evaluating medicaid reform in florida: early findings
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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)pduncan@phhp.ufl.edu
Lilly Bell (Project Manager)lbell@phhp.ufl.edu
Florida Advisory Committee
Technical Advisory Committee
Organizational Analyses
Christy Lemak (Investigator)
clemak@phhp.ufl.edu
Amy Yarbrough (Investigator)
ayarbro@phhp.ufl.edu
Fiscal Analyses
Jeffrey Harman (Investigator)
jharman@phhp.ufl.edu
Quality of Care, Outcomes, and
Enrollee Experience Analyses
Allyson Hall (Investigator)
hallag@phhp.ufl.edu
Rada Dagher (Investigator)
rdagher@phhp.ufl.edu
Low-Income Pool Analyses
Niccie McKay (Investigator)
nmckay@phhp.ufl.edu
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 pduncan@phhp.ufl.edu 352 273 6065
Allyson Hall hallag@phhp.ufl.edu 352 273 5129
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