Access to Care in Rural Arizona Setting the Stage Marcus Johnson Director, State Health Policy & Advocacy Vitalyst Health Foundation 7/25/2017
Health Care Reform IDEAL REALITY 2
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U.S. Health Care System 4
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% 0.0 2.0 4.0 6.0 8.0 10.0 12.0 14.0 16.0 18.0 20.0 5 Source: OECD
Percent Health Care Spending Trends as a Percentage of GDP 1980 2014 18 16 14 12 10 8 6 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%) 4 2 0 1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 2014 Source: Commonwealth Fund, Mirror, Mirror 2017 GDP refers to gross domestic product. Data in legend are for 2014. Source: OECD Health Data 2016. Data are for current spending only, and exclude spending on capital formation of health care providers. 6
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.= $9,892 0 2000 4000 6000 8000 10000 12000 7 Source: OECD
80 United States Life Expectancy (years) 78.8 78 76 74 72 70 68 66 64 1960 1962 1964 1966 1968 1970 1972 1974 1976 1978 1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 2014 8 Source: OECD
85 84 83 82 81 80 U.S. 78.8 Life Expectancy by Country (2015) Average 80.5 79 78 77 76 9 Source: OECD
Health Outcomes US Performance U.S. Deaths following stroke Preventable deaths Infant mortality 10 Source: Commonwealth Fund Mirror, Mirror, 2017
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 2017 11
Healthcare Overhaul INSURANCE COVERAGE HEALTHCARE FINANCE CARE DELIVERY 12
Access to Care in Arizona
MOVING AWAY FROM 14
MOVING TOWARD 15
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
Access to Coverage in Arizona
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 (#) 300,000 250,000 200,000 150,000 100,000 50,000 0 2006 2008 2010 2012 2014 2016 2018 Year Enrollment Freeze Medicaid Expansion Childless Adults (0-100% FPL) Adult Expansion (100% - 133% FPL) KidsCare Source: https://archive.azahcccs.gov/ 18
Who s Covering Arizona? Health Insurance Coverage of the Total Population - Arizona 2017 1,922,724 470,000 140,079 Medicaid Marketplace Other * Marketplace enrollment reflects effectuated #s from 2/17. Total enrollment = 196,291. Source: AHCCCS Source: CMS 19
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
Arizona s Marketplace/Exchange Average Premiums for Arizona Marketplace Enrollees 2016 2017 % Change Total Premium Sticker Price $324 $611 88.6% Consumer Cost after Subsidies (among those receiving subsidies) $120 $104 13.3% Number of Insurers in Arizona s Marketplace 2014 2015 2016 2017 2018 8 11 8 2 2? Source: Kaiser Family Foundation Roughly 40,000 do not receive subsidy (0.006% of AZ population) Source: CMS, CMS 21
Exchange Enrollees: - With 1 or more insurer = 99.7% - With only 1 insurer = 25.84% Source: CMS/CCIIIO 22
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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