2012 Ohio Medicaid Assessment Survey Research Conference Data spotlight on key populations and patient-centered medical home status in Ohio

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1 2012 Ohio Medicaid Assessment Survey Research Conference Data spotlight on key populations and patient-centered medical home status in Ohio June 28, 2013 Hosted by The Ohio Colleges of Medicine Government Resource Center Agenda Welcome and Introductions State Agency Sponsor Keynotes OMAS Introduction and Methods Patient-Centered Medical Home Status in Ohio Break A Health Profile of Women and Children in Ohio Emerging Challenges of Serving Ohio s Children with Special Health Care Needs OMAS Dashboard: Interactive Data Analysis Closing Remarks 2 1

2 Welcome and Introductions Lorin Ranbom Director Ohio Colleges of Medicine Government Resource Center 3 Sponsors and Collaborators Sponsors Ohio Office of Medical Assistance Ohio Medicaid Ohio Department of Health The Ohio State University Collaborators Ohio Department of Mental Health Ohio Department of Developmental Disabilities Ohio Department of Alcohol & Drug Addiction Services Bowling Green State University Nationwide Children s Hospital The University of Cincinnati Cleveland State University Kent State University Wright State University Ohio University Case Western Reserve University The University of Mount Union Project Management Ohio Colleges of Medicine Government Resource Center RTI International (Survey Vendor) 4 2

3 OMAS now and in the future OMAS 2012 was funded by MEDTAPP to inform OMA about: The potential impact of Medicaid Expansion The impact of other policy initiatives Current funding for OMAS 2012 ends June 30, GRC and sub-contractors will not respond to un-funded requests for assistance with using or analyzing OMAS data. Data are still available online: Self-service OMAS Dashboard on the GRC portal: Public use dataset and documentation: grc.osu.edu/omas 5 OMAS now and in the future Future plans for OMAS: OMAS-related work will be postponed until the project is funded, which may depend on Ohio s decision about Medicaid expansion. If funded: fielding would probably start several months after Medicaid expansion begins. sample size would depend on amount of non-federal match available from sponsors. 6 3

4 2012 OMAS Research Projects Addressing questions relevant to Ohio Medicaid Patrick Beatty Deputy Director and Chief Policy Officer Ohio Office of Medical Assistance The Value of the 2012 Ohio Medicaid Assessment Survey Research Projects to Public Health Jessica Foster, MD, MPH, FAAP Medical Director, Bureau for Children with Developmental and Special Health Needs, Ohio Department of Health Data spotlight on key populations and patient-centered medical home status in Ohio June 28,

5 ODH: Who are We? Ohio Department of Health (ODH) is a data-driven public entity ODH has more professionally-trained public health personnel than any other organization in the state ODH key partners include local public health, other state agencies and others including: The federal government (i.e., CDC) Ohio s universities Ohio s health professional associations Ohio s medical and health service community ODH uses the Ohio Medicaid Assessment Survey (OMAS) to inform this network of public health stakeholders PCMH Vision Optimal health for all Ohioans Mission Protect and improve the health of all Ohioans by preventing disease, promoting good health and assuring access to quality care Infant Mortality Obesity Tobacco Strengthen Relationships With External Stakeholders Enhance the Work Climate at ODH 5

6 Value of OMAS to Public Health Makes available population data on health, health behaviors, and access to care that are unavailable elsewhere Provides health data for specific populations that cannot be derived from existing national surveys African American Hispanic Asian Ohio county type classifications ODH Priority Topics Addressed in OMAS The Ohio Medicaid Assessment Survey addressed key ODH strategic plan initiatives, including: Maternal and child health Patient-Centered Medical Home (PCMH) Obesity Smoking and substance use Health risk behaviors Chronic diseases Health demographics 6

7 Contact Information Jessica Foster, MD, MPH, FAAP Medical Director, CYSHCN Medical Director, BCDSHN Ohio Department of Health OMAS Introduction and Methods Tim Sahr Director of Research and Analysis Ohio Colleges of Medicine Government Resource Center 14 7

8 Outline OMAS Overview Survey Content and Sample Design Final Survey Sample and Response Rates Analyzing OMAS Data Online Access to Data and Results 15 OMAS Overview 8

