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Healthy Howard Health Plan: a Summary of Health Care Utilization in 2009

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Healthy Howard Health Plan: a Summary of Health Care Utilization in 2009 RESEARCH REPORT #2 Healthy Howard Health Plan: A Summary of Health Care Utilization in 2009 RESEARCH REPORT #2 Prepared for Healthy Howard, Inc. by the Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health November 2010 1 RESEARCH REPORT #2 ACKNOWLEDGEMENTS Healthy Howard, Inc. is a 501(c)(3) organization created to administer the Healthy Howard Health Plan. It provided funding to the Department of Health, Behavior and Society (HBS) at the Johns Hopkins Bloomberg School of Public Health (JHSPH) to conduct a formal evaluation of the Healthy Howard Health Plan. This report was prepared by the evaluation team. Members of the evaluation team and their affiliations are listed below. The evaluation plan for HHHP was reviewed by the JHSPH Institutional Review Board (IRB) and deemed not human subjects research. The authors wish to thank Healthy Howard, Inc., Johns Hopkins HealthCare LLC, and the Howard County Health Department (including Keyuri Joshi, the Health Department’s summer intern) for their assistance in providing the data needed for this report. Report Authors Elizabeth Edsall Kromm, PhD, MSc Adjunct Assistant Professor, HBS and Senior Advisor to the Health Officer, Howard County Health Department David R. Holtgrave, PhD Professor and Chair, Health, Behavior and Society (HBS) Eileen M. McDonald, MS Associate Scientist, HBS Shannon Frattaroli, PhD, MPH Assistant Professor, Department of Health Policy and Management (HPM) A copy of Research Report #2 is available for download from the Department of Health, Behavior and Society’s website at http://www.jhsph.edu/dept/hbs Suggested Citation: Edsall Kromm E, Holtgrave DR, McDonald EM, Frattaroli S. Healthy Howard Health Plan: A Summary of Health Care Utilization in 2009. Research Report #2. Baltimore, MD: Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, November 2010. 2 RESEARCH REPORT #2 TABLE OF CONTENTS EXECUTIVE SUMMARY 5 PART I: HEALTHY HOWARD HEALTH PLAN SERVICE NETWORK 7 PART II: MEMBER ENROLLMENT AND UTILIZATION TRENDS 13 Time Spent Active in HHHP 13 Member Cost Profile 15 PART III: TYPE AND VOLUME OF HEALTH CARE, CY 2009 17 In-Patient Hospital Care 18 Emergency Department (ED) Care 19 Primary Care Services 21 Out-of-Network Care 23 PART IV: DISCUSSION 24 REFERENCES 26 3 RESEARCH REPORT #2 LIST OF TABLES AND FIGURES Table 1: HHHP Service Network, CY 2009 8 Table 2: 2009 HHHP Members, Status as of 7/10 and Net Active Months 14 Table 3: Submitted Claims, Volume and Type, CY 2009 17 Table 4: HHHP Network Providers, Claims Submitted, CY 2009 18 Table 5: Nature of In-Patient Hospital Care, CY 2009 19 Table 6: CY 2009 Actual ED Use Compared to Member Self-Report and National Estimates of U.S. Adults 18-64 with Incomes Greater than or Equal to 100% Federal Poverty Level (FPL), by Insurance Status 20 Table 7: CY 2009 ED Visits by CPT Code 20 Table 8: CY 2009 Primary Care by ICD-9-CM Categories 22 Table 9: Out-of-Network Care Compared to Total Care Costs for Nine Members, CY 2009 23 Figure 1: Average Monthly Covered Cost per Member, per Member Month in Program, CY 2009 15 4 RESEARCH REPORT #2 EXECUTIVE SUMMARY The Healthy Howard Health Plan (HHHP) is a public-private health care program designed to connect uninsured residents of Howard County, Maryland, to an affordable and comprehensive network of HEALTHY HOWARD HEALTH PLAN health care services. To our knowledge, it is the first plan in the nation to couple health care services with compulsory health WHO’S ELIGIBLE? coaching. To qualify, a person must meet all of the criteria listed below: - A Howard County resident HHHP was designed to fill an important gap for thousands of working - A US citizen or legal permanent families who find themselves without affordable health care options. resident These are people who do not have access to an employer-sponsored - Between the ages of 19 & 64 health plan and cannot afford to purchase private family coverage, - Not eligible for & not enrolled in but make too much money to qualify for state or federal health other health care programs such as insurance programs. Data from the 2008 American Community Medicaid, Medicare, MCHP or PAC Survey indicate between 11,800 and 19,300 Howard County - Currently uninsured & without health insurance for at least six residents are uninsured (U.S. Census, 2008). months (unless lay off resulted in involuntary loss of coverage) The Plan is administered by a non-profit organization – Healthy - Annual income ≤ 300% of the Howard, Inc. Operating costs are supported by member fees, county Federal Poverty Level (FPL) funding and private foundation grants. In addition, strong partnerships with local providers have translated into in-kind WHAT SERVICES ARE INCLUDED? support and an expanded network of services for HHHP members. Members have access to the following HHHP is the vision of the Howard County Executive and Health