Avalere Health LLC | The intersection of business strategy and public policy A Home Health Co-Payment: Affected Beneficiaries and Potential Impacts April.

Slides:



Advertisements
Similar presentations
DataBrief: Did you know… DataBrief Series September 2011 No.17 Differences in Medicare Spending by Disability and Residence Medicare spends almost four.
Advertisements

Overview of Health Care Coverage and Cost Trends in Minnesota Presentation to the State Budget Trends Study Commission April 22, 2008 Julie Sonier Director,
Long Term Care, Family Caregiving and the Law of Succession Part One Josephine Gittler The Aging Population, Alzheimer’s and Other Dementias: Law and Public.
K A I S E R C O M M I S S I O N O N Medicaid and the Uninsured Figure 0 Medicaid: The Basics Diane Rowland, Sc.D. Executive Director Kaiser Commission.
DataBrief: Did you know… DataBrief Series ● February 2011 ● No. 12 Dual Eligibles Across the States In 2008, dual eligibles as a percent of the total Medicare.
What Is Long Term Care?. u Long Term Care is an ever changing array of services aimed at helping people with chronic conditions cope with limitations.
DataBrief: Did you know… DataBrief Series ● September 2011 ● No. 16 Residence Setting by Level of Disability Less than 40% of older Americans with moderate.
Challenges of Serving Low-income Medicare Beneficiaries: Impact of Cost Sharing Cindy Parks Thomas Brandeis University Schneider Institute for Health Policy.
Reduction of Medicaid Expenditures from State Prescription Programs in Illinois and Wisconsin Donald S Shepard, PhD* Desiree Koh, * Cindy Thomas, PhD*
Medicare & Medicaid. 2 Medicare – Medical Care for the Elderly l Institutional features – Part A—Hospital insurance – Part B—Physician, Outpatient hospital,
DataBrief: Did you know… DataBrief Series ● February 2011 ● No. 10 Dual Eligibles – Health Services Utilization In 2008, dual eligibles were 23% more likely.
The Health Care Industry Part 2 - Medical Insurance Karen F. Nichols, MSA School of Allied Health Professions University of Nebraska Medical Center.
Study Finds Higher Costs for Caregivers of Elderly By JANE GROSS Published: November 19, 2007
MEDICARE: PAST, PRESENT AND FUTURE James G. Anderson, Ph.D. Department of Sociology & Anthropology.
MEDICARE: PAST, PRESENT AND F UTURE James G. Anderson, Ph.D. Department of Sociology & Anthropology.
Long-Term Care and Aging HAS Aging Society Americans are living longer Chronic disease is taking a bigger toll Growing number of older adults Disability.
PPA 419 – Aging Services Administration Lecture 6a – Long- term Care and Medicaid.
Research and analysis by Avalere Health The Opportunities and Challenges for Rural Hospitals in an Era of Health Reform April, 2011.
Out-of-pocket healthcare expenditures for cancer patients in the United States: Findings from the Medical Expenditure Panel Survey Lisa M. Lines, MPH 1,2.
Trends in Health and Aging Major Trends and Patterns in Health and Aging July 2007.
Exhibit 2. Medicare Enrollment, 1970–2080 Enrollment in millions Source: Centers for Medicare and Medicaid Services, 2013 Annual Report of the Boards of.
DataBrief: Did you know… DataBrief Series ● January 2012 ● No. 26 Dual Eligibles, Chronic Conditions, and Functional Impairment By Age Group In 2009, 29%
Medicare: An Overview September 30, 2014 Society for Financial and Professional Development 7 th Annual Financial Literacy Leadership Conference Christina.
NOTES: Numbers may not sum to total due to rounding. People with disabilities under age 65 were not eligible for Medicare prior to SOURCE: Centers.
The Impact of Health Expenses on Older Women ’ s Financial Security Juliette Cubanski, Ph.D. The Henry J. Kaiser Family Foundation AcademyHealth 2007 Annual.
Health Insurance Health Care Systems. Intro:  You are climbing with friends down in the canyon, suddenly you slip and fall. You cannot stand on your.
UllmanView Graph # 1 OVERVIEW Background and Basics of Cost-Sharing Designing Premiums Analysis of Impacts of Four States’ Premium Policies Implications.
DataBrief: Did you know… DataBrief Series ● September 2010 ● No. 3 Dual Eligibles and Medicare Spending For patients with 5 or more chronic conditions,
DataBrief: Did you know… DataBrief Series ● February 2013 ● No. 36 Medicare Beneficiaries With Severe Mental Illness and Hospitalization Rates In 2010,
Avalere Health LLC | The intersection of business strategy and public policy New Data on Residential Care: Trends, Residents, and Rates October 4, 2012.
DataBrief: Did you know… DataBrief Series ● May 2012 ● No. 29 Prevalence of Alzheimer’s Disease and Other Dementias In 2009, 13% of dual-eligible beneficiaries.
Percent of total Medicare population: NOTE: ADL is activity of daily living. SOURCES: Income and savings data from Urban Institute/Kaiser Family Foundation.
Return to Tutorials Tricia Neuman, Sc.D. Director, Medicare Policy Project Vice President, Kaiser Family Foundation For KaiserEDU June 2009 Medicare 101:
25 - 1Copyright 2008, The National Underwriter Company Determining Coverage Needs and Selecting a Long-Term Care Policy  What is it?  Pays for personal.
Medicaid “Reform” and Mental Health Leighton Ku Senior Fellow Presentation at NAMI Conference, June 2005
DataBrief: Did you know… DataBrief Series ● October 2011 ● No. 20 Seniors with Chronic Conditions and Functional Impairment In 2006, over 26% of seniors.
THE COMMONWEALTH FUND Karen Davis President, The Commonwealth Fund January 27, Health Savings Accounts.
Who Are the Dual Eligibles? May 17, 2006 Charles Milligan, JD, MPH Medicaid Commission Meeting.
DataBrief: Did you know… DataBrief Series ● September 2010 ● No. 1 Characteristics of Dual Eligibles 33% of dual eligibles suffer from diabetes, stroke,
How Much Would A Medicare Prescription Drug Benefit Cost? Offsets in Medicare Part A Cost by Increased Drug Use Zhou Yang, Ph.D. Assistant Professor Department.
DataBrief: Did you know… DataBrief Series ● February 2011 ● No. 11 Eligibility Pathways for Dual Eligibles In FY 2008, over 9 million Medicare beneficiaries.
DataBrief: Did you know… DataBrief Series ● February 2013 ● No. 38 Medicare Spending for Beneficiaries with Severe Mental Illness and Substance Use Disorder.
Figure 1 SOURCE: Kaiser Family Foundation analysis of the Medicare Current Beneficiary Survey 2010 Cost and Use file. Selected Demographic Characteristics.
Figure 1 K A I S E R C O M M I S S I O N O N Medicaid and the Uninsured Dual Eligibles: The Basics Barbara Lyons, Ph.D. Director, Kaiser Commission on.
SOURCE: Kaiser Family Foundation estimates based on the Census Bureau's March 2014 Current Population Survey (CPS: Annual Social and Economic Supplements).
Prescription Drug Expenditures and Healthcare Burdens in the Medicaid Population G. Edward Miller, Jessica S. Banthin and Thomas M Selden AHRQ Conference.
1 Cost Sharing for Low-Income Beneficiaries and Supplementing Part D Examples from Pharmacy Plus Medicaid Demonstration Programs Summit for State Health.
DataBrief: Did you know… DataBrief Series ● October 2011 ● No. 21 Dual Eligibles, Chronic Conditions, and Functional Impairment In 2006, 37% of seniors.
View from Maryland: Impact of Medicare Part B Premium Increases National Coalition on Health Care October 13, 2015 Shannon M. McMahon, MPA Deputy Secretary,
Medicaid Lecture 15A Medicaid Established in 1965 along with Medicare Medicaid is a federal and state program that helps low income and disabled individuals.
DataBrief: Did you know… DataBrief Series ● September 2010 ● No. 2 Dual Eligibles and Chronic Conditions 28% of Medicare beneficiaries with 5 or more chronic.
Medical Expenditure Panel Survey (MEPS), Health Care Expenditures for the Elderly with Chronic Conditions in 2012 Jeffrey Rhoades.
DataBrief: Did you know… DataBrief Series ● September 2010 ● No. 4 Low-Income Seniors Seniors living alone have 35% less annual income than seniors living.
DataBrief: Did you know… DataBrief Series ● September 2011 ● No.19 Differences in Hospitalization Rates By Residence Community residents are nearly twice.
MEDICARE PART D July MEDICARE PART D: OVERVIEW Part D provides prescription drug coverage for Medicare beneficiaries. Prescription drug plans compete.
Announcements For Wed Nov 8 … please be sure to read the NYT article in your course packet about Wal-Mart and health care Problem Set #4 due next Thursday.
Avalere Health LLC | The intersection of business strategy and public policy The Impact of Enrollment in the Medicare Prescription Drug Benefit on Premiums.
OLDER ADULTS IN ALAMEDA COUNTY March DEMOGRAPHICS & SOCIAL DETERMINANTS OF HEALTH.
Medicare Beneficiaries Are at Risk for High Costs Nearly one in four is underinsured (average 2013–14) BeneficiariesPercent of Medicare population Millions.
K A I S E R C O M M I S S I O N O N Medicaid and the Uninsured Figure 0 Medicaid’s Origin Enacted in 1965 as companion legislation to Medicare (Title XIX)
DataBrief: Did you know… DataBrief Series ● September 2011 ● No.18 Differences in Service Utilization by Disability and Residence In 2006, seniors with.
A Summary of Insurance Coverage Chapter 2. 2 Overview Extent and nature of coverage Extent and nature of coverage Employer sponsored Employer sponsored.
Medicare Enrollment, NOTES: Numbers may not sum to total due to rounding. People with disabilities under age 65 were not eligible for Medicare.
Percent of Medicare population
August 3, 2017 How Do Retiree Health Costs Affect People and Programs?
Medicare Household Spending Non-Medicare Household Spending
Medicare Enrollment, NOTES: Numbers may not sum to total due to rounding. People with disabilities under age 65 were not eligible for Medicare.
The Latest Trends in Income, Assets, and Personal Health Care Spending Among People on Medicare November 2015.
G. Edward Miller, Jessica S. Banthin and Thomas M. Selden
Presented by Tricia Neuman, Sc.D.
Presentation transcript:

Avalere Health LLC | The intersection of business strategy and public policy A Home Health Co-Payment: Affected Beneficiaries and Potential Impacts April 14, 2011 Avalere Health LLC

© Avalere Health LLC Page 2 Executive Summary 83 percent of Part B home health users who are not dual eligibles do not have Medigap coverage and would have to pay the full co-payment out of pocket »Nearly 60 percent of these home health users have incomes below 200% of the poverty line »The co-payment for three episodes would consume almost 3 percent of annual income for a beneficiary at 150 percent of the federal poverty line, living alone Part B home health users without Medigap coverage are sicker, more likely to have severe disabilities, and more likely to live alone than other Medicare beneficiaries »87 percent of home health users who would pay the co-payment out of pocket have 3 or more chronic conditions; 38 percent live alone »23 percent have disabilities severe enough to quality for a nursing home level of care Studies show that co-payment policies that reduce utilization of services (such as outpatient visits) can lead to higher inpatient costs. 1 * 1 Trivedi, Amal N., Husein Moloo and Vincent Mor. “Increased Ambulatory Care Copayments and Increased Hospitalization among the Elderly.” New England Journal of Medicine 362 (2010):

© Avalere Health LLC Page 3 Home Health Users in 2008 (Part B only) Medicare beneficiaries who use Part B home health services Beneficiary would not be subject to the co-payment Beneficiary might not be subject to the co-payment Beneficiary would be subject to the full co-payment (83% of non-dual home health users) Source: Avalere Health analysis of 2008 Medicare Current Beneficiary Survey, Access to Care file.