9 What is the Ohio Medicaid Assessment Survey? The Ohio Medicaid Assessment Survey (OMAS) is a telephone survey designed to measure the health system experiences of Ohioans. OMAS provides data supporting policy making and strategy development for the efficient and effective operation of Ohio s Medicaid program. OMAS is a critical research dataset for estimates of health insurance status, access to health care, health status, health risks, and family income of children and adults in Ohio. 17 Survey Content and Sample Design 9

10 Main OMAS Topics Medicaid status Insurance status Access to health care Health care utilization Unmet health needs Health risk factors Health status Mental health distress Socioeconomic status Health demographics OMAS questions primarily used are existing, validated items. Some Ohio-specific questions were developed and tested in a pilot study of 200 respondents. 19 OMAS Sample Design Dual-frame landline and cell phone sample Data were collected from late May to early October 2012 Survey vendor was RTI International Interviews were conducted in English and Spanish African-Americans were oversampled Landline and cell phone numbers were sampled randomly, but the landline numbers were stratified, predominantly by county, before sampling

11 OMAS Sample Eligibility Adult sample consisted of Ohio adult residents ages 19 and older Landline sample: Proxy allowed if adult resident was unable due to a condition to answer Child sample consisted of a child in the adult s household, restricted to ages 18 and younger Child question was completed by adult proxy Landline: adult most knowledgeable about the child s health insurance coverage and health status was requested Cell phone: adult respondent Respondent was selected using the most recent birthday method 21 Final Survey Sample and Response Rates 11

12 OMAS Interview Summary 2012 OMAS Interviews Landline Interviews (30.2% response rate) 17,731 Interviews (77% of sample) Cell Phone Interviews (24.4% response rate) 5,198 Interviews (23% of sample) Final Sample Size 22,929 Adult Interviews (19 years & older) 5,515 Child Interviews (0 18 years) Child interview was completed by an adult proxy 23 Analyzing OMAS Data 12

13 Weighting and Imputation Weighting addresses the unequal probability individuals have of being selected for the survey. All analysis of the 2012 OMAS meant to be inferred to Ohio s population (i.e., the total number of Ohioans) should be weighted to obtain correct point estimates (mean or proportion), confidence intervals, and modeled statistics. For key variables, imputation techniques were used to generate a version of each variable with complete data. These variables are indicated by _imp after the variable name. A comprehensive methodology report is available online: grc.osu.edu/omas 25 Recommended Software OMAS is a complex-designed survey (e.g., multiple sample frames, strata, and design calculations). Statistical software that factors for complex design surveys needs to be used in analyses, such as: SAS Stata R Survey Package SPSS SUDAAN Wesvar Web-based analysis is also available online

14 Online Access to Data and Results Data and Results are Available Online Numerous resources are available on the OMAS website (grc.osu.edu/omas). These materials can be downloaded and include: A public version of the 2012 OMAS dataset; Total documentation of the dataset; Excel spreadsheets of basic statistical runs; Special topic reports and briefs (Publication List); Sample analysis code for SAS and Stata; and Materials related to the 1998, 2004, 2008, and 2010 Ohio Family Health Survey (OFHS)

15 Patient-Centered Medical Home Status in Ohio Robert Ashmead, MS Ohio Colleges of Medicine Government Resource Center Eric Seiber, PhD The Ohio State University College of Public Health 29 Outline Background Research Aims Data Sources and Methods Key Measures Results Discussion Key Considerations 30 15

16 Background History of the Patient-Centered Medical Home Patient-Centered Medical Home (PCMH) is a health care model for coordinated and comprehensive primary care. The medical home concept was originally introduced in the 1960 s as a central location of all medical information on a child. Several definitions of PCMH have been released by professional associations and agencies, starting in

17 PCMH Characteristics American Academy of Pediatrics Accessible Continuous Comprehensive Family-centered Coordinated Compassionate Culturally effective Agency for Healthcare Research and Quality Patient-centered Comprehensive care Coordinated care Superb access to care Systems-based approach 33 PCMH Recognition/Accreditation and Research Practice systems can gain PCMH recognition or accreditation from groups such as the National Committee for Quality Assurance (NCQA). Full implementation of the PCMH model and evidence of its effectiveness are in their early stages. The PCMH model has shown the potential to improve care, reduce costs, and improve patient experience

18 Research Aims Research Aims 1. Develop a proxy measure of PCMH utilization from the existing 2012 OMAS survey questions. 2. Describe the status of PCMH in Ohio among adults ages years, children, and seniors in both the overall and Medicaid populations. 3. Describe PCMH use among demographic groups and other subpopulations of interest. 4. Characterize PCMH use across places of usual source of care and geographic regions