services in Howard County: - Primary care visits Officer and is part of a larger initiative to build a model public health - Free or discounted prescriptions community. - Diagnostic & lab tests - Urgent care About the Research Report Series - Emergency room care - In-patient hospital care An evaluation team was assembled prior to HHHP’s implementation. - Mental health care In consultation with Healthy Howard, Inc. staff, several evaluation - Substance abuse treatment aims were developed that serve to guide the ongoing evaluation of - Specialty care the Plan. The formal evaluation is being conducted by researchers - Reduced cost dental & vision care from the Johns Hopkins Bloomberg School of Public Health. - Rehabilitation services - Physical & occupational therapy In order to provide timely information to funders and community - Personalized health coaching partners, the evaluation team committed to producing a series of HOW MUCH DOES IT COST? Research Reports. These reports provide results from analyses of Monthly fee is based on income & different aspects of the program and are intended to inform whether the person joins alone or with a assessments of program performance and to facilitate specific plan partner. Monthly fees: improvements. - Individual ≤ 200% FPL $50 - Couple ≤ 200% FPL $80 Research Report #1, released in March 2010, presented findings - Individual 201%-300%FPL $85 - Couple 201%-300%FPL $130 regarding inaugural members’ living and working conditions, health status, health behaviors and priority health goals. Source: Healthy Howard, Inc., 2010 5 RESEARCH REPORT #2 Research Report # 2 – Overview and Key Findings Research Report #2 examines the health care utilization and costs incurred by members during HHHP’s first year of operation. Part I begins with an overview of the HHHP’s service network. Part II describes member enrollment activity over the past 19 months. A description of the type and volume of care provided during the plan’s first year of operation based on available administrative data follows in Part III. Part IV provides a complete discussion of the report findings. This analysis expands our understanding for what it means to transition out of uninsured status and the likely types of care and costs newly insured will incur upon entry into a formal health access network. A bulleted list of key findings appears below. HHHP service network is complex and comprehensive o Primary care home and large hospital system serve as cornerstones of network and provide majority of health care to members. o Community investment – pro bono care by local providers drives service network. o Estimated cost of health care services delivered in 2009 is $727,629 based on available data. o Network appears to be a good fit to member needs with 94.5% of known health care costs accrued from in-network services. HHHP may effectively function as a temporary access program o Disenrollment rate for Plan’s inaugural members is stable over time at 35%. o As of July 2010, the average period of enrollment is 9.8 months for those who first became active in 2009. o Health care utilization concentrated in members’ first four months. o Disenrollment occurs not long after period of highest service use. HHHP members had unmet needs at time of enrollment o High volume of immunizations and preventive screenings/tests administered by primary care provider. o Claims data indicate 14.2% prevalence of essential hypertension and 6.8% prevalence of diabetes among members with at least one primary care encounter in 2009. Both conditions are amenable to modifications in health-related behaviors. o Two percent of members required at least one in-patient hospital stay in 2009. HHHP members demonstrated low utilization of Emergency Department (ED) services o An estimated 8.5% (44) of HHHP members made at least one trip to the ED in 2009. o ED utilization among HHHP members is lower than national averages. Twenty percent of uninsured and 19% of insured U.S. adults reported at least one ED visit in the past 12 months (NCHS, 2010). o Analysis of evaluation and management codes from ED encounter found the majority of visits to be appropriately urgent. 6 RESEARCH REPORT #2 PART I: HEALTHY HOWARD HEALTH PLAN’S SERVICE NETWORK HHHP is not health insurance. It is a county-based public-private health care program. The Plan’s design had not previously been seen in Maryland and therefore required legislation at the state level to define operation requirements, appropriate regulatory structure and ensure consumer protections. At the end of Maryland General Assembly’s 2009 Legislative Session, a new subtitle was inserted into the Insurance Article of the Annotated Code of Maryland.1 While an analysis of HHHP’s network development is beyond the scope of this report, an overview of service scope provides essential context for understanding members’ utilization and health care costs. There are two provider cornerstones to the HHHP network – Chase Brexton Health Services (Chase Brexton) and Howard County General Hospital (HCGH).
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