices for Enrollees (including PSNs)
• The Choice Counseling Process
• Disease Management Programs
• Encounter Data
Mixed Views About Some Reform Elements
• Choices
• Enhanced Benefit Accounts Program
• Risk-Adjusted Rates
• Opt-out Program
Difficulties Associated with Managed Care
• Provider Perspectives• Specific Issues for Some Populations
– Mental Health– Disabled– Others
• CAHPS-Style Surveys– Benchmark: Fall 2006– Round 1: Fall 2007 - Spring 2008
• Qualitative Interviews – Early experiences and health beliefs
• Broward and Duval: focus groups, in-depth interviews• Baker, Clay, and Nassau: focus groups
– Longer-term experiences• Broward and Duval: in-depth interviews, focus groups
Patient Experiences
Allyson Hall and R. Paul Duncan
Consumer Assessment of Healthcare Providers and Systems Survey
Ratings (0-10)
• Overall plan satisfaction
• Overall satisfaction with care
• Personal doctor rating
• Specialist rating
Consumer Assessment of Healthcare Providers and Systems Survey
Preliminary analysis• Crosstabs (various permutations)
– 2006 vs.2007-2008• SSI vs. non-SSI• Broward vs. Duval
• Duval– 2006 vs. 2007-2008 differences tend to be not
significant
• Broward– 2006 vs. 2007-2008 some statistically significant
differences
Demographic Characteristics Broward and Duval counties only
2006 (pre-Reform)
Unweighted n=5,767
2007-2008 (Year 1)
Unweighted n=6,209
Weighted
% Excellent or very good health 60.56% 59.83%
% Female 53.90 54.25
% Hispanic/Latino 20.28 20.35
% Black/African-American 55.50 55.57
% SSI 19.23 18.91
Mean Age* 16.56 15.43
* Statistically significant difference
CAHPS: Summary of Findings SSI - Broward and Duval
% rating 9-10 2006 (pre-Reform)
2007-2008 (Year 1)
Overall plan satisfaction* 54.51 48.64
Overall satisfaction with care* 57.64 51.28
Personal doctor rating 68.10 67.72
Specialist rating 64.25 62.43
* Statistically significant differences
CAHPS: Summary of Findings SSI - Broward County
% rating 9-10 2006 (pre-Reform)
2007-2008 (Year 1)
Overall plan satisfaction* 53.39 45.76
Overall satisfaction with care* 56.41 48.68
Personal doctor rating 67.09 67.01
Specialist rating 64.56 64.35
* Statistically significant differences
CAHPS: Summary of Findingsnon SSI - Broward County
% rating 9-10 2006 (pre-Reform)
2007-2008 (Year 1)
Overall plan satisfaction 59.88 60.10
Overall satisfaction with care* 68.98 62.53
Personal doctor rating* 70.97 76.74
Specialist rating 60.29 62.58
* Statistically significant differences
Qualitative Interviews with BeneficiariesDemographics
• Approximately 76 participants to date– About half of sample from six Focus Groups – Others from in-depth interviews
• Gender: predominately female• Race / Ethnicity: (predominately Black)
– Blacks, Whites, Hispanics, Other
• Age: – Range 15 – 61 years
• Eligibility:– > 75% SSI
Major Themes
• Control of health is influenced by individual ability, help from others, money, and faith
• Relationships with physicians are important
• Before Reform enrollees experienced barriers to care
• Active participation in plan selection
• Maintaining continuity of care is important to enrollees
• For some, finding a primary care provider is problematic
• Some enrollees expressed discontent with Choice Counselors
• For some greater restrictions associated with access to specialty services and prescription drugs
• The Enhanced Benefits Account program is a relatively untested concept for enrollees
Fiscal AnalysisJeff Harman
– Had to live at least one month in a Reform county– Had to be eligible through TANF or SSI– Excludes Dually Eligible, Medically Needy, ICF/DD,
MediKids, Women with Cervical or Breast Cancer– Only months in Reform county and Reform-eligible– Only Reform-eligible services used in the calculations– Excluded most waiver services (AIDS, DD, etc.), school-
based services, Home Safe Net, Supportive Living, and BHOS Services
N = 2,733,140 person-months
Pre-Reform Expenditures
– Only beneficiaries enrolled in Reform plan or PSN included in calculations
– Expenditures were payments made to PSNs or Plans
• PSN payments based on FFS claims of enrollees• Plan payments based on risk-adjusted monthly
capitated premiums– Encounter data not available at this time
N = 945,635 person-months
Reform Expenditures
Total PMPM Expenditures In The Year Prior To Reform And First 10 Months of Reform
$238
$128
$905
$241
$120
$835
All Enrollees TANF SSI
Pre-Reform Reform
Total PMPM Expenditures In The Year Prior To Reform And First 10 Months of Reform
By County
$253$214
$129 $127
$1,055
$695
$261$211
$120 $120
$967
$649
Broward Duval BrowardTANF
DuvalTANF
BrowardSSI
Duval SSI
Pre-Reform Reform
Fiscal Analysis: Conclusions
• Total PMPM expenditures increased by an average of $3– Overall increase due to greater percentage of
enrollees in SSI in Reform than pre-Reform
• Average expenditures decreased when comparing by eligibility category– $8 drop for TANF (6.3%)– $70 drop for SSI (7.7%)
• Looking at longer-term trends
No “Bottom Line” Yet, But…
• ‘Process’ of reform smooth
• Varied patient experiences– Positive and negative
• Relative to the previous year – some savings
• Possible market changes
Team Effort
Babette Brumback, PhDLorna ChorbaJianyi Zhang, PhDLilly Bell, MHA
Contact:
Paul Duncan [email protected] 352 273 6065
Allyson Hall [email protected] 352 273 5129