Health Indicator System

For Rhode Islanders

On Medicaid

Presented by:

Jane Griffin, MPH

Project Director, RI Medicaid Research and Evaluation project

RI Department of Human Services

Presented to:

Academy Health – State Health, Research and Policy Interest Group

June 25, 2005

Purpose of RI Health Indicator System

To assess, design, monitor and evaluate health services and program interventions for Rhode Islanders on Medicaid using existing public health data sets, statewide surveys, and Medicaid program data.

Design of Health Indicators

Review policy studies, performance measure projects and research literature for recommended health outcome measures for an age-specific program population. Program staff selects priority measures.

TABLE 1: RECOMMENDED HEALTH INDICATORS FOR CHILDREN WITH DISABILITIES

Accreditation groups/

Consensus panels

Policy/Government groups

Published in Journals

FACCT/

NCQA

NACHRI TitleV-MCHB

Johns

Hopkins

Kuhlthau Newa-check

Powe Pantel

Utilization X

Preventive visit (well child)

X X X X X

Acute visits X X

Dental X X

Emergency * X X

Mental health * X X

Pharmacy/RX X X

Hospital Readmits *

X

* Program staff priority

Identify Health Indicator Data Sets

• Data set that collects health outcome/measures on an ongoing annual basis

• Includes health coverage so analysis can be made comparing privately insured with Medicaid

• Data sets collected on Medicaid recipients including MMIS and surveys

Data Sets in RI Medicaid Data Archive

• Vital Statistics Birth/Death File 1993-2003

• Behavioral Risk Factor Surveillance System (BRFSS) 1996-2003

• RI Health Interview Survey 1996, 2001

• Hospital Discharge Data Set 1992-2003

Public Health Data Sets:

Data Sets in RI Medicaid Data Archive

• Children with Disabilities

• Adults with Disabilities

• Children with Insurance Gaps

• Foster Children

Program Data:

• Medicaid Management Information System (MMIS)

Surveys on RI Medicaid Population:

Examples of Health Indicators by Medicaid Population Group:

• Healthy Children and Families

• Children with Disabilities

• Adults with Disabilities

• Uninsured

Health Indicators for Healthy Children and Families:

• Short Interbirth Interval

• Infant Mortality

• Repeat Teen Births

Figure 1Health Indicator – Short Interbirth Interval

Percent of Women with Short Interbirth Interval (<18 months) by Insurance Status 1993-2001

27.8 27.5 28.7

40.838.2

30 28.6 29.8 30.728.9 29.7 30.3

2827.526.628.4

30.227.2

10

20

30

40

50

1993 1994 1995 1996 1997 1998 1999 2000 2001

Private Medicaid

Data Source: Medicaid Research & Evaluation Project, Health Indicator ProjectVital Statistics Birth File 1993-2001 – (n=111,865)

Figure 2 Health Indicator - Infant Mortality

Rhode Island Infant Mortality by Insurance Status 1990-1999

10.6%

7.2% 7.1% 6.8%

6.0%5.3% 4.7% 4.7%

5.4% 5.3%

8.5%

10.7%9.9%

7.2% 7.2% 7.0%

6.4%6.4%5.4%4.8%

0%

5%

10%

15%

90 91 92 93 94 95 96 97 98 99

Public (n=325) Private (n=470)

Data Source: Medicaid Research & Evaluation Project, Health Indicator ProjectLinked Birth Death File 1990-99, Division of Family Health, Department of Health (n=905)Deaths per 1000 births to Infants 0-364 days – 3 year moving average

Figure 3 Health Indicator – Teen Repeat Births

Percent of Teen Mothers with Previous Live Births by Insurance Status 1993-2001

7.8%

11.7%14.7%

23.3%25.8%

24.2% 24.9%22.0%

12.4%

7.7%

12.8%15.4%

12.6%15.2%

26.0%26.8%24.1%23.0%

0%

5%

10%

15%

20%

25%

30%

35%

1993 1994 1995 1996 1997 1998 1999 2000 2001

Private Medicaid

Data Source: Medicaid Research & Evaluation ProjectVital Statistics birth File 1993-2001 (n=11,748)

Health Indicators for Children with Special Health Care Needs:

• Leading Cause of Hospitalizations

• Repeat Hospitalizations

Figure 4Health Indicator – Mental Health

Leading Causes of Hospitalizations by Principal Diagnosis by CSHCN Group

54.3

103.4 4.2

52.6

12.8

03.8

75.6

4.9 5.1 3.2

86.6

1.15.7

1.5

0

20

40

60

80

100

% o

f T

otal

Hos

pita

liza

tion

s

SSI KB AS TP

Respiratory V-Code Factors InjuryMental

Data Source: Medicaid Data ArchiveMMIS CY 2000, Children <21 on FFS Medicaid

Figure 5Health Indicator - Percent of Children and Adolescents with Repeat

Hospitalizations by Diagnoses 1: Physical vs. Mental Fee-For-Service Medicaid Recipients 2, Ages 21 and Under

