Empowering Patients & Consumers to Access and Effectively Use High-Value Care

Empowering Patients & Consumers to Access and Effectively Use High-Value Care Marcia J. Nielsen, PhD, MPH Executive Director

High-Value health care • Gives individuals information to make informed health care decisions • Provides comprehensive, meaningful information to providers to improve patient care • Kansas Health Policy Authority (KHPA) consumers: • Purchase $2.5 billion of health care • Medicaid, S-CHIP, State Employee Health Plan • Tasked with coordinating health and health care for Kansas • Acknowledge that different populations have different health needs

Health Needs of Disabled Individuals • Extremely High Health Care Costs • Health care costs for disabled consumers are 4 to 7 times those of their non-disabled peers • Health insurance an absolute necessity • Inadequacies of private health insurance • Lack of Personal Assistance Services (PAS), mental health parity, access to specialists • High Unemployment • Nationwide, 70% of people with disabilities unemployed; In Kansas, 46.3%* • Many disincentives for disabled persons to work • * Cornell University 2006 Disability Status Report

Empowering Kansans with Disabilities & Chronic Illness Federal programs that work in Kansas

Ticket to Work:Federal Initiative to Promote Employment: • Employment Services: • TW-WIIA provides voucher system for obtaining employment services (the “Ticket”) • Health Insurance: • States allowed to develop Medicaid Buy-In program for individuals with disabilities and chronic illness who earn too much for traditional Medicaid

Working HealthyMedicaid Buy-In for Disabled Kansas Workers • Provides health insurance benefits • Full Medicaid coverage; personal and other services for those who need them • Medicare Part B coverage paid by Medicaid • Health insurance premiums paid by individual workers • Provides greater financial security • Targeted to those under 300% FPL (about $30,000 for a single person); no premiums for those under 100% FPL • Allows individuals to keep cash assets up to $15,000 • Retirement accounts (no limit); • Individual Development Accounts (no limit) • Benefits planning • Elimination of “spend-down”

Working Healthy Progress 1,040 Source: Mary Ellen Wright; Senior Manager, Working Healthy; Jean Hall, PhD, Program Evaluator, KU

Hall, Jean; PhD; Principal Investigator;University of Kansas Center for Research on Learning Division of Adult Studies

All expenses were adjusted using the Consumer Price Index for medical care. Each year was adjusted forward to meet 2007 prices. Hall, Jean; PhD; Principal Investigator;University of Kansas Center for Research on Learning Division of Adult Studies

Working Healthy is Working in Kansas • Successful Employment • 90.2% of original Working Healthy group is currently employed, compared to 40% of a comparison group • 77% have worked at their current job for more than a year • 75.5% are satisfied or very satisfied with their current employment • Appropriate Health Care Services • 86.1% report they are able to get the medical services they need • Improved Quality of Life • More than half of individuals enrolled report improvements in mental health, financial status, level of independence

Role of the Benefits Specialists • Benefits Specialists: • Collect data on individual’s current benefits status • Provide critical analysis of work, earning, and resources in these benefits • Provide options to individual (and support network if appropriate) about impact of employment or increased employment on benefits • Work with staff to establish medical coverage and other benefits. • Compare and contrast Working Healthy with other available programs

Demonstration to Maintain Independence & Employment (DMIE) • DMIE is a disability prevention program & study • Goal: to determine if medical assistance (Medicaid wrap-around) can prevent loss of employment due to a potentially disabling physical or mental impairment • Current enrollment n= 444; Began April 2006 • Full time employment • Participants not currently in application process for disability • Targeted to enrollees in Kansas High Risk Pool • Enrollees in KS high risk pool at a rate 8 times higher the general population • Targeted to those with significant under-insurance • 91% have out-of-pocket expenses >10% of family income for self & family

Work Opportunities Reward Kansans (WORK):“Cash and Counseling” Opportunities • Provides more servicesthan Medicaid buy-in • Individual directs resources to their personal needs/preferences • Kansas the first state to receive approval • New program under the Deficit Reduction Act (currently enrolled n=72) • Promotes employment for individuals with severe disabilities. • Developmental and physical disabilities, and traumatic brain injury • Provides Personal Services • Assistive Technology and Home Modifications • Independent Living Counseling • Individuals must be in “competitive employment”

High-Value health system for disabled individuals and workers • Value for individuals/consumers • Benefits specialists promote employment by helping individuals to navigate the complexity of various federal and state benefits • Monthly medical costs decreased significantly • Cycle of poverty broken for disabled and chronically ill through accumulation of assets • Value for public/employers • Employment attainable with appropriate supports • Contribution to the system through payment premiums and payment of taxes • Address workforce shortages by employing those who want to work

Recommendations to Promote Employment • Recognize that having a disability does not mean someone unemployable • Eliminate need to demonstrate inability to work in order to receive health care coverage • Develop comprehensive, seamless system of health care services and supports to help those who can stay in the workforce • Promote harmony in federal/state programs

Health System Recommendations Significant need for bipartisan federal leadership: • All individuals must be covered by health insurance • Consider new models of governance to oversee private/public programs • Promote coordination of care that empowers individuals • Promote value through: • Cost effectiveness analysis • Evidence based medicine Leaders' Project on the State of American Health Care

Working Healthy Mary Ellen Wright, Senior Manager Nancy Scott; Project Coordinator Daniel Lassley; Employment Specialist D’Ann Schlink; Support Staff DMIE Program Jennifer Telshaw; Program Coordinator Sherry Marney; Support Staff University of Kansas; Center for Research on Learning Division of Adult Studies Jean P. Hall, Ph.D., Principal Investigator (jhall@ku.edu) Noelle K. Kurth, M.S., Project Coordinator (pixie@ku.edu) Emily Fall, Graduate Research Assistant (eledford@ku.edu) KHPA Working Healthy Staff and University of Kansas Evaluators

Empowering Patients & Consumers to Access and Effectively Use High-Value Care