© Avalere Health LLC Page 4 Potential Impact of Proposed Home Health Co-Payment The co-payment could constitute a significant financial burden »The co-payment for three episodes would represent 3 percent of annual income for a beneficiary at 150 percent of the poverty line, living alone »Almost 60 percent of (non-dual eligible) home health users without Medigap coverage have incomes under 200 percent of the Federal Poverty Level The co-payment proposal will affect a vulnerable population »Home health users are sicker, more likely to have a disability, and more likely to live alone than other Medicare beneficiaries. »Studies suggest that the negative effects of cost-sharing disproportionately affect poorer, sicker beneficiaries A home health co-payment could lead to unintended effects »In some states, the proposed co-payment could shift costs from Medicare to Medicaid »Imposing cost-sharing for this population could lead to higher utilization of inpatient services, meaning increased costs for Medicare 1 1 Trivedi, Amal N., Husein Moloo and Vincent Mor. “Increased Ambulatory Care Copayments and Increased Hospitalization among the Elderly.” New England Journal of Medicine 362 (2010):

Potential Financial Impacts of a Home Health Co-Payment The intersection of business strategy and public policy

© Avalere Health LLC Page 6 Co-Payments Could Constitute a Financial Burden for Low- Income Beneficiaries »83 percent of Part B home health users who are not dual eligibles do not have Medigap coverage, and would have to pay the full co- payment out of pocket »This group of home health users is predominantly lower-income – 58 percent are below 200 percent of the Federal Poverty Line (FPL), compared to 41 percent of all Medicare beneficiaries 1 »The co-payment for three episodes would consume almost 3 percent of annual income for a beneficiary at 150 percent of the FPL, living alone »Studies suggest that low-income beneficiaries often perceive co- payments to be a significant financial burden 2 1 Dual eligibles are excluded from both groups. 2 Ku, Leighton, Elaine Deschamps and Judi Hilman. “The Effects of Copayments on the Use of Medical Services and Prescription Drugs in Utah’s Medicaid Program.” Center on Budget and Policy Priorities, November 2004.

© Avalere Health LLC Page 7 Three or More Episodes Would Represent 3-7 Percent of Annual Income for Low-Income Beneficiaries – Comparable to Spending on Transportation or Clothing 1 Number of Home Health Episodes Living Arrange- ment Co-Pay as Percent of Household Income at 100 Percent FPL Co-Pay as Percent of Household Income at 150 Percent FPL Co-Pay as Percent of Household Income at 200 Percent FPL One EpisodeAlone1.4%0.9%0.7% 2-person1.0%0.7%0.5% Two EpisodesAlone2.8%1.8%1.4% 2-person2.0%1.4%1.0% Three Episodes Alone4.1%2.8%2.1% 2-person3.1%2.0%1.5% Five EpisodesAlone6.9%4.6%3.4% 2-person5.1%3.4%2.5% Note: These data were calculated as a percentage of the 2011 Federal Poverty Level for a household of one or two ($10,890 and $14,710, respectively), assuming a $150 per episode co-payment. 1 Individuals under 65 years old devoted 4.1 percent of annual expenditures to car payments and 3 percent to apparel. Consumer Expenditures in Bureau of Labor Statistics. U.S. Department of Labor. March 2010.

