August Data Jam: Understanding Your Organization’s Cost and Utilization Data Scott E. Wetzler, PhD. Montefiore Medical Center
Scott E. Wetzler, PhD President & CEO University Behavioral Associates Montefiore Medical Center SWETZLER@montefiore.org Elizabeth Arend, MPH Quality Improvement Advisor National Council for Behavioral Health ElizabethA@TheNationalCouncil.org
CMS Change Package: Primary and Secondary Drivers Patient and Family- 1.1 Patient & family engagement Centered Care 1.2 Team-based relationships Design 1.3 Population management 1.4 Practice as a community partner 1.5 Coordinated care delivery 1.6 Organized, evidence-based care 1.7 Enhanced access Continuous, Data- 2.1 Engaged and committed leadership Driven Quality 2.2 QI strategy supporting a culture of quality and safety Improvement 2.3 Transparent measurement and monitoring 2.4 Optimal use of HIT Sustainable 3.1 Strategic use of practice revenue Business 3.2 Staff vitality and joy in work Operations 3.3 Capability to analyze and document value 3.4 Efficiency of operation
Review: May Data Jam • The New York State Department of Health stores all claims submitted to Medicaid in their Medicaid Data Warehouse (MDW) • Montefiore Medical Center (MMC) has a Data Exchange Agreement for the Care Transitions Network to: ✓ Access Medicaid claims of clients served by CTN enrollees ✓ Aggregate all claims for an organization’s population ✓ Classify claims into service categories to create reports illustrating the service utilization and cost patterns of an organization’s population ✓ Distribute reports to enrolled organizations to inform and support risk contracting
Remember… • Organization or provider NPI may be used to identify your population • Due to the time lag inherent in claims data, each year of data is generated with a 3-month run-out to improve completeness and maximize comparability • Completion factor needed to fully understand total costs
Report Structure I. Population Overview II. Service Categories, Subcategories, and Associated Cost Totals III. Cost Analysis in PMPM (“per member per month”) a) By aid category (HARP vs. SSI vs. TANF/SN populations) b) In organization vs. out of organization (excluding pharmacy & case management) c) Medical vs. behavioral (excluding pharmacy & case management) *Each section includes a two year look-back
Questions? 7
Thank you! www.CareTransitionsNetwork.org CareTransitions@TheNationalCouncil.org The project described was supported by Funding Opportunity Number CMS-1L1-15-003 from the U.S. Department of Health & Human Services, Centers for Medicare & Medicaid Services. Disclaimer: The contents provided are solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agencies.
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