19 Data Sources and Methods General Methodology Data Sources: 2012 Ohio Medicaid Assessment Survey Ohio Department of Health PCMH Provider Data Analytic Sample: The 2012 OMAS consisted of 22,929 adult interviews and 5,515 child proxy interviews. 227 (0.99%) and 242 (4.39%) were excluded from our analytic sample due to missing, don t know, or refused responses to questions about usual source of care. Descriptive measures rather than statistical testing 38 19

20 Key Measures Care Consistent with a PCMH (CCW-PCMH) Classifies survey respondents into groups based on answers to questions about their health care: Yes, care consistent with a PCMH No, care not consistent with a PCMH Usual source of care, insufficient PCMH Information Individual user perspective not reflective of provider perceptions or experiences. Characterize the health care received, not whether a person s provider is PCMH recognized/accredited: Proxy for PCMH using the information available in the OMAS

21 CCW-PCMH Components Individuals who had the following care components were classified as having CCW-PCMH: 1. Usual source of care 2. Usual source of care was a clinic, health center, doctor s office, or hospital outpatient department (non-e.r. usual source of care) 3. Personal doctor or nurse 4. Health care visit in the past year 41 CCW-PCMH Components 5. a) Provider engagement (adults) provider asked about depression and medication use b) Provider sends appointment reminders (children) 6. (If needed) Enhanced access provider answered questions during regular office hours, received care right away, received care on nights/weekends/holidays 7. (If needed) Specialist care and coordination had limited or no problems seeing a specialist and provider s office seemed informed about care 42 21

22 Results Adults and Children receiving CCW-PCMH About 1 in 5 adults and about 1 in 3 children in Ohio had care consistent with a PCMH. Population Percent CCW-PCMH 90% CI All adults years 18.2 ( ) Medicaid adults years 19.9 ( ) All seniors 19.8 ( ) All children 36.9 ( ) Medicaid children 33.0 ( ) Note that Medicaid refers to those with dual Medicaid/Medicare coverage as well as those covered by Medicaid, without Medicare

23 Which Components were Adults not Meeting? 67.7% of adults ages had a non-e.r. usual source of care and a personal doctor or nurse. Few adults met the provider engagement component. Adult CCW-PCMH component % All adults years % Medicaid adults years Health care visit in the past year a Specialist care/coordination b Usual source of care a Non-E.R. usual source of care c Personal doctor or nurse d Enhanced access e Provider engagement f a. Among all b. Among those who needed specialist care c. Among those with a usual source of care d. Among those with a non-e.r. usual source of care e. Among those who had a personal doctor or nurse and needed enhanced access f. Among those with a personal doctor or nurse 45 Which Components were Children not Meeting? 84.3% of all children had a non-e.r. usual source of care and a personal doctor or nurse. Many children did not meet the enhanced access and provider appointment reminder components. Child CCW-PCMH component Percent of children Percent of Medicaid children Health care visit in the past year a Specialist care/coordination b Usual source of care a Non-E.R. usual source of care c Personal doctor or nurse d Enhanced access e Provider appointment reminders f a. Among all b. Among those who needed specialist care c. Among those with a usual source of care d. Among those with a non-e.r. usual 46 source of care e. Among those with a personal doctor or nurse who needed enhanced access f. Among those with a personal doctor or nurse 23

24 % CCW-PCMH % CCW-PCMH CCW-PCMH by Insurance Type 6.5% of uninsured adults ages years had CCW-PCMH, compared to 20.7% of adults with any type of insurance. 35 CCW-PCMH by Insurance Type among Adults Years Medicaid, no Medicare Dual Medicaid and Medicare Medicare, no Medicaid Employer-Sponsored Uninsured 47 CCW-PCMH by Age Group All Adults Medicaid Age Group (Years) 48 24

25 Percent CCW-PCMH CCW-PCMH by Family Income Percent of 2011 Federal Poverty Level (FPL) CCW-PCMH by Family Income as Percent of 2011 FPL among Adults < Percent FPL 49 CCW-PCMH by Gender and Education The estimated prevalence of CCW-PCMH was higher for females (22.2%) than males (14.1%). This pattern held for the Medicaid population. The estimated prevalence of CCW-PCMH increased steadily from 14.4% among adults ages years who do not have a high school diploma to 22.6% among those with an advanced degree

