2011-12 Healthy San Francisco Annual Report Presented to San - PowerPoint PPT Presentation

2011-12 Healthy San Francisco Annual Report Presented to San Francisco Health Commission September 18, 2012

Outline  Milestones, HSF-SF PATH Transition & HCSO  Enrollment Trends & Participants Demographics  Service Delivery System & Utilization  Participant Experience & Satisfaction  Expenditures & Revenues  ACA Preparations 2

Five Years and Counting (A Few Key Milestones) 6/2011: 2/2009: 2/2012: One Ends 4 th Strength in of 6 finalist year Numbers in 2011 8/2006: having launched in Innovations Health served partnership in Gov’t Care over with San competition Security 100,000 Francisco (Kennedy Ordinance uninsured Health Plan School) approved adults 7/2007: 8/2009: 8/2011: June 2012 HSF Kaiser Mathematica forward: launches Family releases ACA as 2 Foundation independent preparation clinic survey evaluation with pilot finds 94% and finds Supreme participant HSF meeting Court ruling satisfaction its goals 3

HSF- SF PATH Transition  July 2011 movement of over 10,000 HSF participants into a new statewide, federally-supported health program (called SF PATH in San Francisco) in preparation for ACA individual health insurance mandate effective Jan. 2014  SF PATH’s provider network is the Dept. of Public Health  Disenrolling over 10,000 HSF participants impacts FY2011-12 HSF statistics:  Enrollment  Service utilization  Customer service  Expenditures and revenues 4

Health Care Security Ordinance (HCSO) Amendment  Mandates that certain employers make employee health care expenditures  Expenditure options under the Employer Spending Requirement (ESR) vary  Health Insurance  Reimbursement Plans  Direct Reimbursement  City Option (HSF or Medical Reimbursement Account)  Analysis of calendar year 2010 found that among employers who had elected to use reimbursement plans, on average 20% of funds used by employees  Board of Supervisors sought to address this unintended consequence  San Francisco Health Commission supported amending the HCSO  Board amended HCSO (Ordinance #232-11) and effective January 1, 2012  Employers must post the Official OLSE Notice at every workplace or job site  New requirements for employers that impose surcharges on customers to cover ESR costs  New requirements for employers that utilize reimbursement accounts  Amendments were not made to any HSF provisions 5

Enrollment Trends Ended FY2011-12 with 46,800 participants (12% ⇓ from FY2010-11)  60,000 50,000 40,000 30,000 20,000 10,000 - 2007-08 2008-09 2009-10 2010-11 2011-12 # of HSF Participants 24,210 43,200 53,428 54,348 46,822 % Uninsured Enrolled 33% 72% 89% 85% 73%  Combining HSF and SF PATH enrollment - a total of 57,270 adults (89% of uninsured) were served through health access programs  Has served over 116,000 unduplicated adult residents (enrolled and disenrolled) 116,036 120,000 # Ever Enrolled at 100,237 End of Fiscl Year 100,000 80,565 80,000 59,698 60,000 40,000 25,269 20,000 - 2007-08 2008-09 2009-10 2010-11 2011-12 6

Disenrollment Trends As enrollments ⇑ - disenrollments ⇑  2011-12 Disenrollment Reason % Annual Renewal 58%  Disenrolled participants can re- enroll without penalty, if eligible Program Eligibility 21% SF PATH Transition 13%  Ended FY2011-12 with 69,214 Participation Fee 8% disenrollments Other/Voluntary <1%  Targeted retention rate of 52.5% 70.0%  60.0% 60% disenrollment rate in FY2011- Disenrollment Rate 60.0% 12 (69,214 ÷ 116,036 ever enrolled) 46.0% 50.0% 34.0% 40.0%  Of multiple disenrollments 30.0%  20.0% 60% of people were in HSF 10 – 12 20.0% months & 20% in HSF 12+ months 10.0%  Over 80% not due to participation 0.0% fee disenrolment, 2% related to two 2008-09 2009-10 2010-11 2011-12 participant fee disenrollments 7

Participant Demographics Age Income At/Above 201-300% 300% FPL, 50% 43% % of Participants FPL, 11% 3% 40% 25% 30% 23% 20% 101-200% At/Below 9% FPL, 27% 100% FPL, 10% 59% 0% 18-24 25-44 45-54 55-64 Ethnicity/Race Gender 44% 50% % of Participants 45% 40% 35% 27% 30% 25% 16% 20% 15% 5% 4% 10% 3% 1% 5% Female Male 0% 50% 50% Ge nde r: inc lude s174 tra nsg e nde r pe rso ns 8

