Access to Care in Rural Arizona
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- Jonathan Dixon
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1 Access to Care in Rural Arizona Setting the Stage Marcus Johnson Director, State Health Policy & Advocacy Vitalyst Health Foundation 7/25/2017
2 Health Care Reform IDEAL REALITY 2
3 3
4 U.S. Health Care System 4
5 Health Spend by % GDP (2016) United States Switzerland Germany Sweden France Japan Netherlands Norway Belgium Austria Denmark Canada United Kingdom Australia Finland New Zealand OECD AVERAGE Spain Portugal Italy Iceland Slovenia Average= 9% U.S.= 17.2% Source: OECD
6 Percent Health Care Spending Trends as a Percentage of GDP United States (16.6%) Switzerland (11.4%) Sweden (11.2%) France (11.1%) Germany (11.0%) Netherlands (10.9%) Canada (10.0%) United Kingdom (9.9%) New Zealand (9.4%) Norway (9.3%) Australia (9.0%) Source: Commonwealth Fund, Mirror, Mirror 2017 GDP refers to gross domestic product. Data in legend are for Source: OECD Health Data Data are for current spending only, and exclude spending on capital formation of health care providers. 6
7 Health Spend per capita (US$, 2016) United States Switzerland Luxembourg Norway Germany Ireland Sweden Netherlands Austria Denmark Belgium Australia Canada France Japan Iceland United Kingdom Finland OECD AVERAGE New Zealand Italy Spain Slovenia Average= $3,997 U.S.= $9, Source: OECD
8 80 United States Life Expectancy (years) Source: OECD
9 U.S Life Expectancy by Country (2015) Average Source: OECD
10 Health Outcomes US Performance U.S. Deaths following stroke Preventable deaths Infant mortality 10 Source: Commonwealth Fund Mirror, Mirror, 2017
11 Higher health system performance Health Care System Performance vs Spending AUS UK NETH Eleven-country average NZ NOR GER SWIZ SWE CAN FRA US Lower health system performance Lower health care spending Higher health care spending Note: Health care spending as a percent of GDP. Source: Spending data are from OECD for the year 2014, and exclude spending on capital formation of health care providers. Source: Commonwealth Fund, Mirror, Mirror
12 Healthcare Overhaul INSURANCE COVERAGE HEALTHCARE FINANCE CARE DELIVERY 12
13 Access to Care in Arizona
14 MOVING AWAY FROM 14
15 MOVING TOWARD 15
16 Access to Care Health Care Delivery Reform Value-Based Purchasing (bundled payments, capitated rates, MIPS, APMs) Patient-Centered Medical Homes, Accountable Care Organizations, Up/Downside Risk Medicaid Managed Care Retail Healthcare Minute Clinics, Urgent Care, Personal Tech, Consumerism Physician Extenders NPs, PAs Non-clinical Professionals, Care Coordination CHW s, Navigators, Coaches Integrated Care, AHCCCS Integrated Contracts, AHCCCS HCBS Paramedicine, Mobile-Integrated Health Care Accountable Health Communities Grant Community Benefit, Health Needs Assessments & Improvement Plans 16
17 Access to Coverage in Arizona
18 Medicaid Expansion in Arizona Pre-Expansion Post-Expansion AZ Uninsured (Source: Kaiser Family Foundation) Rural AZ Uninsured (Source: Georgetown Center for Children & Families) 21% (2013) 14% (2015) 25% (2009) 17% (2015) Uncompensated Care (Source: Arizona Hospital & Healthcare Association) 350,000 8% (2013) 2.8% (2016) AHCCCS Enrollment Trends by Population Members Enrolled (#) 300, , , , ,000 50, Year Enrollment Freeze Medicaid Expansion Childless Adults (0-100% FPL) Adult Expansion (100% - 133% FPL) KidsCare Source: 18
19 Who s Covering Arizona? Health Insurance Coverage of the Total Population - Arizona ,922, , ,079 Medicaid Marketplace Other * Marketplace enrollment reflects effectuated #s from 2/17. Total enrollment = 196,291. Source: AHCCCS Source: CMS 19
20 Medicaid in Rural Arizona % of AZ Rural Residents Covered by Medicaid >50% Adults Children 34% 54% of all Apache County residents covered by Medicaid. Graham, Navajo and Santa Cruz are close behind. Sources: AHCCCS, AZ Office of Economic Opportunity, Georgetown Center for Children and Families 20
21 Arizona s Marketplace/Exchange Average Premiums for Arizona Marketplace Enrollees % Change Total Premium Sticker Price $324 $ % Consumer Cost after Subsidies (among those receiving subsidies) $120 $ % Number of Insurers in Arizona s Marketplace ? Source: Kaiser Family Foundation Roughly 40,000 do not receive subsidy (0.006% of AZ population) Source: CMS, CMS 21
22 Exchange Enrollees: - With 1 or more insurer = 99.7% - With only 1 insurer = 25.84% Source: CMS/CCIIIO 22
23 Total Healthcare Spend by State (per capita, 2014) AZ = $6,452 (2 nd lowest) U.S. Average = $8,045 Source: KFF 23
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