26 CCW-PCMH by Race/Ethnicity The estimated prevalence of CCW-PCMH was higher among white adults ages years and children than among Black/African American and Hispanic adults and children. Percent CCW-PCMH Adults Ages years All Medicaid White Black/African American Hispanic Children All Medicaid White Black/African American Hispanic CCW-PCMH Among Adults with Physical Health Risks The estimated prevalence of CCW-PCMH was higher for adults with physical health risks. Percent of All Adults Ages years with CCW-PCMH Percent of Medicaid Adults Ages years with CCW-PCMH Risk Factor All Adults Cancer Diabetes Obesity Hypertension Heart Condition

27 % CCW-PCMH Prevalence of CCW-PCMH by Place of Usual Source of Care All adults ages Medicaid adults ages All children Medicaid children Clinic or health center Doctor's office Hospital outpatient department 53 Adult CCW-PCMH by Medicaid Service Region All adults ages years Percent CCW- PCMH Northwest 18.1 Northeast 20.3 Northeast Central 16.7 East Central 19.6 Central 17.2 West Central 18.3 Southwest 17.3 Southeast

28 Discussion Discussion The CCW-PCMH measure was developed to provide a baseline of PCMH care utilization in Ohio. We found that CCW-PCMH was not typical for adults or children, and was not the standard of care for any demographic group, place of care, or geographic region. As the PCMH model advances, patient and provider engagement will influence the success of PCMH implementation. Future OMAS work should seek to better measure PCMH engagement

29 Limitations This measure is limited to patient experiences and perceptions. These analyses are limited to questions and measures implemented in PCMH measurements would benefit from questions addressing: Patient-provider communication, Provider knowledge of patient s medical history, and Time spent with provider. 57 Key Considerations 29

30 Key Considerations Early adoption of PCMH recognition or accreditation was primarily in urban and suburban areas with most locations in and around Cincinnati, Columbus, and Cleveland. Different dynamics outside of urban markets may affect the spread of PCMH recognition or accreditation. Provider engagement is an area with great potential for improvement. While a majority of adults and children had a personal doctor or nurse that they identified with, few reported care that suggested basic provider engagement such as sending out appointment reminders. 59 Key Considerations A significant proportion of Ohio s adults and children still did not have a personal doctor or nurse. While this proportion is lower in Ohio than in than in other states, it represents a large population of Ohioans who might benefit from participation in a PCMH. Health system entities, insurers, and government entities could concentrate efforts to increase basic services consistent with the PCMH model

31 Break Please help yourself to the refreshments. A Health Profile of Women and Children in Ohio Kelly Balistreri, PhD Kara Joyner, PhD Department of Sociology Center for Family and Demographic Research (CFDR) Bowling Green State University 31

32 Outline Background Research Aims Data Sources and Methods Key Measures Results Discussion Key Considerations 63 Background 32

33 Healthy Children Need Healthy Parents A primary component of the US Department of Health and Human Services Healthy People 2020 focuses on improvements in maternal and child health. A better understanding of health care utilization and health-related behaviors among children and women of reproductive ages is needed prior to the possible expansion of Medicaid in Research Aims 33

34 Research Aims Provide health profiles of Ohio women of reproductive ages (19 44) and children (0 18), with a focus on lowincome populations. Health status Health risk behaviors Socioeconomic stressors Identify unmet needs for health care by insurance coverage. Identify determinants of racial/ethnic disparities in access to and utilization of health care among lowincome women. 67 Data Sources and Methods 34

35 Data Sources and Methods 2012 Ohio Medicaid Assessment Survey Women ages 19 through 44 years (N=3,164) Currently or recently pregnant (N=371) Low-income at or below 138% FPL (N=1,357) Children ages 0 through 18 years (N=5,515) Low-income at or below 200% FPL (N=2,500) Survey logistic regression, predicted probabilities, decomposition analyses 69 Key Measures 35

36 Key Measures Health status and conditions Overall general, dental, and vision health Mental health-related functional impairment 14 days functional impairment due to a mental health condition in past 30 days (stress, depression, emotional problems, or substance abuse) Specific conditions (obesity, heart disease or stroke, high blood pressure, diabetes, or cancer) Health risk behaviors Smoking, excessive alcohol use, or misuse of prescription pain reliever Physical activity and screen time in children 71 Key Measures Socioeconomic stressors and household characteristics Marginal food security, financial stress 2011 family income as percent of the Federal Poverty Level (FPL) Characteristics of responding adult attached to child (smoking, disability, alcohol use) Unmet need for health care and health care access No usual source of care Uncertain access to care Care consistent with a patient-centered medical home (PCMH) 72 36

