National Data for Exchange Marketing Strategy Planning

Marketing Education Outreach Workgroup

BACKGROUND RESEARCH

Presented by Shana Montrose on July 20, 2011 and updated to reflect workgroup contributions

Predicting the Exchange Population PwC Health Research Institute, July, 2011

• 87% of consumers in the individual exchanges are expected to be eligible for government subsidies because of their incomes

• 82% of those who will be eligible for the subsidy are not aware of their eligibility

• 7.1% of the Colorado population will be enrolled in the individual Exchange by 2019

• 97% of the individual Exchange customers in 2014 will have been previously uninsured:– 76% of this population reported having been uninsured due to cost– 55% reported being more likely to buy health insurance because of government

subsidies – Nearly 40% said they are more likely to buy insurance because of the individual

mandate. • Those who are Medicaid eligible and Exchange subsidy eligible are less

aware of the individual mandate than those who are not subsidy eligible.

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Disclaimer

The Exchange Planning Team contracted Dr. Jonathan Gruber, an economist from MIT to develop a model that will help us determine likely users, by demographic characteristic, of the Exchange in Colorado. National data may or may not influence these categories. The purpose of this background information is to start a conversation about market segmentation and strategic market targeting. Once Colorado data is available, we will rely on that.

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Characteristics of a High Quality Plan, According to Consumers

PwC Health Research Institute, July, 2011

71%Benefits

60% Provider Network

40%Lower cost than competitors

30%High quality rating from independent organization

25% Different healthcare venue options (e.g. retail clinic)

22%High consumer ratings/reviews

20% Well known company name

4% Higher cost than competitors

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INCOME AND EMPLOYMENTChapter 1

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Average Monthly Uninsured Worker and Dependents in Colorado by Type of Worker (thousands)

Lewin Group, 2007

• 37.5 % of Colorado’s uninsured work for firms that do not offer health coverage to their employees

• 21% are ineligible for their employer’s coverage

• 11% percent of uninsured workers and dependents are eligible for but do not take the coverage offered by their employer

Firms and Employment in Colorado by Industry and Firm Size, 2006-2007 (non-farm, thousands)

US Small Business Administration, Office of Advocacy ,2009

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Employed persons by class of worker and part-time status (thousands)

Department of Labor, 2011

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AGE AND OBJECTORS Chapter 2

Invincibles PwC Health Research Institute, July, 2011

• 63% of 18-24 year olds and 57% of 25-34 year olds are familiar with the individual mandate compared to 47% of 35-44 year olds

• 23-24% of 18-34 year olds would give up choice of doctors for lower cost (compared to 8% of 45-64 year olds)

• 23% of 18-24 year olds and 17% of 25-34 year olds plan to use the Exchange in 2014

• 42-43% of 18-34 year olds would consider purchasing insurance from a non-traditional source compared to 19% of 45-54 year olds 11

Low-Duration PurchasersOliver Wyman, 2010* see report for more information, context is missing on slide

• The number of low-cost individuals terminating in less than six months increased from 3,145 in 2006 to 15,991 in 2008, an increase of over 400%

• The high number of low-cost individuals indicates that relatively health members are also dropping coverage and therefore are not contributing a full year of premium to the overall risk pool

• There are reasons for both high-cost and low-cost subscribers to maintain individual coverage for a short period of time, including a move out of state or obtaining employer-sponsored coverage. However, we believe it is unlikely these reasons can explain the increase in the proportion of subscribers that are dropping coverage

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RACE, ETHNICITY, LANGUAGE, CULTURE

Chapter 3

DIMENSIONS

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Age

GenderIncome

Legacy

Foreign Born, < 5 years in

U.S.

Foreign Born, 5 or

more years in US

Spanish

Korean, Chinese, Tagalog

German,French, Russian

Profile of Hispanic Adults in the US PEW Hispanic Center and RWJF, 2008

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The majority of the US Hispanic population is young, has a high school diploma or less, is from Mexico and has lived in the US for 15+ years. Hispanics speak English-only, Spanish-only and are bilingual. Only 16% are not eligible for the Exchange because of legal status.

