Health Services Access, Quality, and Financing

High Deductible Health Insurance Plans in Rural Areas

Abstract: 

Enrollment in high deductible health plans (HDHPs) has increased amid concerns about growing health care costs to patients, employers, and insurers. Prior research indicates that rural individuals are more likely than their urban counterparts to face high out-of-pocket health care costs relative to income, despite coverage through private health insurance, a difference related both to the lower income of rural residents generally and to the quality of the private plans through which they have coverage. Using the 2007-2010 National Health Interview Survey, this study examines rural residents’ enrollment in HDHPs and the implications for evolving Affordable Care Act Health Insurance Marketplaces.

Rural residents with private insurance are more likely to have an HDHP than are urban, especially when they live in remote, rural areas. Among those covered by an HDHP, rural residents are more likely to have low incomes and more limited educational attainment than urban residents, suggesting that it will be important to monitor HDHP enrollment, plan affordability, and health plan literacy among plans available through the Health Insurance Marketplaces.

Associated Research & Policy Brief: Rural Residents More Likely to be Enrolled in High Deductible Health Plans

Suggested Citation: Lenardson JD, Ziller EC, Coburn AF. High Deductible Health Insurance Plans in Rural Areas. Portland, ME: University of Southern Maine, Muskie School of Public Service, Maine Rural Health Research Center; May, 2014. Working Paper #55.

Publication Type: 
Report
Publish Date: 
May 13, 2014
URL: 
http://muskie.usm.maine.edu/Publications/rural/High-Deductible-Insurance-Plans-Rural.pdf

Understanding Changes to Physician Practice Arrangements in Maine and New Hampshire

Abstract: 

This report examines trends in the organization and ownership of physician practices in Maine and New Hampshire. The Maine Office of MaineCare Services and the New Hampshire Office of Medicaid Business and Policy observed a trend in the conversion of physicians from private practice to other practice arrangements including Rural Health Clinics (RHCs), Federally Qualified Health Centers (FQHCs), hospital-owned practices, and hospital outpatient departments. Faced with increased costs for care provided within these facilities, both Medicaid programs sought to understand more about these changes, including their magnitude, the forces driving them, and their short and longer-term implications.

Suggested Citation:

Lenardson J, McGuire C, Alfreds S, et al.  Understanding Changes to Physician Practice Arrangements in Maine and New Hampshire. Portland, ME: University of Southern Maine, Muskie School of Public Service, Institute for Health Policy; January 2008.

Publication Type: 
Report
Publish Date: 
January 31, 2008
URL: 
http://muskie.usm.maine.edu/Publications/ihp/PhysicanPracticeChanges.pdf

Health Care Access and Use Among the Rural Uninsured

Abstract: 

The uninsured have poorer access to care and obtain care at greater acuity than those with health insurance; however, the differential impact of being uninsured in rural versus urban areas is largely unknown. Using data from the 2002–2007 Medical Expenditure Panel Survey, we examine whether uninsured rural residents have different patterns of health care use than their urban counterparts, and the factors associated with any differences. We find that being uninsured leads to poorer access in both rural and urban areas, yet the rural uninsured are more likely to have a usual source of care and use services than their urban counterparts. Further, controlling for demographic and health characteristics, the access and use differences between the uninsured and insured in rural areas are smaller than those observed in urban areas. This suggests that rural providers may impose fewer barriers on the uninsured who seek care than providers in urban areas.

Suggested Citation:

Ziller EC, Lenardson JD, Coburn AF.  Health Care Access and Use Among the Rural Uninsured. J Health Care Poor Underserved. 2012; 23(3):1327-1345.  doi: 10.1353/hpu.2012.0100

Publication Type: 
Journal Article
Publish Date: 
August 1, 2012
URL: 
http://muse.jhu.edu/login?auth=0&type=summary&url=/journals/journal_of_health_care_for_the_poor_and_underserved/v023/23.3.ziller.pdf

Children Served by MaineCare 2012: Survey Findings

Abstract: 

The purpose of the annual Survey of Children Served by MaineCare is to monitor the quality of services delivered by MaineCare, the State's Medicaid and CHIP program.  The 2012 survey examines the experiences of families with children. ages 0-17, who are enrolled in MaineCare using a standardized survey instrument (Consumer Assessment of Healthcare Providers and Systems--CAHPS--4.0H Child Medicaid Health Plan Survey). MaineCare scores very favorably compared with national benchmarks on CAHPS measures of Getting Needed Care, Getting Care Quickly, and How Well the Child's Doctors Community, with ratings at or above the 75th percentile on all the composites and individual items.  Overall ratings of the child's personal doctor, ratings of the child's specialist, and ratings of all the child's health care are also among the highest nationally.  Areas for improvement included MaineCare customer service and care coordination.  Continued administration of the CAHPS 4.0H Child Medicaid Health Plan Survey is recommended for 2013 and beyond to allow for ongoing monitoring of patient experience with and computation of trend results of the MaineCare program as well as ensuring that the MaineCare program complies with federal CHIPRA measure reporting requirements.