© Avalere Health LLC Page 8 Home Health Co-Payments Likely to Affect Low-Income, Sicker Medicare Home Health Beneficiaries Many low-income beneficiaries are not enrolled in programs that may cover the co-payment, and even those with Medigap may not be protected 1. Pezzin, Lilianna E. and Judith D. Kapser. “Medicaid Enrollment among Elderly Medicare Beneficiaries: Individual Determinants, Effects of State Policy, and Impact on Service Use.” Health Services Research 37(4) (2002). 2. Haber, Susan G., Walter Adamache, Edith G. Walsh, Sonja Hoover and Anupa Bir. “Evaluation of Qualified Medicare Beneficiary (QMB) and Specified Low-Income Medicare Beneficiary (SLMB) Programs.” RTI, % Medicare Savings Programs One-third of eligible Medicare beneficiaries are not enrolled in the Qualified Medicare Beneficiary (QMB) program, which covers Medicare cost- sharing requirements 2 Medigap Only 17 percent of Part B home health users have coverage. Some existing Medigap plans do not cover co-payments; the extent to which these co-payments would be covered is unclear Medicaid More than half of eligible, community-dwelling beneficiaries are not enrolled. 1 These beneficiaries are the poorest and least likely to be able to afford a co-payment If beneficiaries with low income and/or in poor health forgo needed care, both adverse health events and inpatient costs could increase The remaining 83 percent of these non-dual eligible home health users will be subject to the full co-payment; these beneficiaries are disproportionately low- income, in poor health, and living alone, putting them at risk of health decline

Profile of Part B Home Health Users Who Would be Subject to the Co-Payment The intersection of business strategy and public policy

© Avalere Health LLC Page 10 Part B Home Health Users without Medigap Are Older and in Poorer Health than Other Medicare Beneficiaries Source: Avalere Health analysis of 2008 Medicare Current Beneficiary Survey, Access to Care file. 1 This is considered a measure of moderate to severe disability and is often the eligibility threshold for a nursing home level of care. Part B Home Health Users without Medigap All Medicare Beneficiaries Over age %11.7% Live alone38%31.8% Have 3 or more chronic conditions 86.7%68.6% Have 2 or more Activities of Daily Living limitations %5.8% Report fair or poor health48.4%26.7% Are in somewhat or much worse health than last year 44%23.1%

© Avalere Health LLC Page 11 Part B Home Health Users without Medigap Are More Likely to Have Five or More Chronic Conditions Source: Avalere Health analysis of 2008 Medicare Current Beneficiary Survey, Access to Care file. Home health users are defined as individuals with Part B reimbursement; this excludes many but not all Part A users.

© Avalere Health LLC Page 12 Home Health Users without Medigap Are More Likely to Have Moderate to Severe Disability Source: Avalere Health analysis of 2008 Medicare Current Beneficiary Survey, Access to Care file. Home health users are defined as individuals with Part B reimbursement; this excludes many but not all Part A users. 1 Kaye, Stephen, Charlene Harrington and Mitchell P. LaPlante. “Long-Term Care: Who Gets It, Who Provides It, Who Pays, And How Much?” Health Affairs 29(1) (2010): Note: In most states, people requiring assistance with 2 or more Activities of Daily Living (bathing, dressing, transferring, using the toilet, eating, and continence) are considered to have an “institutional level of need”, meaning they are sufficiently disabled as to potentially need placement in a nursing home or to need other paid long-term care services. 1 35% receive assistance with 1 or more ADLs 10% receive assistance with 1 or more ADLs