Service Delivery System – Medical Home is Foundation 40  37 HSF medical 35 # of HSF Medical Homes homes increased 35 31 29 from 35 to 37 in 30 27 FY 2011-12 25 20  SFCCC medical 15 homes have 55% 10 of HSF 5 enrollment with transition of over 0 2007-08 2008-09 2009-10 2010-11 2011-12 10,000 HSF participants into SF PATH – all of SFCCC 55.0% whom had a DPH # of HSF Participants DPH 30.0% medical home Kaiser 6.0%  B&T 2.9% On average, 50% of HSF medical SMP 2.7% homes were open CCCHA 2.3% to new participants BAART 1.0% 0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 9

Context for Service Utilization  Trends examined in  Preventive and primary care services  Appropriate utilization  Quality  Calculation–rates per 1,000 participants per year  Standard measure for reporting/comparing utilization  Calculation is A multiplied by B:  A: # of “things” in a month ÷ # of participants in a month  B: 1,000 * 12 (# of months) = 12,000  Utilization analysis dependent upon complete data from all providers -- medical homes, hospitals, etc.  90% of hospital data is San Francisco General; likely underreporting  Almost 63% of participants have a chronic condition – participants not evenly distributed across medical homes  HSF-SF PATH transition resulted in changes in utilization 10

Overall Service Utilization Trends  Over the past three years, the percentage of all HSF participants receiving at least one service (primary care/ specialty, inpatient and/or prescriptions) in a 12-month period has remained relatively constant Percent of Participants Utilizing 80.0% 70.0% at Least One Service 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% Primary/Specialty Care Inpatient Admit Prescription 2009-10 75.4% 2.4% 47.9% 2010-11 73.3% 1.6% 45.5% 2011-12 74.6% 2.0% 48.9% 11

Service Utilization (Primary Care & Appropriate Use)  HSF participants continue to utilize primary care at the same rate as the National Medicaid Average – 3 visits per year  73% of HSF participants continuously enrolled received primary care visit  Emergency department utilization (133 per 1,000) is lower than state average (275 per 1,000) – note potential underreporting and HSF-SF PATH shift  Use of ED for avoidable conditions (8%) remains lower than State benchmark for Medi-Cal (18%)  Decreases in hospital admissions, acute hospital days, and average length of hospital stay – note potential underreporting and HSF-SF PATH shift 12

Service Utilization (Measurements of Quality) Follow-up Office Visit w/i 80.00%  30-day hospital 30 Days of Discharge readmission rate 77.01% 76.96% 76.54% of 7% is lower 72.43% 72.49% 72.18% 72.25% than the 18% national rate 67.85% 67.55% 67.53% 67.34% (Agency for 63.96% HealthCare 60.00% FY2008-09 FY2009-10 FY2010-11 July 2011 - Mar Research and 2012 Quality) All Participants With Chronic Disease  Follow-up care Without Chronic Disease after an inpatient discharge 87.46% 88.0% constant from Asthma Test Medication % of Individuals with 2009-10 to 2011- 86.0% Asthma Receiving 86.90% 86.90% 86.90% 86.90% 12 at 72% 84.0% 82.34% 82.04% 82.0% 80.4%  HSF met the 80.0% National Medicaid 78.0% Average for 76.0% patients with 2008 2009 2010 2011 asthma HSF Nat'l Medicaid Avg 13

Participant Experience and Satisfaction - Complaints  HSF participant complaint rate remained relatively constant at FY2011- 12 at 0.79 per 1,000 participants  435 complaints in FY2011-12 with top complaints in areas of access (21%) and quality of service (20%) 1.60 1.50 1.40 Rate Per 1,000 Participants 1.20 1.00 0.90 0.80 0.79 0.80 0.70 0.60 0.40 0.20 0.00 FY2007-08 FY2008-09 FY2009-10 FY2010-11 FY2011-12 14

Participant Experience and Satisfaction - HAQ  Health Access Questionnaire (HAQ) captures applicant’s self-reported pre- and post-HSF health access experience  Four year HAQ comparison for participants with continuous enrollment found no consistent response for general health, but consistent responses in the following: a usual source of care; an improved rating of medical care ED utilization; difficulty accessing care; delays in getting care/medication; delays in care due to cost 15

Employer Spending Requirement (ESR)  Health Care Security Ordinance (HCSO) mandates that certain employers make health care expenditures on behalf of employees  City Option is available to employers – employees receive  Healthy San Francisco or  Medical Reimbursement Account  By end of FY 2011-12, 1,427 employers had used the City Option to meet the ESR (from FY 2007-08 to 2010-11)  $40.96 million contributed to City Option in FY 2011-12  $25.37 (62%) million for Medical Reimbursement Accounts  $15.39 (38%) million for Healthy San Francisco 16