Accountable Care Collaborative Program Improvement and Advisory - PowerPoint PPT Presentation

Health Care Affordability and the Accountable Care Collaborative Program Improvement and Advisory Committee Kim Bimestefer August 21, 2019 1

Our Mission Improving health care access and outcomes for the people we serve while demonstrating sound stewardship of financial resources 2

Medicaid Trends May 2018 to April 2019 3

Benefit Trends May 2018 to April 2019 ICF: intermediate care facility PDN: private duty nursing • • HBU: hospital backup PMPM: per-member-per-month • • 4

Members and Expenditures by Cost Group Members $25,000+ $25,000+ 57,605 $3,878,571,891 4.4% 51.1% Expenditures Members Members Less than $25,000 Less than $25,000 $3,714,241,165 1,249,524 48.9% 95.6% 4.4% of members are responsible for 51% of cost 5

Clinical Stratification Find the Right Focus; Maximize Value Targeted care Proven population coordination and disease health programs Improve Trajectory Prevent Trajectory management programs promote health improve acute and and well being chronic conditions Manage Trajectory Specialized programs manage complex conditions Impactable priorities and program referrals continuously informed by clinical stratification

Fab Five Initial Areas of Opportunity CY 2018 Adult w/ Pregnant Children w/ Adults Disabilities Children Women and Disabilities Under 65 Under 65 Newborns • 37,067 members • Over $25k annually • $2.46B annually • Medicaid primary 7

Population Detail by RAE FY2018-19 YTD through March 8

Big Ten Costs (PMPY) Average Total Paid per Member per Year Indicator All RAEs RAE 1 RAE 2 RAE 3 RAE 4 RAE 5 RAE 6 RAE 7 Heart Failure $35,075 $32,381 $31,335 $38,913 $30,982 $37,839 $38,561 $31,950 COPD $26,141 $23,544 $22,456 $30,166 $23,076 $27,151 $29,097 $26,008 Diabetes $20,287 $19,455 $17,685 $20,764 $19,612 $20,688 $23,486 $19,266 Hypertension $19,054 $18,440 $17,328 $20,080 $17,864 $19,854 $21,934 $16,997 Pain Medication $18,648 $16,258 $16,028 $22,035 $16,753 $18,115 $18,872 $19,069 Anxiety/Depression $13,627 $12,398 $12,502 $14,214 $13,361 $14,947 $14,238 $13,068 Depression $14,841 $13,722 $14,174 $15,258 $14,326 $16,579 $15,626 $13,925 Anxiety $13,699 $12,325 $12,503 $14,357 $13,718 $14,610 $14,083 $13,522 Substance Use Disorder $13,132 $11,872 $11,906 $14,263 $11,394 $14,694 $14,252 $12,229 Opioid Use Disorder $15,692 $15,675 $16,223 $17,461 $12,309 $16,688 $16,653 $14,970 Alcohol Use Disorder $13,936 $12,084 $12,112 $14,607 $12,839 $16,194 $14,757 $12,846 Other SUD $12,893 $11,484 $11,325 $14,171 $10,959 $15,028 $13,880 $12,200 Maternity $9,564 $9,645 $9,154 $9,470 $10,183 $10,182 $9,297 $9,099 9

Top 10 Comorbidities Total Cost Top 10 Comorbidity Total Spend Average Total Paid per Total Paid per Client Count Member per Year Condition Condition Condition Year Anxiety/Depression 64,343 $6,500 $418,245,475 Chronic Pain 20,814 $17,936 $373,313,701 Hypertension 24,027 $10,664 $256,213,432 Chronic Pain Anxiety/Depression 16,143 $13,434 $216,859,117 Hypertension Anxiety/Depression 9,874 $17,425 $172,055,560 Substance Use Disorder 25,217 $5,723 $144,304,359 Diabetes Hypertension 10,036 $14,106 $141,568,641 Substance Use Disorder Anxiety/Depression 16,116 $7,731 $124,592,117 Chronic Pain Substance Use Disorder Anxiety/Depression 7,489 $14,354 $107,495,487 Diabetes Hypertension Anxiety/Depression 4,260 $24,360 $103,772,187 $2,058,420,075 10

Comorbidity Effect Average Total Paid per Member per Year # Comorbidities All RAEs RAE 1 RAE 2 RAE 3 RAE 4 RAE 5 RAE 6 RAE 7 1 $9,127 $8,527 $7,694 $10,430 $8,050 $8,467 $9,381 $9,540 2 $13,564 $13,143 $11,659 $15,044 $12,298 $13,880 $14,473 $12,937 3 $19,268 $18,008 $16,595 $21,071 $17,612 $19,883 $21,687 $18,198 4 $26,940 $25,150 $24,668 $29,281 $24,744 $28,778 $30,838 $23,820 5 $37,760 $34,459 $35,862 $39,834 $34,603 $41,375 $40,801 $36,026 6 $54,583 $46,325 $49,870 $56,798 $56,446 $59,331 $59,109 $49,425 7 $77,748 $73,587 $53,017 $91,439 $72,393 $77,163 $115,745 $51,084 8 - - - - - - - - 11

Big Ten Focused Programs - DRAFT • Identified through Clinical Stratification & top PAC conditions • Determine best in class practices/programs • May centralize some programs 1. Maternity 6. COPD 2. Complex Newborns 7. Anxiety/Depression 3. Diabetes 8. Chronic Pain 4. Hypertension 9. SUD 5. Cardiovascular Disease 10. Transplants 12

Major Communications to RAEs 1. Last two quarterly meetings – HCPF/RAEs 2. Formal notice dated July 31 3. Seeking partnership to change focus, Medicaid member health, cost control impact, KPIs during this FY for next FY 4. Everyone is collaborating nicely 13

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Thank You! 15