AHCCCS Data Sets Improve Population Heath Management

Rene Q. Lizarraga, B.S.Thomas M. Ball, M.D., M.P.H.

The University of Arizona Health Plans

Population Health Management

Iden

tify

At-

Risk

Mem

bers

Analytics

App

ly E

ffecti

ve In

terv

entio

n

Interventions

Hav

e M

embe

rs P

artic

ipat

e

Engagement

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Data Provided by AHCCCS to Support Our Analytic Efforts

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Behavioral HealthTribal HealthMedicare

Significant Delay Policy

Moderate DelayProgram Development

& Monitoring

Real Time Member Care

The University of Arizona Health Plans Primary Use of AHCCCS Blind Spot Data Sets

Pharmacy

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Translating Data into Action: Timing is Critical

Behavioral Health Variables Of Interest

From 834 Enrollment File: RBHA indicator

From DBHS in Blind Spot Database: ICD-9/DSM diagnostic codes SMI determination identifier Behavioral health utilization

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Key Variable: Use of RBHA indicator in 834 Enrollment File

Health Disparities Among Those With Behavioral Health Conditions

Maricopa Health Plan

Yearly Cost Per Diagnosed Member

CY 2012 CY 2013 % Change CY13 vs CY12

BH Non-BH BH Non-BH BH Non-BH

Diabetes $ 9,747 $ 7,228 $ 9,293 $ 6,093 -5% -16%

COPD $ 7,172 $ 4,763 $ 5,537 $ 3,571 -23% -25%

Asthma $ 7,366 $ 4,229 $ 5,403 $ 3,063 -27% -28%

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SMI Qualifying Diagnosis in Pima County - Adult Members

Less than 35 y.o. 50 y.o. or older P value

Female 57.8% 67.6% .002

Spanish speaker 4.6% 8.3% .033

Diabetes 6.8% 29.4% (20.1%) <.001

Hypertension 7.4% 40.5% (29.1%) <.001

CHF 0.8% 4.1% (3.5%) <.001

Asthma 16.3% 16.0% (5.4%) .927

COPD 0.8% 7.9% (2.9%) <.001

PMPM medical expense $641 $578 .226

ED/PCP spend 8.3:1 4.2:1 .001

Used BH services 61% 72% .001

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Younger population need Member Engagement Older population need Care Coordination

Key Variable: ICD-9/DSM Diagnoses in Blind Spot Database

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Physical Health Medical Expense & Hospitalizations by Behavioral Health Category

BH Group PMPM Cost

No BH utilization Comparison Group

BH utilization by non-SMI + 47%

SMI qualifying diagnosis + 78%

SMI diagnosis in Pima County

Where do they get admitted?

BH facility only 13%

PH facility only 82%

Both BH & PH facilities

5%

Use of behavioral health services and an SMI qualifying diagnosis incrementally increase physical health medical expense

Behavioral health issues need to be addressed during care transitions from PH facilities

Key Variables: Use of both RBHA indicator, SMI qualifying diagnoses & admission data

P<.001 P<.001

Determined v. Non-determined Adults (≥18) with SMI

SMI-Determined

Use of RBHA

SMI-Qualifying Diagnosis

4.6%

1.3%

6.1%1.4%

Not in a group – 86.5%

Key Variables: Use of both RBHA indicator, SMI qualifying diagnoses & SMI determination information

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Total Admissions by Whether Member with SMI has Completed Determination Process

0%30%60%90%

2 or moreOneZero

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P=0.36

*No significant differences for PH or BH Admissions, Readmissions or ED use

Tribal Claims Data Of >120,000 UFC members, 2.8% (3,618) report their Race as NA/AI Of UFC members, 0.3% (370) have IHS as a secondary FSC (Payer) Of UFC members, 56 members received a service paid for by IHS

Represents 454 claims 6 ED visits 1 inpatient hospital stay

Consequences outside of Maricopa County are: 75.4% of those with an IHS FSC are over 18 years of age compared to 56.5% of

those without an IHS FSC

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Hypothesis: receiving services from both Health Plan and IHS is only likely for members living geographically close to both IHS services within their service delivery area and Health Plan services outside of their service delivery area.

Next Steps Continue use of data sets provided by AHCCCS for population health management

Identify opportunities to target care coordination efforts most effectively

Develop new programs for specific high risk subgroups

Utilize pharmacy data for member-specific interventions Identify members needing metabolic monitoring

Identify members with dangerous utilization patterns

Review patterns of care between AHCCCS and IHS within Maricopa County

Investigate potential uses of Medicare (Part C and Part D) data

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Summary AHCCCS provided data sets allow identification of vulnerable populations to guide

program development initiatives.

These data sets can be used to monitor impact of interventions focused on whole-person care, such as Super Utilizer initiatives.

October 1, 2015 provides the opportunity to assess the value of integrated care for members with SMI determination and co-morbid chronic physical health conditions by comparison to members with SMI qualifying diagnoses without determination who will remain with their chosen health plan.

NA/AIs (living outside of Maricopa County in Southern or Central Arizona) with UFC are unlikely to utilize IHS services.

AHCCCS provided supplementary data sets serve a critical function until completion of a well functioning state-wide HIE.

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Questions?

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