More than an insurance mandate - PowerPoint Presentation

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More than an insurance mandate

Factors Influencing Student Utilization of Student Health Centers

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Tyler G. James, M.S., CHES

®

Katherine Lindsey, M.S., CPC, CHDA

University of Florida, Gainesville, FLSlide2

A note on accessibility

If we need to speak up, please give us a thumbs-up.

If we need to slow down, please give us a thumbs-down.

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Thanks to our collaborators

Dr. Guy Nicolette – Director, Student Health Care CenterDr.

JeeWon Cheong – Assoc. Prof., Health Ed. & Beh.Leanne

Dumeny

– MD/PhD Student

Meagan K. Sullivan – MPH candidate

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Overview

Part I: The Mandate

Part II: Health Insurance Needs AssessmentPart III: Application to Health Promotion

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How many of you have an insurance Requirement?

Who’s in the audience

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How many of you Are Actively trying to create one?

Who’s in the audience

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A recent ACHA survey showed that

38 percent of public colleges require health insurance and 77 percent of private colleges

require health insurance.Fun Fact

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The Mandate

Part I

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Why does it matter?

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Then and Now

That was 2014…Does it still matter?

Let’s take a quick look at how ACA impacted the college student population (Next few slides courtesy of Lookout Mountain Group analysis of American Community Survey)

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Then and Now

(cont’d)

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19.2% uninsured

8.7% uninsuredSlide12

Then and Now

(cont’d)

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12.3%Slide13

One Step Further…

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Engaging Stakeholders

How we passed through the Board of TrusteesMeaningful conversation (Top 10/Preeminence)

How we implemented within the universityModels we looked at – hard vs. softDifference student subgroups – athletes, health professions, international

Determining comparable coverage guidelines

Working with health professionals across campus

Use ACA as framework

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Implementation Committees

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Newly Created Mission & Vision

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The age range of college students accounts for the largest group of uninsured and under-insured individuals in the nation. Here at the University of Florida, preserving our student’s health and wellness are paramount.

There are times when students’ health or well-being, access to health services, or payment for healthcare can hinder them from achieving their academic goals.

This platform was founded on removing as many obstacles as possible for our students to reach graduation.Slide17

Requirement Cycle

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Requirement Cycle

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Requirement Cycle

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Requirement Cycle

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Requirement Cycle

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Requirement Cycle

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Requirement Cycle

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What now?

Is the Mandate Working?

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TOTAL SHCC VISITS per month

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TOTAL SHCC VISITS per month

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ACA

UFSlide27

TOTAL SHCC VISITS per month

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ACA

UFSlide28

TOTAL SHCC VISITS per month

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ACA

UF

Pre-UF Mandate:

6118 visits/m

Post-UF Mandate:

6116 visits/mSlide29

Impact ON UNIVERSITY AND SHC

More competition

University infrastructure for insurance billing In- vs. out-of-networkImpact on out-of-state students

Impact of geographic coverage constraints

Wrap around policies

Appeal process

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The NEEDS ASSESSMENT

Part II

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HOW CAN WE INCREASE STUDENT UTILIZATION OF SHC?

Question posed to our Student Health Advisory Board, made up of 3 sub-committees.

SHAB finance sub-committee project for AY 2016-2017.

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The U.S. Healthcare SYSTEM

IS COMPLEX

Healthcare in the U.S. is expensive and payment processes are complex. Historically, there has been a focus on access in the form of

financial access

.

Health insurance mandates increase the insured population – which ‘cures’ the problem of financial access.

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Uberoni

,

Finegold

, & Gee (2016)Slide33

ACCESSING SHC

s IS EASY…

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Large proportion of college students have health insurance

Higher uptake of

healthcare services

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Turner & Keller (2015); ACHA (2017);

Lau et al. (2013); Cohen et al. (2013)Slide34

What is preventing students from using SHC

s?

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Large proportion of college students have health insurance

Higher uptake of

healthcare services

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Turner & Keller (2015); ACHA (2017);

Lau et al. (2013); Cohen et al. (2013)Slide35

POTENTIAL BARRIERS

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Health literacy impacts healthcare use

“The degree to which individuals have the

capacity to obtain, process, and understand basic health information and services needed to make appropriate decisions.”

23-37% of the adult population has inadequate health literacy.

1-in-15 college students are at risk for low health literacy.

College students prefer Internet media, but have low eHealth literacy.

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Kindig

et al. (2004);

Macabasco

-O’Connell et al. (2011);

McKee et al. (2015); Menendez et al. (2015);

Makert

et al. (2017); Stellefson et al. (2011)Slide37

Health insurance literacy

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Lynn Quincy (2012); Norton et al. (2014);

Paez

et al. (2014); Bartholomae et al. (2016)Slide38

Young adults and health insurance literacy

Young Americans (18-29) are unfamiliar with insurance terms and cost calculations.

