Colorado Medicaid Medicaid Readmissions Judy Zerzan, MD, MPH Colorado Department of Health Care...
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Colorado Medicaid Medicaid Readmissions Judy Zerzan, MD, MPH Colorado Department of Health Care Policy and Financing 1 Zerzan
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Transcript of Colorado Medicaid Medicaid Readmissions Judy Zerzan, MD, MPH Colorado Department of Health Care...
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Medicaid Readmissions
Judy Zerzan, MD, MPH
Colorado Department of Health Care Policy and Financing
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Overview
• Medicaid Medical Directors Learning Network Readmission Project
• Colorado Readmissions• Next Steps
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Medicaid Medical Directors Learning Network
• Funded by AHRQ and supported by Academy Health• 45 States represented• Focused on use of evidence based medicine,
measurement and improvement of healthcare quality, and healthcare system redesign
• Projects– Atypical antipsychotics– Re-hospitalizations– Peri-natal Outcomes
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icaid MMDLN Readmission Project
• Benchmarks for Medicaid readmissions– Excluded duals –Medicare/Medicaid
• Compare differences in readmits– Demographics– Health plan type
• Compare variation in readmits
• Policy collections and development
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icaid Project Methods
• Event-based rates (as opposed to person-based)
• Age Range: – <1– 1-12– 13-20– 21-44– 44-64
• Obstetrics/ Non-Obstetrics• Gender• Race/Ethnicity • Physical Health/Behavioral Health• Fee-for-Service/Managed Care
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icaid Draft Results
Population Rate
Pediatrics (0-20) 5.0%
OB 3.3%
non-OB 5.7%
Adults (21-64) 10.6%
OB 3.6%
non-OB 16.6%
Overall 7.9%
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Range Adult Non-OB 7.5%-23%
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icaid 30 Day Readmission Age 45-64
• Draft• Fee-for-service = 18%• Primary care case management
= 21%• Managed care organization 11%
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Top 10 MDC for Readmissions
Category nameShare of All Readmissions
Readmission Rate
Mental Disorders 17% 17%
Diseases of the Digestive System 11% 16%
Diseases of the Respiratory System 10% 14%
Complications of Pregnancy & Childbirth 9% 5%
Injury & Poisoning 8% 15%
Diseases of the Circulatory System 7% 16%Symptoms, Signs, & Ill-Defined Conditions 7% 21%Endocrine, Nutritional & Metabolic, & Immunity 5% 19%Diseases of the Blood & Blood-Forming Organs 4% 19%
Infectious and Parasitic Diseases 4% 20%8Zerzan
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icaid Colorado 2009 Data
AgeTotal # of
events Total Paid
30 day
# % Paid
<1 4,949 $34,859,905 332 6.7% $2,737,328
1-12 5,417 $32,949,161 396 7.3% $4,206,909
13-20 7,317 $34,302,832 459 6.3% $2,640,409
21-44 27,158 $131,244,788 2,239 8.2% $3,906,704
45-64 7,182 $60,929,775 1,678 23.4% $12,724,939
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icaid Readmissions Over Time
Age 2009 2010
% readmission amount paid % readmission amount paid
<1 6.7% $2,737,328 5.9% $2,653,071
1-12 7.3% $4,206,909 7.2% $4,230,779
13-20 6.3% $2,640,409 6.9% $3,177,554
21-44 8.2% $13,906,704 7.5% $11,568,865
45-64 23.4% $2,724,939 23.8% $2,725,212
Total $36,216,289 $34,355,481
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icaid Next Steps
• Dive into data– Top 10 hospitals and nursing homes – Top 10 diagnoses for age group
• Have 48 hr non-payment policy
• Potentially preventable readmissions
• Develop transition program?
• Develop capacity of nursing home to treat early?
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