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US Citizen Children of Undocumented Parents Pew Hispanic Center, 2009

• In 2003, of the 4.3 million children of unauthorized immigrants, 2.7 million, or 63%, were born in the United States.

• In 2008, of the 5.5 million children of unauthorized immigrants, 4 million, or 73%, were born in the United States.

• Among children under 6 whose parents are unauthorized immigrants, 91% were born in the U.S.; among those ages 14 to 17, 50% are U.S. born.

Reasons Hispanics Lack Usual Health Care Provider PEW Hispanic Center and RWJF, 2008

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Hispanics Lacking Usual Health Care Provider PEW Hispanic Center and RWJF, 2008

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How Hispanics Receive Information PEW Hispanic Center and RWJF, 2008

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Getting Care Outside the US PEW Hispanic Center and RWJF, 2008

• The numbers: About one in 12 Hispanics (8 percent) in the U.S. have obtained medical care, treatment or drugs in Latin America during the previous year, and one in six (17 percent) knows a family member or friend who has done so.

• Quality of care: Latinos who describe their recent medical care in the United States as only fair to poor are somewhat more likely to get medical services outside the country—11 percent have, compared with 6 percent of those who describe their care in this country as excellent.

• The uninsured: Hispanics without health insurance also are more likely to have received care in another country. Of those without insurance, 11 percent did; of those with insurance, 7 percent did.

• Those without a regular provider: Of Latinos with a regular provider in the U.S. medical system, 8 percent say they have gotten care abroad, compared with 10 percent of those with no regular provider.

• Language: A higher share of bilingual (10 percent) and Spanish-dominant (9 percent) Hispanics seek medical care in Latin America than do English speakers (4 percent).

• Education: One in 10 people with at least some college education report getting recent treatment or drugs in Latin America, compared with single-digit percentages for those with less education.

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Language Spoken at Home in Colorado (Number of Speakers)

Spanish: 515,262

2005 American Community Survey

German: 23,939

French: 15,072

Vietnamese: 14,163

Chinese: 9,945

Russian: 13,978

Korean: 9,580

Tagalog: 9,370

GENDERChapter 4

Uninsured by Gender, Poverty, Age, Race in the USCommonwealth Fund, May 2011

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Women in Individual Market Commonwealth Fund, May 2011

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Women Affected by Medical Debt Commonwealth Fund, May 2011

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How Women will Gain Coverage in 2014 Commonwealth Fund, May 2011

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Women in Subsidized Exchange Commonwealth Fund, May 2011

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Uninsured Men by Marital Status

Institute for Women’s Policy Research Fact Sheet. More Men to Benefit from Expanded Coverage under Healthcare Reform. June, 2010. http://www.cepr.net/index.php/publications/reports/more-men-to-benefit-from-expanded-coverage-under-healthcare-reform/

Uninsured by Gender

Institute for Women’s Policy Research Fact Sheet. More Men to Benefit from Expanded Coverage under Healthcare Reform. June, 2010. http://www.cepr.net/index.php/publications/reports/more-men-to-benefit-from-expanded-coverage-under-healthcare-reform/

GEOGRAPHY AND DISTRIBUTION CHANNELS

Group 5

The Rural Uninsured (National data)Center for Rural Affairs, 2009

• Rural residents were found to be twice as likely to be underinsured as urban residents

• 8% of the general population depends on individual policies with reduced benefits and high deductibles, but 33% of farmers and ranchers rely on such policies

• 25% of non-corporate farms and ranches carry medical debt and 25% of that number report that medical expense "contribute to their financial problems"

• Approximately 50% of rural employees work for small businesses, as compared to 37% of urban employees, and small business employees are twice as likely to be uninsured

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Internet Connection USDA, National Agricultural Statistics Service, 2009

Total Dial-Up DSL Cable Satellite Wireless Other/Unknown

CO 12 14 7 32 28 7

US 23 36 11 13 13 4

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Economic Class

Dial-Up DSL Cable Satellite Wireless Other/Unknown

West$10,000-$99,999

17 37 10 16 16 4

US$10,000-$99,999

23 36 11 13 11 5

NotesPrimary method of internet access for those operators who have access to the internet.

