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Transcript of 1 Empowering Patients & Consumers to Access and Effectively Use High-Value Care Marcia J. Nielsen,...
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Empowering Patients & Consumers to Access and
Effectively Use High-Value Care
Marcia J. Nielsen, PhD, MPHExecutive Director
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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
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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
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Empowering Kansans with Disabilities & Chronic Illness
Federal programs that work in Kansas
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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
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Working Healthy Medicaid 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”
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Working Healthy Progress
0
200
400
600
800
1000
1200
J uly02
J une03
J une04
J une05
J une06
J une07
J une08*
No Premium
Premium
1,040
Source: Mary Ellen Wright; Senior Manager, Working Healthy; Jean Hall, PhD, Program Evaluator, KU
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Hall, Jean; PhD; Principal Investigator; University of Kansas Center for Research on Learning Division of Adult Studies
9Hall, Jean; PhD; Principal Investigator; University of Kansas Center for Research on Learning Division of Adult Studies
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Hall, Jean; PhD; Principal Investigator; University of Kansas Center for Research on Learning Division of Adult Studies
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Hall, Jean; PhD; Principal Investigator; University of Kansas Center for Research on Learning Division of Adult Studies
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Hall, Jean; PhD; Principal Investigator; University of Kansas Center for Research on Learning Division of Adult Studies
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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
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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
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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
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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
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Work Opportunities Reward Kansans (WORK): “Cash and Counseling” Opportunities
Provides more services than 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”
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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
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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
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Health System RecommendationsSignificant 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 analysisEvidence based medicine Leaders' Project on the
State of American Health Care
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KHPA Working Healthy Staff and University of Kansas Evaluators
Working Healthy Mary Ellen Wright, Senior
Manager Nancy Scott; Project
Coordinator Daniel Lassley; Employment
Specialist D’Ann Schlink; Support StaffDMIE 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 ([email protected])
Noelle K. Kurth, M.S., Project Coordinator ([email protected])
Emily Fall, Graduate Research Assistant ([email protected])