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Low Income Health Program Performance Dashboard

Santa Cruz January 1, 2012 - 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 Cruz 1/1/2012-12/31/2013

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 Cruz 3 1/1/2012-12/31/2013

This dashboard is specific to Santa Cruz, for the time period January 1, 2012 – 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.

1/1/2012-12/31/2013 4 LIHP Performance Dashboard - Santa Cruz

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 Cruz

• Implementation Date: January 1, 2012 • Current Income Limit: 100% FPL • New LIHP

– Did not participate in the Health Care Coverage Initiative, the previous waiver demonstration

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

– Network includes both public and private contract providers • Total Population: 259,000

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

1/1/2012-12/31/2013 LIHP Performance Dashboard - Santa Cruz 5

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

ENROLLMENT AND DEMOGRAPHICS

Total Unduplicated Monthly Enrollment, Program-to-Date

1/1/2012-12/31/2013 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: 37,304

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 Cruz

852

1,14

5 1,33

0

1,54

9 1,67

8 1,83

9 1,95

3 2,07

9

2,16

7

2,19

7

2,16

7

2,14

0

1,87

4

1,74

6

1,64

0

1,51

4

1,42

2

1,33

4

1,26

2

1,17

0

1,09

7

1,05

8

1,05

1

1,04

0

Jan'

12Fe

b'12

Mar

'12

Apr'1

2M

ay'1

2Ju

n'12

Jul'1

2Au

g'12

Sep'

12O

ct'1

2N

ov'1

2D

ec'1

2Ja

n'13

Feb'

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ar'1

3Ap

r'13

May

'13

Jun'

13Ju

l'13

Aug'

13Se

p'13

Oct

'13

Nov

'13

Dec

'13

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.

1/1/2012-12/31/2013 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

500

1,000

1,500

2,000

2,500

Feb'

12M

ar'1

2Ap

r'12

May

'12

Jun'

12Ju

l'12

Aug'

12Se

p'12

Oct

'12

Nov

'12

Dec

'12

Jan'

13Fe

b'13

Mar

'13

Apr'1

3M

ay'1

3Ju

n'13

Jul'1

3Au

g'13

Sep'

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3

Existing Enrollees Newly Enrolled Disenrolled

Demographic Characteristics of Cumulative Unduplicated Enrollees – Age and Gender

1/1/2012-12/31/2013 9

Total Cumulative Unduplicated Enrollees: 2,441


6.3%

11.0%

10.4%

7.7%

9.2%

12.7%

13.3%

29.5%

Male: (56.3%)

7.8%

9.3%

7.7%

5.6%

7.0%

10.3%

17.2%

35.1%

Female: (43.7%)

7%

10%

9%

7%

8%

12%

15%

32%

<=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.

10

Current Santa Cruz FPL Limit = 100%

Total Cumulative Unduplicated Enrollees: 2,441 Note: All enrollees meet program eligibility rules, regardless of cases where data are unavailable.

1/1/2012-12/31/2013 LIHP Performance Dashboard - Santa Cruz

59.7%

15.2% 14.7%

10.4%

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: 2,441

57.0%

2.4%

22.1%

1.4% 0.8%

16.3%

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: 2,441

90.3%

9.4%

0.2%

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


Total Cumulative Unduplicated Enrollees: 2,441

10.3%

6.4%

4.1%

15.2%

18.4%

Diabetes Asthma/COPD CAD/CHF Dyslipidemia Hypertension

UTILIZATION OF HEALTH SERVICES

Utilization Methods and Time Frame of Analyses

15

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.

1/1/2012-12/31/2013 LIHP Performance Dashboard - Santa Cruz

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.

January 1, 2012 - 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: Not Yet Implemented Quarter 2: Not Yet Implemented Quarter 3: 1,366 Quarter 4: 1,898 Quarter 5: 2,238 Quarter 6: 2,198 Quarter 7: 1,878 Quarter 8: 1,515 Quarter 9: 1,263

83.6% 80.1%

75.3% 72.2% 72.3%

74.5% 76.9%

16.8% 14.9% 13.8% 11.0% 11.5% 11.9% 12.4%

9.5% 8.1% 5.9% 4.6% 4.0% 5.2% 3.6%

62.4% 61.4% 62.5% 60.0% 59.4%

62.5% 64.1%

0

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20

30

40

50

60

70

80

90

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.



Total Enrolled Quarter 1: Not Yet Implemented Quarter 2: Not Yet Implemented Quarter 3: 1,366 Quarter 4: 1,898 Quarter 5: 2,238 Quarter 6: 2,198 Quarter 7: 1,878 Quarter 8: 1,515 Quarter 9: 1,263

325 413 443 354 325 284 269 159 191 167 125 95 100 50

2,142

3,066

3,504 3,368

2,830

2,414

1,984

0

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1000

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3000

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4000


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.



Total Member Months Quarter 1: Not Yet Implemented Quarter 2: Not Yet Implemented Quarter 3: 3,327 Quarter 4: 5,066 Quarter 5: 6,199 Quarter 6: 6,504 Quarter 7: 5,260 Quarter 8: 4,270 Quarter 9: 3,529

293 245 214 163 185 200 229 143 113 81 58 54 70 43

1,931 1,816

1,696

1,554 1,614

1,696 1,687

0

500

1000

1500

2000

2500




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.



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

Active User Member Months Quarter 1: Not Yet Implemented Quarter 2: Not Yet Implemented Quarter 3: 3,151 Quarter 4: 4,833 Quarter 5: 5,905 Quarter 6: 6,196 Quarter 7: 5,065 Quarter 8: 4,138 Quarter 9: 3,453

309 256 225 171 192 206 234 151 119 85 61 56 72 43

2,039 1,903

1,780

1,631 1,676 1,750 1,724

0

500

1000

1500

2000

2500



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.


Total Number of IP Days Quarter 1: Not Yet Implemented Quarter 2: Not Yet Implemented Quarter 3: 769 Quarter 4: 638 Quarter 5: 647 Quarter 6: 361 Quarter 7: 303 Quarter 8: 355 Quarter 9: 119

4.8

3.3 3.9

2.9 3.2

3.6

2.4

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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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