Economic class refers to sales and government payments received during the previous year.

Computer Access and Ownership USDA, National Agricultural Statistics Service, 2009

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A farm is "any place from which $1,000 or more of agricultural products were produced and sold, or normally would have been sold, during the year.“ There were 36,500 farms in Colorado in 2009.

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Customers’ Experience with Purchasing on the Internet

PwC Health Research Institute, July, 2011

33% of individuals surveyed with incomes less than 138%FPL said they have never purchased any of the items to the left on the internet

Long-term care insurance 2%

Medical/health insurance 5%

Life insurance 5%

Car insurance 17%

None of these 19%

Download music 31%

Airline tickets 45%

Hotel rooms 46%

Books 52%

Clothing 53%

Who Uses and Owns Smartphones?

Pew Research Center, 2011

Android vs. iPhone vs. Blackberry

Pew Research Center, 2011

MILITARYChapter 6

Uninsured Vets Die Unnecessarily Physicians for a National Health Program, 2009

38“Like other uninsured Americans, most uninsured vets are working people - too poor to afford private coverage but not poor enough to qualify for Medicaid or means-tested VA care,” said Dr. Steffie Woolhandler, professor at Harvard Medical School.

Excess = unnecessary

HTTP://WWW.PNHP.ORG/NEWS/2009/NOVEMBER/OVER_2200_VETERANS_.PHP

Uninsured VeteransHealth Care Financing & Economics, 2010 (MEPS and CPS data)

• Less that 1% of the non-elderly population is comprised of veterans with low-income (below 125%FPL). However, 43% of this subgroup that is not in federal Medicaid eligibility categories is uninsured.

• Data: 109,703 observations from MEPS, respondents ages 25-61, of these 8,431 represent veterans.

• The insurance rate for veterans is lower than for the general population. In the West 16.8% of the total population are uninsured compared to 10.5% of veterans.

• In the West, veterans under 125%FPL experienced uninsurance rates twice as high as those above 125%FPL. 39

Uninsured VeteransHealth Care Financing & Economics, 2010 (MEPS and CPS data)

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TRIBESChapter 7

Where People Receive CareIHS, 2006

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Why People Seek CareIHS, 2006

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Leading Health Problems by AgeIHS, 2006

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Incoming Referrals IHS, 2006

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Clinicians Documenting Patient EducationIHS, 2007

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Patient Education by LocationIHS, 2007

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Education TopicsIHS, 2007

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http://www.ihs.gov/healthcommunications/index.cfm?module=dsp_hc_internet_access

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Cues Suggestive of Low Health Literacy• A number of cues may be suggestive of low health literacy

status. These cues can include: • Hand brochure to patient upside down and see if they correctly

align the page in order to read it. • Ask the patient if the print is clear enough to read on the

brochure. • Registration and other forms may be filled out incompletely or

incorrectly. • Patient gives excuses when asked to read something (i.e. forgot

reading glasses). • Patient hands medical brochures/materials to a relative or

other person. • Patient cannot describe how to take medications. 50

http://www.ihs.gov/healthcommunications/index.cfm?module=dsp_hc_internet_access

LGBTChapter 8

• The ratio of uninsured gay individuals is 2:1 compared to heterosexuals. (www.lgbtcancer.com, 2006)

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LGBT etc.http://data.lambdalegal.org/publications/downloads/whcic-insert_low-income-or-uninsured.pdf