37 Results Insurance Coverage Ohio women (19-44) 74 37

38 Insurance Coverage Low-Income Ohio women (19-44) 75 Statistically Significant Differences In the figures, letters indicate which groups are significant different from one another (p.05). a = Medicaid enrolled differs significantly from Other insured. b = Medicaid enrolled differs significantly from Uninsured. c = Other insured differs significantly from Uninsured. An asterisk indicates.05 p

39 Adjusted Percentage of Fair/Poor Health and Mental Health-Related Functional Impairment Low-Income Ohio Women (19-44) 77 Adjusted Percentage with Health Conditions Low-Income Ohio Women (19-44) 78 39

40 Adjusted Percentage Engaging in Health Risk Behaviors Low-Income Ohio Women (19-44) 79 Adjusted Percentage with Characteristics of Socioeconomic Stress Low-Income Ohio Women (19-44) 80 40

41 Adjusted Percentage Reporting Unmet Needs and Access to Care Low-Income Ohio Women (19-44) 81 Usual Source of Care by Race/Ethnicity Low-Income Ohio Women (19-44) 82 41

42 Health Insurance Coverage Ohio Children (ages 0-18) 83 Health Insurance Coverage Low-Income Ohio Children (ages 0-18) 84 42

43 Prevalence of Fair or Poor Health Ohio Children (select ages) 85 Prevalence of Health Conditions Ohio Children (select ages) 86 43

44 Prevalence of Health Behaviors Ohio Children (select ages) 87 Adjusted Percentage with Characteristics of Socioeconomic Stress Low-Income Ohio Children (select ages) 88 44

45 Adjusted Percentage with Unmet Health Care Needs by Insurance Coverage Low-Income Ohio Children (0-18) 89 Adjusted Percentage of Health Care Access by Insurance Coverage Low-Income Ohio Children (0-18) 90 45

46 Discussion Discussion Ohio Women (19-44) Women of reproductive ages who are uninsured are disproportionately young, minority, and low-income. Obesity and smoking are prevalent among women with Medicaid coverage. Women with Medicaid coverage have the lowest level of unmet need for health care compared to either uninsured women or those insured by other means. Low-income Hispanic women are much more likely than African American and white women to report they have no usual source of care

47 Discussion Ohio Children (0-18) Medicaid insures two out of five Ohio children. A relatively high percentage of Ohio children insured by Medicaid are overweight or obese. Ohio Medicaid is as effective as private coverage at providing care to low-income children. Uninsured children in Ohio are more likely to have an uncertain source of care and are less likely to receive preventative care. 93 Key Considerations 47

48 Key Considerations Uninsured women of reproductive age in Ohio report many risk factors, including a lack health care access. Disparities between white and Hispanic women in health care access could be reduced by increasing levels of insurance coverage among Hispanic women. Expanding coverage to uninsured women of reproductive ages may increase the use of preventative care services which are important for not only ensuring a healthy pregnancy, but also important for promoting healthy behaviors. 95 Key Considerations Outreach efforts could be made to eligible families who are not enrolled in Medicaid as a means of safeguarding the nutritional health of infants and young children. Expanded efforts to enroll eligible children in Medicaid may help alleviate unmet needs for health care among uninsured children. Expanding Medicaid coverage to parents may encourage enrollment of uninsured children and ensure that they receive needed health care services

49 Emerging Challenges of Serving Ohio s Children with Special Health Care Needs Deena Chisolm, PhD Associate Professor of Pediatrics and Public Health The Ohio State University The Research Institute at Nationwide Children s Hospital Outline Background Research Aims Data Sources and Methods Key Measures Results Discussion Key Considerations 98 49

50 Background Children with Special Health Care Needs CSHCN those who have or are at risk for a chronic physical, developmental, behavioral, or emotional condition and who also require health and related services of a type or amount beyond that required by children generally. (McPherson et al., 1998)

51 Why study CSHCN? 40% of health care expenditures for children More unmet needs Worse outcomes Poor health status School absenteeism Parents stop working May reduce expenditures through care coordination 101 Transition to Young Adulthood Young adults with special health care needs (YASHCN) Insurance/provider changes compromise care Affected by Affordable Care Act?