Lower health insurance self-efficacy found among younger individuals.

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Lynn Quincy (2012); Norton et al. (2014);

Paez

et al. (2014); Bartholomae et al. (2016)Slide39

METHODS

Administered in March 2017.Random sample of 10,000 on-campus students.

Incentive: First, middle, and last 10, $20 Amazon® gift card.

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MEASURES

Kaiser Family Foundation Health Insurance KnowledgeHealth Insurance Literacy Measure (self-efficacy)

Health service utilization

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Sample CHARACTERISTCS

1,450 completed variables of interest.63% female

65.3% white65% undergraduate

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HEALTH SERVICE UTILIZATION

55.8% used the SHC in the past 12m.85.6% used any healthcare office in the past 12m.

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HEALTH INSURANCE LITERACY

Knowledge: M = 5.8 (range: 0-10), Med = 6.00Self-efficacy: M = 2.48 (range: 1-4), Med = 2.50

Knowledge and self-efficacy were correlated (r = 0.43).

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KNOWLEDGE ITEM DIFFICULTY

Item

% Correct

Definition of “health insurance premium”

79.5%

Health insurance premium must be paid every month

78.5%

Definition of “annual health insurance deductible”

67.4%

Calculate out-of-pocket costs for hospital stay with deductible and copay

48.3%

Definition of “annual out-of-pocket limit”

68.6%

Definition of “health insurance formulary”

18.6%

Definition of a health plan “provider network”

80.9%

Not all doctors who provide care at in-network hospital may be in-network

39.0%

Calculate out-of-pocket costs when insurer pays a portion of allowed charges for out-of-network lab tests

24.8%

Ability to appeal health plan denial

70.6%

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HEALTH INSURANCE LITERACY AND GENERAL HC USE (PAST 12m)

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HEALTH INSURANCE LITERACY AND GENERAL HC USE (PAST 12m)

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SHC use (past 12m)

Interaction of self-efficacy and knowledge not significant.Main effect of self-efficacy was significant.

Increased odds: female, preference for SHC, having school health insurance, being a U.S. citizen, living on-campus.

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Key points

College students have low health insurance literacy. Increasing health insurance literacy may increase HC utilization.

Self-efficacy and marketing is important.

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Application to health promotion

Part III

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Health Education/Promotion Has a Responsibility

65% of students agreed or

strongly agreed that they want more information on health insurance.76% of students

agreed

or

strongly agreed

that the

university should do more to ensure students know about health insurance.50Slide51

Health Education/Promotion has a responsibility

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But, What you can do depends on your context.

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DIVERSITY IN THE Field

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ACHA (2016)Slide54

DIVERSITY IN THE FIELD

9.0% Hispanic Serving Institutions

1.4% HBCUs

(2014)

6.0% Faith-based Institutions

23.5% of HE/P specialists are working in one-person units

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ACHA (2016)Slide55

DIVERSITY IN THE FIELD

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ACHA (2016)Slide56

TIME TO GET CREATIVE

Find about 4-5 people around you to be in a group.

With your group, determine a context and develop a program to increase health insurance literacy among your college population.

You will have ~5 minutes to work with your group.

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YOUR PROGRAM SHOULD

Address an aspect of health insurance literacy.

Be theory- and evidence-informed and socioecological based.

Be feasible for the context of the your everyday practice.

Tip: Think outside the box and how your existing collaborations may help your program.

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ACHA –

Standards of Practice

(2012)Slide58

Potential MESSAGE CHANNELS

E-mail

A videoBrochures or pamphletsSocial media postsNon-credit face-to-face workshops

Non-credit online workshops

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YOU HAVE 5 minutes.

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YOU HAVE 4 minutes.

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YOU HAVE 3 minutes.

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YOU HAVE 2 minutes.

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YOU HAVE 1 minute.

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TIME IS UP.

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WHO WANTS TO SHARE?

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OUR PLAN – DEVELOPMENT

Partnered with academic unit (HEB) to work with graduate students in their program planning course.

Continued discussions with Student Affairs, CHES and MCHES consultants.

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POTENTIAL STRATEGIES

Update SHC’s website to be more user-friendly and integrate communication theory.

Develop video-based online module to improve health insurance literacy required by Student Affairs/Registrar. – When?

Work with internal marketing team to develop targeted messages (based on demographics and healthcare use).

Work with HE/P unit to develop messages to improve health insurance literacy.

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BRIEF NOTE ON APPROACHES

Recommend not placing too high of an emphasis on just providing knowledge.

Knowledge is neither necessary nor sufficient for behavior.

We recommend using constructs from Bandura’s Social-Cognitive Theory to develop programs on health insurance literacy.

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Thank you!

Questions or Comments?

Contact Tyler: tjames95@ufl.eduContact Kat: katlin@ufl.edu

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