Transcript National Numbers - Connect for Health Colorado

BACKGROUND RESEARCH
National Data for Exchange
Marketing Strategy Planning
Marketing Education Outreach Workgroup
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.
2
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.
4
Characteristics of a High Quality Plan,
According to Consumers
PwC Health Research Institute, July, 2011
71%
60%
40%
30%
25%
22%
20%
4%
Benefits
Provider
Network
Lower cost than
competitors
High quality
rating from
independent
organization
Different
healthcare
venue options
(e.g. retail
clinic)
High consumer
ratings/
reviews
Well known
company name
Higher cost
than
competitors
5
Chapter 1
INCOME AND EMPLOYMENT
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
7
Firms and Employment in Colorado by Industry
and Firm Size, 2006-2007 (non-farm, thousands)
US Small Business Administration, Office of Advocacy ,2009
8
Employed persons by class of worker and part-time
status (thousands)
Department of Labor, 2011
9
Chapter 2
AGE AND OBJECTORS
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 4564 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 Purchasers
Oliver 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
12
Chapter 3
RACE, ETHNICITY, LANGUAGE,
CULTURE
DIMENSIONS
Spanish
Legacy
Foreign
Born, 5 or
more years
in US
German,
Foreign
Born, < 5
years in U.S.
French,
Russian
Korean,
Chinese,
Tagalog
Age
Income
Gender
14
Profile of Hispanic Adults in the US
PEW Hispanic Center and RWJF, 2008
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.
15
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.
16
Reasons Hispanics Lack Usual Health
Care Provider
PEW Hispanic Center and RWJF, 2008
17
Hispanics Lacking Usual Health Care
Provider
PEW Hispanic Center and RWJF, 2008
18
How Hispanics Receive Information
PEW Hispanic Center and RWJF, 2008
19
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.
20
Language Spoken at Home in Colorado
(Number of Speakers)
Korean: 9,580
Spanish: 515,262
Vietnamese: 14,163
German: 23,939
Russian: 13,978
French: 15,072
21
Chinese: 9,945
Tagalog: 9,370
2005 American Community Survey
Chapter 4
GENDER
Uninsured by Gender, Poverty, Age,
Race in the US
Commonwealth Fund, May 2011
23
Women in Individual Market
Commonwealth Fund, May 2011
24
Women Affected by Medical Debt
Commonwealth Fund, May 2011
25
How Women will Gain Coverage in
2014
Commonwealth Fund, May 2011
26
Women in Subsidized Exchange
Commonwealth Fund, May 2011
27
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/
Group 5
GEOGRAPHY AND DISTRIBUTION
CHANNELS
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
31
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
Economic
Class
West
Dial-Up
DSL
Cable
Satellite
Wireless
Other/
Unknown
17
37
10
16
16
4
23
36
11
13
11
5
$10,000$99,999
US
$10,000$99,999
Notes
Primary 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.
32
Computer Access and Ownership
USDA, National Agricultural Statistics Service, 2009
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.
33
Customers’ Experience with
Purchasing on the Internet
PwC Health Research Institute, July, 2011
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%
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
34
Who Uses and Owns Smartphones?
Pew Research Center, 2011
Android vs. iPhone vs. Blackberry
Pew Research Center, 2011
Chapter 6
MILITARY
Uninsured Vets Die Unnecessarily
Physicians for a National Health Program, 2009
Excess =
unnecessary
“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.
HTTP://WWW.PNHP.ORG/NEWS/2009/NOVEMBER/OVER_2200_VETERANS_.PHP
38
Uninsured Veterans
Health 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 Veterans
Health Care Financing & Economics, 2010 (MEPS and CPS data)
40
Chapter 7
TRIBES
Where People Receive Care
IHS, 2006
42
Why People Seek Care
IHS, 2006
43
Leading Health Problems by Age
IHS, 2006
44
Incoming Referrals
IHS, 2006
45
Clinicians Documenting Patient
Education
IHS, 2007
46
Patient Education by Location
IHS, 2007
47
Education Topics
IHS, 2007
48
http://www.ihs.gov/healthcommunications/index.cfm?module=dsp_hc_internet_access
49
http://www.ihs.gov/healthcommunications/index.cfm?module=dsp_hc_internet_access
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
Chapter 8
LGBT
• The ratio of uninsured gay individuals is 2:1
compared to heterosexuals.
(www.lgbtcancer.com, 2006)
52
LGBT etc.
http://data.lambdalegal.org/publications/downloads/whcic-insert_low-income-or-uninsured.pdf
The ratio of uninsured gay individuals is 2:1 compared to heterosexuals
(www.lgbtcancer.com, 2006)
53
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-thechannel.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-toFind-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-ofmanagement/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
54
Resources
•
•
•
•
•
•
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-centerrural-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
55