52 Research Aims Specific Aims Estimate CSHCN/YASHCN prevalence Describe CSHCN/YASHCN characteristics Describe how Medicaid CSHCN differ Describe changes in CSHCN since 2008 Identify characteristics of CSHCN who have barriers to care Describe outcomes associated with not having care consistent with a medical home

53 Data Sources and Methods Data Sources OMAS Child version (5,515 proxy responses) Adult version (1,122 respondents, ages 19-25) Ohio Family Health Survey (2008) Similar to OMAS, but only ages 0-17 National Survey of CSHCN (2009/10) Somewhat similar to OMAS, but only ages 0-17 To compare our findings

54 Key Measures CSHCN Status Five anchor items: Does/Is the child 1. need or use medicine? 2. need or use more medical care, mental health or educational services than is usual? 3. Limited or prevented in his/her ability to do the things most children of the same age can do? 4. Need or get special therapy? 5. Have any kind of problem for which he/she needs treatment or counseling?

55 CSHCN Status Two follow-up questions Is this because of any medical, behavioral, or other health condition? (omitted for #5) Is this a condition that has lasted or is expected to last for at least 12 months? 109 Complexity of Need Functional limitations Needs services and prescriptions Needs services only Need prescriptions only No functional limitations

56 Results CSHCN Prevalence 23.1% of Ohio children 0-18 years old About 670,000 children (90% CI: 637, ,535) 388,000 covered by Medicaid* 396,000 lack care consistent with a medical home *throughout presentation, refers to individuals with any Medicaid coverage 2012 Ohio Medicaid Assessment Survey

57 YASHCN Prevalence Not comparable to CSHCN measure 11.7% of Ohio young adults About 124,000 people (90% CI: 105, ,123) 41,000 covered by Medicaid 91,000 lack care consistent with a medical home 87% of uninsured YASHCN are 138% FPL 2012 Ohio Medicaid Assessment Survey 113 Characteristics of Children with and without SHCN Percent of CSHCN Percent of Children without SHCN Male Age (% years old) Race/Ethnicity (% African-American) Parent/Legal guardian s marital status (% divorced/separated) Ohio Medicaid Assessment Survey

58 Characteristics of Children with and without SHCN (2) Income (as % of the federal poverty level) 100% % % % >300% Health insurance Uninsured Medicaid Employer-sponsored insurance Other 2012 Ohio Medicaid Assessment Survey Percent of CSHCN Percent of Children without SHCN CSHCN have more unmet needs Percent with unmet needs during past year 8.3% 7.3% 9.0% CSHCN children without SHCN 4.0% 2.1% 2.2% unmet dental needs* 2012 Ohio Medicaid Assessment Survey unmet prescription needs other unmet health needs *among children age

59 CSHCN use more acute care services Health care utilization during past year CSHCN children without SHCN 80.1% 79.6% 82.2% 70.8% 32.6% 15.9% 12.2% 4.5% 1 emergency room visit 1 overnight hospital stay well-child visit dental visit* 2012 Ohio Medicaid Assessment Survey *among children age CSHCN with Medicaid are sicker 32.5% 39.7% 24.4% 22.9% CSHCN with Medicaid CSHCN with no Medicaid 15.0% 6.9% Currently has asthma 1 emergency room visit Fair/Poor general health status 2012 Ohio Medicaid Assessment Survey

60 but do not have significantly more unmet needs 3.00 Adjusted odds ratios (with 95%CI) for unmet needs: Comparing CSHCN with Medicaid (reference) vs. CSHCN with ESI Unmet prescription needs Unmet dental needs* Other unmet needs Models adjusted for age, gender, race/ethnicity, income, care consistent with a medical home, general health status, and complexity of need. *among children age Ohio Medicaid Assessment Survey 119 Changes Since 2008 CSHCN population became larger 575,000 to 640,000 (0-17 year olds) CSHCN population became poorer and was more likely to be covered by Medicaid Few differences in demographics, needs, or care utilization 2012 Ohio Medicaid Assessment Survey; 2008 Ohio Family Health Survey

61 Changes Since 2008 Number of Ohio CSHCN by income as percentage of Federal Poverty Level (FPL), 2008 & ,619 >300% FPL % FPL % FPL % FPL <100% FPL 191,458 82,622 73,926 58, ,133 81,474 79,588 65, , Ohio Medicaid Assessment Survey; 2008 Ohio Family Health Survey 121 Changes Since 2008 Number of Ohio children (0-17) with special health care needs by insurance type/status, 2008 & ,403 16,700 36,560 Uninsured 27, ,259 Other 270,173 Employer- Sponsored Medicaid 260, , Ohio Medicaid Assessment Survey; 2008 Ohio Family Health Survey