53The ratio of uninsured gay individuals is 2:1 compared to heterosexuals (www.lgbtcancer.com, 2006)

Resources

• Livingston, Gretchen. Hispanics, Health Insurance and Health Care Access. Pew Hispanic Center, Sept., 2009. Available at: http://pewhispanic.org/reports/report.php?ReportID=91 Accessed on: 7/18/2011

• Livingston, Gretchen, Minushkin, Susan and Cohen, D’Vera. Hispanics and Health Care in the United States: Access, Information and Knowledge. Pew Hispanic Center and Robert Wood Johnson Foundation, 2008. Available at: http://pewhispanic.org/files/reports/91.pdf. Accessed on: 7/20/2011

• Colorado Health Institute, Issue Brief: The Magnitude of Underinsurance in Colorado. Prepared for the Colorado Trust, June, 2010. Available at: http://www.coloradotrust.org/attachments/0001/2839/IssueBrief_Uninsurance_6-02-10final.pdf Accessed on: 7/18/2011

• PricewaterHouse Health Research Institute. Change the channel: Health insurance exchanges expand choice and competition, July 2011. Available at: http://www.pwc.com/us/en/health-industries/publications/change-the-channel.jhtml Accessed on: 7/18/2011

• MLA Language Map Available at: http://www.mla.org/map_main. Accessed on 7/20/2011• R. Robertson and S. R. Collins, Women at Risk: Why Increasing Numbers of Women Are Failing to Get the Health

Care They Need and How the Affordable Care Act Will Help, The Commonwealth Fund, May 2011. Available at: http://www.commonwealthfund.org/Content/Charts/Issue-Brief/Women-at-Risk-2011/Women-Struggle-to-Find-Affordable-Coverage.aspx Accessed on: 7/22/2011

• Smith, Aaron. 35% of American Adults Own a Smart Phone. Pew Research Center. July, 2011. Available at: http://pewinternet.org/~/media//Files/Reports/2011/PIP_Smartphones.pdf Accessed on: 7/22/2011

• MIT Sloan School of Management, 2002. Available at: http://ocw.mit.edu/courses/sloan-school-of-management/15-812-marketing-management-fall-2002/lecture-notes/lecture03_segmentation.pdf Accessed on: 7/26/2011

• Migration Policy Institute. Available at: http://www.migrationinformation.org/datahub/state.cfm?ID=CO Accessed on: 7/26/2011

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• Enroll UX 2014 Strategy Phase. http://www.enrollux.org/• Blankenau, Joe., Bailey, Jon M. and Hudson, Julia.The Causes and Consequences of the Rural Uninsured. Center for Rural Affairs. No.3,

2009. Available at: http://www.cfra.org/newsrelease/2009/05/04/rural-americans-more-likely-be-uninsured-and-underinsured-center-rural-affair Accessed on: 7/27/2011

• United States Department of Agriculture State Fact Sheets: Colorado, Updated 2011. Available at: http://www.ers.usda.gov/statefacts/CO.HTM Accessed on: 7/27/2011

• USDA and National Agriculture Statistics Service. Farm Computer Usage and Ownership, 2009. Available at: http://usda.mannlib.cornell.edu/usda/current/FarmComp/FarmComp-08-14-2009.pdf Accessed 7/27/2011.

• Welch, Dianna K. and Geisa, Kurt. Analysis of Individual Health Coverage in Massachusetts Before and After the July 1, 2007 Massachusetts Merger of the Small Group and Nongroup Health Insurance Markets. Oliver Wyman, June 2010. Available at: http://www.mass.gov/Eoca/docs/doi/Companies/adverse_selection_report.pdf Accessed 7/27/2011

• Trends in Indian Health: Part 6 Community Health. Indian Health Service, 2006-2007 Available at: http://www.ihs.gov/NonMedicalPrograms/IHS_stats/files/Trends%20Part%206-Community%20Hlth%20Stat.pdf Accessed 7/27/2011

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Resources