coverage churn in california...source: authors’ analyses of august 2017 vericred provider network...
TRANSCRIPT
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Coverage Churn in California
John A. Graves, Ph.D. Vanderbilt University School of Medicine
Select Committee on Health Delivery Systems and Universal
Coverage January 2018
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Churn refers to transitions in health insurance due to changes in income, job, and family circumstances.
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Each year, one in six US adults change their primary source of health insurance.
Source: Authors analyses’ of Medical Expenditure Panel Survey data
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Over the next two years, nearly 11 million Californians will change their current source of insurance.
4.2 million 800,000
4.1 million 1.8 million
Source: Authors’ analyses of MEPS and CPS data.
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Each month, roughly 5,000 to 10,000 people move between Covered California and Medi-Cal.
Source: Covered California http://board.coveredca.com/meetings/2016/10-27/Reports%20and%20Research%20Final.pdf
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Source: Kaiser Family Foundation
Erosion of employment-based insurance contributes to churn.
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Roughly one-quarter of employer-insured adults transition off over a two-year period – a 10% increase since the early 2000s.
Source: Graves and Mishra (Milbank Quarterly 2017)
• Young adults • Low-income adults • Hispanic adults • Adults in fair or poor health • Service industry workers
• Older adults • Married adults • Females • College degree
More likely to transition Less likely to transition
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Source: Graves and Mishra (Milbank Quarterly 2017)
Americans formerly covered by an employer are increasingly reliant on family members.
Likelihood a policyholder of an employer plan was able to find a job with health benefits after a job change.
Probability that policyholder enrolled under a family member’s policy after a job change.
Likelihood that employers include a surcharge for covering spouses & retirees.
-15%
2 x
From 2004 to 2013 …
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The ACA has impacted churn in important ways.
Source: Graves and Nikpay (Health Affairs 2017)
Improved retention in public insurance programs (e.g., Medi-Cal).
Fewer becoming uninsured.
Overall churn rates similar to pre-ACA period. No Change
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Source: Graves and Nikpay (Health Affairs 2017)
Under the ACA, Americans are spending less time uninsured.
NON-GROUP INSURANCE (COVERED CA)
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Source: Graves and Nikpay (Health Affairs 2017)
Under the ACA, Americans are spending less time uninsured.
PUBLIC INSURANCE
(MEDI-CAL)
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The ACA has impacted churn in important ways.
Source: Graves and Nikpay (Health Affairs 2017)
Take-up of public coverage among those with employer based insurance (i.e., little evidence of “crowd out”).
No Change
Transitions from employer-based coverage to uninsured status. No Change
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Source: 1Barnett et al. (J. Gen. Int. Med. 2017)
New primary care physician visits among those switching from private insurance.1
Frequent plan switching affects utilization and costs
+47%
New primary care physician visits among those switching from Medicaid.1
+203%
ED visits among those switching from Medicaid.1 +15%
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Source: 1Gruber & McKnight (2016); 2 Sommers et al (2016)
Frequent plan switching affects utilization and costs
Savings from switch to narrow network plan only among people who are able to maintain their PCP.1
34% of churners in KY, AR and TX either skipped doses or stopped taking medications.2
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Churn affects access to and continuity of care
Many marketplace plans offer little out-of-network coverage.
Percent of Silver plans with NO out-of-network coverage
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Marketplace plans have narrower provider networks than employer-based plans.
Churn affects access to and continuity of care
vs.
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2017 Primary Care Physician Networks in Marketplace Plans (Sacramento, CA)
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Source: Authors’ analyses of August 2017 Vericred provider network data.
2017 Primary Care Physician Networks in Marketplace Plans (Sacramento, CA)
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Churn among both individuals and plans puts an onus on regulatory and policy approaches to ensure accurate and accessible provider networks.
• We face challenges from churn no matter where we go from here. • As employer-based coverage becomes less prevalent,
more will rely on other coverage sources. • Insurer withdrawals means people must switch plans. • Robust competition in marketplaces means people shop
& switch plans.
• The basis for informed consumer and patient choices is information; ensuring accurate and up-to-date provider directories is key.
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Key Questions
• Should there be a role for transitional coverage policies (e.g., short-term insurance plans)?
• Mandated provider network criteria vs. consumer information tools?
• 12-month continuous eligibility for Medi-Cal adults?