INDIANAPOLIS--(BUSINESS WIRE)--Indiana residents who are paying for their health care benefits under the state’s novel approach to Medicaid are accessing more preventive services, following up on care more and using the ER for non-emergency treatment less than members in traditional Medicaid plans, according to a new white paper by Anthem, Inc.’s Public Policy Institute.
The early success from Healthy Indiana Plan (HIP) 2.0 with respect to members’ engagement in their health care runs contrary to long-held assumptions that these types of financial incentives won’t motivate Medicaid members. In fact, members are overwhelmingly satisfied with their health care in spite of contributing to a monthly savings account, according to the study.
“Although this model is still relatively new in Medicaid, Indiana is demonstrating the ways in which alternative approaches to Medicaid expansion can provide positive outcomes for both the member and the state,” said Kristen Metzger, president of Anthem’s Medicaid health plan in Indiana. Anthem’s affiliated health plan is one of three private insurers offering coverage under HIP 2.0, and the data for the white paper was taken primarily from the Anthem plan’s member claims and member research.
HIP 2.0, which began in February 2015 and covers around 387,000 individuals, offers a unique approach to Medicaid benefits under a waiver agreement between the state of Indiana and the federal Centers for Medicare & Medicaid Services. HIP 2.0 offers two major benefit plans: Basic and Plus; both include all required essential health benefits. Plus also includes dental and vision benefits, higher service limits, and a comprehensive drug benefit, and requires members to make a monthly contribution based on their income to their POWER accounts. Basic does not, but does require cost sharing at the time of service for most services.
One of the most revealing findings is that members who pay for Plus – which requires a monthly contribution -- are accessing their benefits, engaging in their care, and seeking care in the most appropriate setting at higher rates than are Basic or traditional Medicaid members. For example:
- The percentage of members who received preventive health screenings, such as screenings for breast cancer and cervical cancer, is higher for Plus versus Basic members. Roughly 39 percent of Plus members received a breast cancer screening (compared to 21 percent of Basic members) while 27 percent of Plus members obtained a cervical cancer screening (compared to 15 percent of Basic members).1
- Plus members are also more likely to follow up on care, with 77 percent of Plus members obtaining appropriate follow-up care for use of an ACE inhibitor, compared to only 66 percent of members in Basic.2
- ER use among Plus members is 21 percent lower than ER use among Basic members.3 Plus members have no cost sharing at the time of service except for CMS-allowable co-payments for non-emergency ER use, which range from $8 to $25.
- ER use among HIP members is substantially lower than ER use among enrollees in Hoosier Healthwise (Indiana’s traditional Medicaid program). HEDIS data show that members who transitioned to HIP from Hoosier Healthwise have 30 percent lower ER utilization compared to ER use while enrolled in traditional Medicaid, resulting in an estimated savings of about $2.5 million.4
Additionally, an overwhelming number of HIP members – nearly 90 percent – are satisfied with their overall health care, according to the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey.
“Early observations of HIP 2.0 suggest that increased ownership of one’s health care has a positive impact on how members engage in their care,” said Jennifer Kowalski, vice president at Anthem’s Public Policy Institute. “This experience adds to the narrative of positive outcomes from approaches that utilize consumer engagement to drive healthier behaviors. It also suggests that even modest member contributions such as those required under HIP Plus, when designed appropriately, can positively influence how members think about and access care.”
The Anthem Public Policy Institute was established to share data and insights to inform public policy and shape the health care programs of the future. The Public Policy Institute strives to be an objective and credible contributor to health care innovation and transformation through publication of policy-relevant data analysis, timely research and insights from innovative programs.
About Anthem, Inc.
Anthem (NYSE:ANTM) is working to transform health care with trusted and caring solutions. Our health plan companies deliver quality products and services that give their members access to the care they need. With over 72 million people served by its affiliated companies, including more than 39 million enrolled in its family of health plans, Anthem is one of the nation’s leading health benefits companies. For more information about Anthem’s family of companies, please visit www.antheminc.com/companies.
1 Data comes from Anthem Insurance Companies, Inc. (February 12, 2016) and represents the period of February 1, 2015 through September 30, 2015.
2 Data comes from Anthem Insurance Companies, Inc. (February 12, 2016) and represents the period of February 1, 2015 through September 30, 2015.
3 Data comes from Anthem Insurance Companies, Inc. (February 12, 2016) and represents the period of February 1, 2015 through September 30, 2015.
4 Data comes from Anthem Insurance Companies, Inc. (February 12, 2016) and represents the period of February 1, 2015 through September 30, 2015.