62 Which CSHCN face barriers to care? Percent of children with unmet needs CSHCN with functional limitations CSHCN with no functional limitations Children without special health care needs 15.7% 22.8% 12.2% 10.7% 12.4% 9.9% 6.1% 6.0% 6.0% 4.0% 2.1% 2.2% Has unmet dental needs* 2012 Ohio Medicaid Assessment Survey Has unmet prescription needs Has other unmet needs *among children age 3 Care is harder to get compared to 3 years ago* 123 CSHCN and Care Consistent with a Patient- Centered Medical Home 36.2% of CSHCN had care consistent with a patient-centered medical home (CCW-PCMH). vs. 36.9% for children without SHCN Lacking CCW-PCMH was not associated with unmet needs, care utilization or health status. The OMAS did not have an assessment for family-centeredness or culturally and linguistically appropriate care Ohio Medicaid Assessment Survey

63 Discussion Key Findings Ohio s CSHCN population is becoming larger and poorer Increasingly reliant on Medicaid Compared to employer-sponsored insurance, Medicaid does a comparable job of addressing CSHCN s needs CSHCN with functional limitations differ from those with less complex needs

64 Key Considerations Key Considerations CSHCN with functional limitations may benefit from ABD s move to managed care Efforts to expand the number of recognized/accredited PCMH s may benefit CSHCN Expanding Medicaid to young adults within 138% of FPL could cover 87% of uninsured YASHCN

65 Future research Align survey measures of children and young adults with SHCN Include more items to clinically describe CSHCN Detailed study of children with disabilities 129 OMAS Dashboard: Interactive Data Analysis Rachel Tumin, MS Survey and Population Health Analyst Manager Ohio Colleges of Medicine Government Resource Center 65

66 Outline OMAS Dashboard Introduction Currently Available Features Live Demonstration Forthcoming Features 131 OMAS Dashboard Introduction 66

67 Historical Approaches to Data Analysis Published results and reports Difficult to provide customized data analysis Time delays Primary data analysis with appropriate software Software is expensive Advanced training Time-intensive 133 A New Tool for Data Analysis The OMAS Dashboard on the GRC Portal is a publically available online tool for real-time data analysis. User-directed data analysis Fast (instant analysis) Free for the consumer Does not require any programming by the consumer

68 Currently Available Features State-Level Estimates Users can calculate estimated proportions and counts for select OMAS measures for adults: Unmet health care need Health status Health care access and utilization Insurance status and demographics Associated standard errors and confidence intervals

69 Stratified Analysis Users can calculate the estimated prevalence and count of these measures in Ohio across four variables: Type of insurance coverage Race/Ethnicity Employment status County type 137 Subpopulation Analysis Users can restrict their analysis to a subset of the whole population. These subpopulations can be defined by: Gender Percent of poverty Age group

70 Live Demonstration Accessing the OMAS Dashboard Go to

71 Forthcoming Features Forthcoming Features Additional measures for adults Health conditions Health behaviors Corresponding measures for children

72 Closing Remarks Tim Sahr Director of Research and Analysis Ohio Colleges of Medicine Government Resource Center 143 Thanks to the OMAS Partnership Thanks to all who worked throughout the 2-year process of the OMAS to get these data and reports to Ohio s health community. A special thanks to: Rachel Tumin, Project Manager Amy Ferketich, Academic Team PI Thomas Duffy and Marcus Berzofsky, RTI International Ohio Medicaid, particularly Dave Dorsky and Mina Chang Mid-Ohio Foodbank The sponsored research teams The GRC researchers and staff

73 Additional Resources are Available Online OMAS website (grc.osu.edu/omas ) Policy briefs and research reports Special topic reports (Publication list) Public dataset, data documentation and methods report OMAS Dashboard on the GRC portal ( ) User-directed data analysis Functionality will continue to grow 145 Further Questions For general inquiries about OMAS or the Dashboard, please contact GRC via the OMAS website (grc.osu.edu/omas /contact) Pursuant to funding, topics and survey question items for future survey consideration can be proposed to the GRC via the OMAS website (grc.osu.edu/omas /contact)

74 Thank You 74