Utilization in the Los Angeles Healthy Kids Program

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Abstract

As part of a multi-year evaluation of the Healthy Kids program in Los Angeles, we analyzed service utilization of Healthy Kids enrollees ages 0 to 18 using health plan encounter and claims data and assessed these data for completeness. Results suggest that actual service rates are higher than administrative data indicate. Other evidence from the evaluation suggests that some services are likely reimbursed by Restricted/Emergency Medi-Cal, and other services are provided just prior to enrolling in Healthy Kids. As a result, some encounters are not captured in health plan data for Healthy Kids, and will present challenges for ongoing program monitoring.

Introduction

The primary goal of the Healthy Kids program is to expand insurance coverage and by extension, improve access to care for previously uninsured children. First 5 LA contracts with the Urban Institute and its partners to provide feedback to stakeholders on the progress of the Children’s Health Initiative in Los Angeles County. The purpose of this study is to analyze service utilization using health plan administrative data and assess the utility of using administrative data for program monitoring.

We present findings on service use by children who enrolled in Healthy Kids in the second year of the program, when data quality was sufficient to support analysis. To help us better understand these data, we compare our measures to similar measures from the San Mateo County Children’s Health Initiative (the only other County CHI where similar analytical data were available), and to findings from an LA Healthy Kids Survey funded by the First 5 LA evaluation. The five measures analyzed were the percentage of Healthy Kids enrollees who received at least one (1) preventive care visit, (2) ambulatory visit, (3) emergency department visit, (4) hospital visit, and (5) prescription filled during their first year on the program.

Our findings, in brief, are as follows:

• The completeness of encounter data increased substantially over the first two years of the Healthy Kids program. This achievement likely reflects both provider incentives to submit encounters put in place by the health plan, and increased provider investment in the program as it matures.
• Administrative data from the LA Healthy Kids program suggest lower rates of utilization by children than administrative data from the San Mateo Healthy Kids program across all measures of service use, including ambulatory and emergency care visits. But these findings may be due to fundamental differences in the administrative data sets, rather than actual differences in service use, suggesting that meaningful comparisons between Healthy Kids programs about utilization levels solely using administrative data may be impractical.
• Administrative data from the LA Healthy Kids program suggest lower rates of utilization than parent reports of their children’s service use in the LA Healthy Kids program from the LA Healthy Kids Survey.
• The best use of Healthy Kids encounter data is the tracking of utilization over time within the Los Angeles (or other county’s) Healthy Kids program, rather than comparisons between programs. Monitoring of a program’s performance will need to include ongoing assessment of the completeness of health plan data in order to distinguish true increases in utilization from improvements in data quality.   

Results presented here based on the administrative data are consistent with evidence from other data sources from the First 5 LA evaluation—including case study interviews with stakeholders, focus groups of parents of Healthy Kids members and outreach workers, and survey results—that strongly suggest enrollees in Los Angeles are receiving services at higher rates than is evident in administrative data. Some of these services are likely reimbursed by Restricted/Emergency Medi-Cal, and others are likely provided just prior to enrolling in Healthy Kids (through CHDP Gateway), given that health care providers enroll about one-third of children into Healthy Kids each year. As a result, some encounters are not captured in the health plan’s data for Healthy Kids.  

Because many Healthy Kids programs are still in the early stages of development, data quality are likely to vary substantially across programs. It will be important to develop standards for assessing the completeness of health plan data in order to facilitate comparison of program performance across county initiatives as these programs mature. The assessment we conducted of L.A. Care’s encounter data is the first step in that direction.

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Disclaimer: The nonpartisan Urban Institute publishes studies, reports, and books on timely topics worthy of public consideration. The views expressed are those of the authors and should not be attributed to the Urban Institute, its trustees, or its funders.