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Consumer Knowledge of Health Insurance Plans and Affordability of Care: An Emergency Department Survey in Three Diverse Communities

Massachusetts Center for Health Information Analysis

August 14, 2013

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Research Team

Principal Investigator Danny McCormick, MD, MPH

Co-InvestigatorsRachel Nardin, MDAssaad Sayeh, MDLeah Zallman, MD, MPH

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Background

Goals of Chapter 58 and 224: improve affordability, access and quality of care

Despite MA reform, rate of uninsurance remains high in some communities Everett: 16% Revere: 15%

Affordability continues to be a barrier for both uninsured and the insured

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Background

Knowledge of insurance products may influence care seeking yet plan knowledge and informational needs are not well understood

Prior population-based surveys on affordability and plan knowledge: May have under-sampled populations at highest risk

—immigrants, non-English speakers and poor Have not analyzed according to insurance type

Understanding these has relevance for ACA

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Research Objectives

In disadvantaged populations and across insurance types:

What is truly affordable for consumers? Do consumers understand their health plans and

the insurance options available to them? To what extent do consumers experience gaps in or

changes to their insurance coverage? What level of cost-sharing is associated with

avoidance of medical care?

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Methods Overview

Phase I: Develop, pilot and administer a consumer survey to patients seen in three socioeconomically diverse communities. Examine by demographic and insurance

characteristics Phase II: Conduct semi-structured, qualitative

interviews (N=10-12) to explore key issues in depth.

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Setting: 3 EDs of Cambridge Health Alliance

Whidden Hospital

Somerville Hospital

Cambridge Hospital

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Study Population

> 230 MA communities travel to overcome access-to-care barriers.

Age <65: 57% state payment sources (36% Medicaid, 5% Comm

Care, 16% HSN), 3% uninsured and 40% privately insured.

Allows sample enriched with policy relevant groups.

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Study Sample

1290 patients Equal numbers of Uninsured, CommCare,

MassHealth, HSN and private insurance Ages 18 to 64 English, Spanish, Portuguese and Haitian

Creole Not intoxicated, delirious, or severely ill

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Survey

Face to face interview Four domains:

Knowledge/Access to information Insurance “churn” Affordability Tipping points

Demographic information Insurance verified, not self report

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Generalizability

3 socioeconomically and racially/ethnically diverse communities

Individuals actually needing care

Trade-off between policy relevant populations and generalizability to the state as a whole

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Progress

Study staff hired

Developed, piloted and started survey

Completed ~75 surveys

Qualitative interviews will begin late August

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Policy Implications

As the Commonwealth of Massachusetts prepares for changes to insurance products under ACA, we hope to provide better information on affordability, knowledge needs, tipping points and churning for disadvantaged populations that are highly affected by these changes but may be underrepresented in state-wide population based surveys.

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Discussion

Questions?

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Sample questions: Knowledge

Knowledge: “Under your current insurance, do you Have a premium/deductible/copay for medication/copay to

see doctor/coninsurance?” Amount of that premium/deductible/…etc. Compared to g

Consequences: “Has uncertainty about what is covered and how much

you have to pay for services ever caused you to delay or to not get any medical care?”

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Sample questions: Sources and Quality of Information

“At the time you applied for or were considering a health plan, did you try to get information . . . through the Health Connector or MassHealth helpline?” through the Health Connector or plan websites?” from a person at health center or other organization?” Helpfulness of these sources

“It was difficult to figure out how to apply for your current insurance.”

“It was difficult to complete the application process.”

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Sample questions: Quality and Understanding of Information

When signing up for insurance. . . Had information needed to make a good decision Had information in primary language Were able to get questions answered Was hard to understand the information

“Have your out-of-pocket costs on your current plan ended up being as you expected?”

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Sample questions: Affordability: General

“Your plan is affordable for you.” Concerned about paying premiums Among uninsured

Lost coverage due to cost Could not find affordable plan

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Affordability: Delayed or Forgone Care

Any Specialist care Regular doctor Preventive care Tests Medications Mental or emotional care Dental Vision Home services such as visiting nurses,

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Affordability: Medical Debt

Unpaid medical bills and amount Gone into debt Contacted by bill collector Consequences

Resulted in difficulty paying for other bills