Suggested citation: Anderson, N., Fox, K., Thayer, D., & Croll, Z. (2013, January). Children served by MaineCare, 2012: Survey findings. Portland, ME: University of Southern Maine, Muskie School of Public Service.

Publication Type: 
Report
Publish Date: 
January 1, 2013
URL: 
http://www.maine.gov/dhhs/oms/pdfs_doc/ihoc/Maine-2012-MaineCare-Children-Survey.pdf

Why Do Some Critical Access Hospitals Close Their Skilled Nursing Facilities While Others

Abstract: 

Critical Access Hospitals (CAHs) have long played an important role in the provision of Skilled Nursing Facilities (SNF), swing bed, and other long term care (LTC) in rural communities and are more likely than other rural and urban hospitals to offer these services. The implementation of the Medicare SNF prospective payment system (PPS) in 1998 and subsequent exemption of CAH-based swing bed services from the SNF PPS in July, 2002 created financial incentives from CAHs to close their SNF units in favor of providing skilled level care using swing beds. During the period 2004 through 2007, 42 CAHs closed their SNF units. Despite the changing financial incentives related to the operation of SNF units by CAHs, 42% of CAHs (456) in 2010 continued to operate SNF units. Little is known about the reasons CAHs decide to close or retain their LTC services. This briefing paper and associated policy brief address this gap by examining the factors related to operation of skilled nursing services by CAHs, and specifically the factors related to closure of skilled nursing units by some CAHs and the continued provision of these services by others.

Key Findings:

  • Critical Access Hospitals (CAHs) that closed Skilled Nursing Facility (SNF) units cited a range of financial challenges related to payer mix, operating costs, cost allocation methods, and service utilization patterns.
  • The availability of alternative local long term care services, including swing beds, often contributed to hospitals’ decisions to close their SNF units.
  • CAHs that continued to operate SNF units were driven primarily by community need, despite the financial disincentive for doing so.
  • Hospitals reported substantial variation in their strategies for using swing beds for SNF, rehabilitation, and post-acute services.
  • Given ongoing concerns about financial viability and low census rates among some CAHs, further research on the ability of CAHs to expand patient services and revenues through swing bed use is warranted.
  • Additional research on the quality and outcomes of skilled care delivered by CAHs in SNF and swing beds is also recommended.

Suggested citation: Gale JA, Croll ZT, Coburn AF, et al.  Why Do Some Critical Access Hospitals Close Their Skilled Nursing Facilities While Others Retain Them?  Portland, ME: Flex Monitoring Team; December 2012.

Publication Type: 
Report
Publish Date: 
December 30, 2012
URL: 
http://flexmonitoring.org/documents/PolicyBrief31-CAh-SNF-services.pdf

Improving Health Outcomes for Children (IHOC): Summary of pediatric quality measures for children enrolled in MaineCare FFY 2009 - FFY 2012

Abstract: 

This report, authored by USM Muskie School research staff, presents the results of the 16 CHIPRA Core Measures that were collected using MaineCare claims or Vital Statistics data and reported in the State of Maine’s FFY 2012 CHIP Annual Report to the Centers for Medicare and Medicaid Services (CMS). Also included in this report are an additional three measures from the Improving Health Outcomes for Children (IHOC) project’s Master List of Pediatric Measures. In addition to presenting results in graphs and narrative, this report also provides measure definitions and background information about each measure topic.

The goal of this document is to present the claims- and vital statistics-based CHIPRA and IHOC measure results in a user-friendly format for IHOC project stakeholders. Measures are grouped by topic. For each topic, a Background section provides a brief description and rationale for collection. (The background discussion for CHIPRA Core Measures is drawn from the Background Report for the Initial, Recommended Core Set of Children’s Healthcare Quality Measures for Voluntary Use by Medicaid and CHIP Programs. Available at: http://www.ahrq.gov/chipra/corebackgrnd.htm) Next, we provide a general description of how each measure is defined, followed by the results.

Suggested citation: Anderson N, Meagher T. Improving Health Outcomes for Children (IHOC): Summary of Pediatric Quality Measures for Children Enrolled in MaineCare FFY 2009 - FFY 2012.   Portland, ME: University of Southern Maine, Muskie School of Public Service; April 2013.

Publication Type: 
Report
Publish Date: 
April 30, 2013
URL: 
http://www.maine.gov/dhhs/oms/pdfs_doc/ihoc/Summary_of_Pediatric_Quality_Measures_2012.pdf

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