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Low Income Health Program Performance Dashboard

Santa Clara 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 - Santa Clara 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 - Santa Clara 3 7/1/2011-12/31/2013

This dashboard is specific to Santa Clara, 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 - Santa Clara

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. 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: Santa Clara

• Implementation Date: July 1, 2011 • Current Income Limit: 133% 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: 1,823,000

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

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

http://www.dhcs.ca.gov/provgovpart/Pages/Deliv_SantaClara.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: 382,199

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 - Santa Clara

6,10

2 6,

349

6,51

6 6,

789

7,15

0 7,

591

8,09

9 8,

602

9,22

0 9,

859

10,4

69

11,0

40

11,6

21

12,0

61

12,4

49

12,9

42

13,2

48

13,4

85

13,9

95

15,1

23

15,9

29

16,4

75

17,0

33

17,4

01

17,7

01

18,0

01

18,2

18

18,6

97

19,4

98

20,5

36

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

5,000

10,000

15,000

20,000

25,000

Aug'

11Se

p'11

Oct

'11

Nov

'11

Dec

'11

Jan'

12Fe

b'12

Mar

'12

Apr'1

2M

ay'1

2Ju

n'12

Jul'1

2Au

g'12

Sep'

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ct'1

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2D

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2Ja

n'13

Feb'

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ar'1

3Ap

r'13

May

'13

Jun'

13Ju

l'13

Aug'

13Se

p'13

Oct

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Nov

'13

Dec

'13

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.


0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

18,000

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: 27,902


21,729

5,592

1

1,573

MCE New MCE Existing HCCI New HCCI Existing

Demographic Characteristics of Cumulative Unduplicated Enrollees – Age and Gender

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



7.7%

11.7%

10.2%

7.6%

8.4%

10.3%

14.2%

29.9%

Male: (50.3%)

7.3%

9.0%

6.1%

4.2%

5.5%

8.5%

13.7%

45.6%

Female: (49.7%)

7%

10%

8%

6%

7%

9%

14%

38%

<=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 Santa Clara FPL Limit = 133%

Total Cumulative Unduplicated Enrollees: 27,902 Note: All enrollees meet program eligibility rules, regardless of cases where data are unavailable.

7/1/2011-12/31/2013 LIHP Performance Dashboard - Santa Clara

77.4%

3.6% 5.7% 4.2% 5.6% 2.5%

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: 27,902

24.0%

5.1%

31.9%

28.9%

7.7%

White African American Latino Asian/PI Other

Demographic Characteristics of Cumulative Unduplicated Enrollees – Preferred Language


Note: Classification of Languages follows the US Census guidelines. Total Cumulative Unduplicated Enrollees: 27,902

75.0%

6.7%

16.3%

2.0%

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



16.7%

6.3%

3.4%

24.5%

29.6%

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 - Santa Clara

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 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: 6,912 Quarter 2: 7,851 Quarter 3: 9,538 Quarter 4: 11,375 Quarter 5: 13,121 Quarter 6: 14,187 Quarter 7: 16,698 Quarter 8: 18,369 Quarter 9: 19,346

63.5% 63.9% 63.9% 61.3%

59.0% 58.1% 57.6% 55.3% 54.1%

6.0% 5.7% 6.4% 7.6% 6.6% 5.9% 8.2%

10.9% 12.4%

1.3% 1.4% 1.6% 1.7% 1.9% 1.7% 2.0% 3.1% 2.2%

56.0% 54.1% 54.4%

50.1% 47.8% 46.2%

48.0% 45.3% 45.0%

0

10

20

30

40

50

60

70

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


Total Enrolled Quarter 1: 6,912 Quarter 2: 7,851 Quarter 3: 9,538 Quarter 4: 11,375 Quarter 5: 13,121 Quarter 6: 14,187 Quarter 7: 16,698 Quarter 8: 18,369 Quarter 9: 19,346

502 570 768 1,100 1,097 1,099 1,864

2,834 3,464

106 116 170 205 275 274 379 682 527

7,203 7,892

10,011 10,577

11,609 11,828

15,648 15,885 16,686

0

2000

4000

6000

8000

10000

12000

14000

16000

18000


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: 18,967 Quarter 2: 21,530 Quarter 3: 25,921 Quarter 4: 31,368 Quarter 5: 36,131 Quarter 6: 39,675 Quarter 7: 45,047 Quarter 8: 50,909 Quarter 9: 53,920

79 79 89 105 91 83 124

167 193

17 16 20 20 23 21 25 40 29

1,139 1,100

1,159

1,012 964

894

1,042

936 928

0

200

400

600

800

1000

1200

1400




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: 17,231 Quarter 2: 19,969 Quarter 3: 23,938 Quarter 4: 28,812 Quarter 5: 32,971 Quarter 6: 35,975 Quarter 7: 40,588 Quarter 8: 44,681 Quarter 9: 44,835

87 86 96 115 100 92 138

190 232

18 17 21 21 25 23 28 46 35

1,254 1,186

1,255

1,101 1,056

986

1,157

1,067 1,116

0

200

400

600

800

1000

1200

1400



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 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: 420 Quarter 2: 472 Quarter 3: 611 Quarter 4: 912 Quarter 5: 1,130 Quarter 6: 1,166 Quarter 7: 1,564 Quarter 8: 2,118 Quarter 9: 2,363

4.0 4.1 3.6

4.4 4.1 4.3 4.1

3.1

4.5

0

1

2

3

4

5

6

7

8

9

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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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