© Avalere Health LLC Page 13 Part B Home Health Users without Medigap Have High Utilization of Other Medicare Services, Despite Cost-Sharing Requirements Source: Avalere Health analysis of 2008 Medicare Current Beneficiary Survey, Access to Care file. Home health users are defined as individuals with Part B reimbursement; this excludes many but not all Part A users. 1 All beneficiaries are subject to a deductible of $162 for Part B-covered services or items. Beneficiary Cost-Sharing Requirement 1 Annual Average for Home Health Users without Medigap Annual Average for All Medicare Beneficiaries Physician claims 20 percent of the Medicare- approved amount 42.7 claims21.9 claims Office visitsSame as above10.8 visits6.5 visits DME claims Same as above6.3 claims1.9 claims Inpatient days $1,132 deductible for days 1– days1.4 days SNF days$0 for first 20 days, $ per day for days 21– days0.7 days Consistent with their poorer health, home health users without Medigap have higher utilization of all Medicare services, which suggests that their home health usage is not driven primarily by the absence of a co-payment; imposing a home health co-payment may not reduce utilization to the extent expected

Research on the Effects of Co-Payments The intersection of business strategy and public policy

© Avalere Health LLC Page 15 Studies Suggest That Co-Payments for Some Services Can Lead to Increased Utilization of More Expensive Services Trivedi et al., in The New England Journal of Medicine, analyzed a nationally representative sample of elderly Medicare managed care enrollees 1 and found that: 1 Trivedi, Amal N., Husein Moloo and Vincent Mor. “Increased Ambulatory Care Copayments and Increased Hospitalization among the Elderly.” New England Journal of Medicine 362 (2010): The authors estimate that the cost of the additional hospitalizations exceeded the savings from the decrease in outpatient visits Decreases Medicare Advantage plans that raised co-payments for outpatient care had 19.8 fewer annual outpatient visits per 100 enrollees, however… Decreases Medicare Advantage plans that raised co-payments for outpatient care had 19.8 fewer annual outpatient visits per 100 enrollees, however… Increases These plans saw 2.2 more annual hospital admissions and 13.4 more inpatient days per 100 enrollees Increases These plans saw 2.2 more annual hospital admissions and 13.4 more inpatient days per 100 enrollees

© Avalere Health LLC Page 16 Adverse Effects of Co-Payments Are Greater for People with Chronic Disease and/or Low Incomes A study on the impact of co-payments in Utah’s Medicaid program found that individuals in poor health suffered adverse effects, especially if they were low income 1  Between 2001 and 2002, Utah instituted co-payments for most services. Co-pays were modest: $2 per physician/outpatient hospital visit or prescription  Nevertheless, 39 percent of beneficiaries stated that the co-payments caused serious financial difficulties Chandra et al., found that when California’s public retirement system raised drug and office co-payments: 1  For beneficiaries with the greatest chronic disease comorbidities (Charlson Index 4 or more), increased inpatient costs exceeded savings from decreased physician and drug use by 78 percent 1 Ku, Leighton, Elaine Deschamps and Judi Hilman. “The Effects of Copayments on the Use of Medical Services and Prescription Drugs in Utah’s Medicaid Program.” Center on Budget and Policy Priorities, November If beneficiaries with low income and/or in poor health forgo needed care, both adverse health events and inpatient costs could increase

Avalere Health LLC | The intersection of business strategy and public policy Data Specifications The intersection of business strategy and public policy

© Avalere Health LLC Page 18 Avalere’s Analysis of Home Health Beneficiaries The data in this presentation were generated using the 2008 Medicare Current Beneficiary Study (MCBS) Access to Care file, which includes the “always enrolled” Medicare population, or beneficiaries who were enrolled for the full calendar year 1 To create a demographic profile of home health users who would be subject to a co-payment, we limited our analysis to: »Part B home health users We excluded: »Dual-eligible beneficiaries »Beneficiaries residing in a facility, such as a nursing home »Beneficiaries reporting that they are enrolled in a Medigap plan Our estimate of home health users who would be subject to a co-payment should be considered a conservative figure, as some Medigap plans do not fully cover co-payments 1 Beneficiaries who died after the fall survey are included in this file. 2 MCBS also includes two income categories for beneficiaries who are unsure of their income: “less than $25,000” and “more than $25,000.” We included these beneficiaries to the extent that they fell into one of our income categories.