Government

Enhanced Medicaid plan sees low sign-ups, but high use

West Virginia's Mountain Health Choices is attracting less-healthy adults, but whether it is improving their health remains unclear.

By Doug Trapp — Posted Aug. 10, 2009

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An analysis of West Virginia's consumer-driven Medicaid reform found that although some participants are confused about how an enhanced-benefit option works, some more frequent health care users are drawn to it because of its more generous prescription drug coverage.

The report -- released July 30 by the West Virginia University's Bureau of Business and Economic Research -- provides the most comprehensive insight so far into Mountain Health Choices, the state's attempt to get relatively healthy Medicaid enrollees engaged in their health care. The program has been operating in most parts of the state for more than 18 months.

Mountain Health Choices offers enhanced benefits to selected Medicaid enrollees who agree to follow a wellness plan, to listen to physician orders and to arrive on time for medical appointments. The benefits include weight counseling and assistance in quitting smoking. Enrollees who don't opt in are signed up for a basic plan with somewhat fewer benefits than traditional Medicaid.

The WVU review, based on a mail survey of more than 1,000 Medicaid enrollees in Mountain Health Choices, provided some unexpected results.

While some at the state's Medicaid agency thought that the enhanced benefits would attract healthier enrollees, the opposite was true for adults, according to Tami Gurley-Calvez, PhD, study co-author and research assistant professor at WVU.

"It appears now that the enhanced plan is kind of a chronic disease management program for adults," Gurley-Calvez said. Adults in the enhanced plan visited physicians more often and filled more prescriptions than did adults in the basic plan. Those who chose the enhanced plan were especially attracted to it because it does not have the four-prescription-per-month limit of the basic plan, she said.

But children's enrollment in the enhanced plan was more a function of parents' attitude, outlook and engagement than of the kids' health needs, the report said.

Also surprising, Gurley-Calvez said, was that Mountain Health Choices enrollment hasn't seen the traditional increase many programs achieve with time. Although enrollees said physicians influenced their decision to enroll in the enhanced plan, members who only heard about it from family were less likely to do so.

The state's Medicaid agency didn't set enrollment goals for Mountain Health Choices, but enhanced plan membership has been low. Of the 162,523 enrollees eligible for the enhanced plan as of Aug. 1, 2009, only 23,228 chose it, including 2,062 adults. The state has about 400,000 Medicaid enrollees. Gurley-Calvez said the WVU team will look further into the data to get more answers as to why so many members ended up in the basic plan. At first look, enrollees seem to be satisfied with their regular Medicaid coverage, she said.

The report will help the state Medicaid bureau communicate better with enrollees, said agency spokeswoman Shannon Landrum. For example, Mountain Health Choices members said program mailings were the most helpful form of communication.

But although it's true that many enrollees remembered the mailings, "that didn't translate into understanding of the program," Gurley-Calvez said. About half of those surveyed either were not aware that there were two plans or did not know in which plan they were enrolled.

The WVU report leaves some key questions unanswered, said Renate Pore, president of the consumer advocacy group West Virginians for Affordable Health Care. For example, is the program improving the health of the Medicaid population? More information is needed about whether the program is improving childhood obesity rates, as well as asthma care and prevention, Pore said.

The report also does not show if enhanced-plan members are more frequent users of health care because of their medical needs or if they are just more engaged in their health care than average Medicaid enrollees, said Evan Jenkins, the West Virginia State Medical Assn's executive director. "I think the answer is some of both."

Very few physicians returned a parallel survey designed to assess doctors' perception of and involvement in Mountain Health Choices. Still, Jenkins said he isn't hearing many physician complaints.

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ADDITIONAL INFORMATION

Enhanced Medicaid benefits attract high utilizers

A West Virginia University review of the state's consumer-driven Medicaid reform -- known as Mountain Health Choices -- found that adults and children enrolled in the enhanced-benefits package visited their doctors more often than those who opted for the basic plan. The survey of more than 1,000 enrollees found that:

  • Adults in the enhanced plan on average visited physicians more than twice as often and filled 150% more prescriptions than adults in the basic plan.
  • Children in the enhanced plan averaged 60% more physician visits than kids in the basic plan.
  • Children enrolled in the enhanced and basic plans were comparably healthy, but parents of kids in the enhanced plan were more engaged in their children's health care and more optimistic about their outcomes than were parents of kids in the basic plan.
  • About a quarter of Medicaid enrollees were not aware that Mountain Health Choices had basic and enhanced plans. Another 25% did not know in which plan they were enrolled.
  • All Mountain Health Choices plan members generally were satisfied with their coverage, rating it on average 4 points out of a possible 5. Most planned to stay enrolled where they were for three or more years.

Source: West Virginia University, College of Business and Economics, Bureau of Business and Economic Research. Some results are based on July 2008 figures. (link)

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