Calendar Year 2000

37.5%

21.2%

0%

10%

20%

30%

40%

50%

Percent

At least 1 diagnosis of Mental Disorder

1. Includes Principal, Secondary or Tertiary Diagnosis

2. Total Recipients =12,062

Physical Diagnosis Only(n=448)(n=415)

Health Indicators for Adults with Disabilities

• Leading Cause of Hospitalizations

• Repeat Hospitalizations

Figure 6Health Indicator – Mental Health Hospitalizations for Adults

Leading Causes of Hospitalization by Principal Diagnosis for Fee-For-Service Medicaid Recipients Ages 21-64

24.5

12.4 12.1

9.26.8

4.3

26.2

4.5

10.2

3.5

11.99.8

27.3

4.3

11.1

2.9

11.19.1

0

10

20

30

40

Mental Metabolic Heart Disease Infection Respiratory Digestive

% o

f T

otal

Hos

pita

lizat

ions

199819992000

Data Source: Health Indicator Project, Medicaid Data Archive, ICD-9 GroupingsMMIS Extract (1998 n = 6,423 hospitalizations; 2000 n = 7,397)

Figure 7 Health Indicator - Percent of Working-Age Adults with Repeat

Hospitalizations by Diagnoses 1: Physical vs. Mental Fee-For-Service Medicaid Recipients 2, Ages 21 to 64

Calendar Year 2000

41.1%

29.2%

0%

10%

20%

30%

40%

50%

Percent

At least 1 diagnosis of Mental Disorder

1. Includes Principal, Secondary or Tertiary Diagnosis

2. Total Recipients =25,485

Physical Diagnosis Only

(n=1,984)(n=2,377)

Health Indicators for Uninsured Rhode Islanders

• Changes in Type of Insurance Coverage

• Uninsured Rhode Islanders by Age Group

• Uninsured Rhode Islanders by Income

Figure 8Changes in Type of Insurance Coverage

For Rhode Islanders <65 Years Old1996-2003

12.2 11.7

72.8 70.2 72.8 75.9 77.7 73.969.3 70.4

12.316.5 15.8

8.112 11.5 6.9 9 11.3

13.98.5 10.7 119.9

0

20

40

60

80

1996 1997 1998 1999 2000 2001 2002 2003

% Uninsured % Employer Based % Medicaid

Data Source: Medicaid Research and Evaluation Project; RI Access Project US Bureau of the Census, Current Population Surveys 1996-2003 (September estimate, 2004)

Figure 9Percent Uninsured Rhode Islanders by Age Group

Ages 18-64 – 1996-2003

15.5

18.5

9.28.2 8.2 8.3 7.6

6.7

9.1

6.9

4.5 4.4

12.814.1 14.5 14.1

12.8

16.8

6.8

6

5.8 6.95

7.3

0

5

10

15

20

1996 1997 1998 1999 2000 2001 2002 2003

Ages 18-34 Ages 35-49 Ages 50-64

Data Source: Medicaid Research and Evaluation Project; RI Access Project Behavioral Risk Factor Surveillance System 1996-2003, RI Department of Health

Figure 10Percent Uninsured Rhode Islanders by Income Level

Ages 18-64 – 1996-2003

22.2 23.1

9.27.7 8.7 8.2

11.29.2 10

13.4

1.1 1.42.8 3.2

24.522.321.1

25.6

19.7

26.5

2.12.82.11.6

0

10

20

30

1996 1997 1998 1999 2000 2001 2002 2003

<$25,000 $25,000-$49,000 >$50,000

Data Source: Medicaid Research and Evaluation Project; RI Access ProjectBehavioral Risk Factor Surveillance System 1996-2003, RI Department of Health

Creating Health Indicators from the Medicaid Management

Information System (MMIS)

 

List of Health Indicators by Population Type Recommended from Expert Panels /Policy Literature* and can be designed from MMIS

  Measures found in 3 or more policy studies

HealthyAdolescents

Children with DisabilitiesHealthyAdults

Adults withDisabilities

       

Physical exams, checkups Preventive visits CVD Screening Assisted Living Facilities

Dental visits Acute visits Breast Cancer Screening Specialists

Family Planning Visits Dental Visits Cervical Cancer Screening Nursing Home (stays & days)

Mental health visits/readmits Emergency Department Visits Colorectal Cancer Screening

 Hospital (stays & days)

Immunization (HepB) Mental Health Diabetic Retinal Exams Emergency Department Visits

AIDS/HIV Pharmacy/RXInfluenza/pneumonia vaccination Rehab Services (PT, OT, ST)

Motor Vehicle Accident Hospital Readmits Dental visits Readmits (7,14,30 days)

Violence/Homicide Specialty care appointments   ACS Hospitalizations

Depression/SuicideDurable medical equipment/assistive tech   Primary Care Doctor Visits

AsthmaPhysical, speech, occupational therapy   Unmet Need for Care

Diabetes Mental health counseling   Average Costs

  Respite care    

  Length of time with PCP    

  Total annual $ spent on child    

Conclusion

Health Indicator System is an effective program evaluation

model that state Medicaid programs can use to identify

unmet needs and evaluate program initiatives