Users of Long Term Services and Supports (LTSS) in California:
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1 Users of Long Term Services and Supports (LTSS) in California: August 9, 2012 Andrew B. Bindman, M.D. Professor Medicine Director, CAMRI University of California
2 California Medicaid Research Institute (CAMRI) Multi campus collaborative within the University of California (UC) Partners with California s Medi Cal program to perform timely, policy relevant research camri.universityofcalifornia.edu 2
3 Project Team Members Andrew B. Bindman, M.D. (Principal Investigator) Robert J. Newcomer, Ph.D. Charlene Harrington, R.N., Ph.D. Arpita Chattopadhyay, Ph.D. Julie Stone, M.P.A. Sei J. Lee, M.D. Todd Gilmer, Ph.D. Taewoon Kang, Ph.D. Phillip Chu, M.A. Chi Kao, Ph.D. Denis Hulett, M.S. 3
4 Assembling Medi Cal, Medicare and State Data Files Comprehensive statewide study of users of LTSS, including dual eligibles Assembling an integrated and longitudinal database of Medicaid, Medicare and state data (CYs ) 19 claims, assessment, eligibility and other files from CMS, Medi Cal and other state departments 1.58 million study participants 4
5 Preparing Analytic Files Establishing a gold standard for correcting inconsistent coding of beneficiary characteristics Turning diagnoses into risk groups to measure individuals risks of using LTSS Extracting functional status from assessment files and linking it with service use Linking services and costs across payers Bundling services into episodes Using discharge data and assessment files to fill in for missing managed care claims 5
6 Examples of Key Questions What are the characteristics and needs of users of home and community based services (HCBS)? What services do they use? What are their outcomes? How much do LTSS users cost to Medi Cal and Medicare by service category: acute, postacute, and LTSS? 6
7 Reports on The SCAN Foundation Website California s Medi Cal Home & Community Based Services Waivers, Benefits & Eligibility Policies, A Case Study in Assembling Medicaid and Medicare Claims and Assessment Data in California Recipients of Home and Community Based Services in California 7
8 Forthcoming Deliverables Medicaid and Medicare Costs on Acute, Post Acute and Long Term Services and Supports in California (forthcoming) Users service patterns and costs prior to receipt of nursing home care and their cost trajectory afterward (expected September 2012) Simulation model estimating utilization and costs of institutional and HCBS services by health status and disease burden (expected February 2013) 8
9 Recipients of HCBS in California Available on The SCAN Foundation s website: work/california medicaid research instituterecipients home and community bas
10 HCBS Study Population Persons age 18 and older Received Medi Cal funded HCBS in 2008 Home Health (HH) In Home Supportive Services (IHSS) Adult Day Health Care (ADHC) Targeted Case Management (TCM) Any section 1915(c) Home and Community Based Services (HCBS) waiver Excluded populations Individuals with a diagnosis of developmental disability Program for All Inclusive Care for the Elderly (PACE) 10
11 Mean Age of HCBS Users, % 9.3% 80% 79.1% 60.7% 60% 90.7% 40% 20% 0% 39.3% Dual Eligibles Medi Cal Only All HCBS Users Ages Age
12 HCBS Users by Type of Service, 2008 IHSS Only 81.5% Dual Eligibles N = 352,282 IHSS & Other HCBS 13% ADHC Only 3.6% TCM Only 3.6% HCBS Waivers Only 0.5% Other HCBS Combos 0.2% HH Only 0.1% IHHS Only 60.6% Medi Cal Only N = 124,813 HH Only 9.7% TCM Only 17.9% IHSS & Other HCBS 6.7% ADHC Only 3.5% HCBS Waivers Only 0.3% Other HCBS Combos 1.3% 12
13 Medi Cal s Section 1915(c) HCBS Waivers, 2008 Two Largest Eligibility Groups All HCBS Waiver Users Multi Purpose Senior Services Program AIDS Assisted Living Other HCBS Waivers Users 16, % 13.4% 5.1% 3.6% Aged (40%) Disability (30%) Aged (47%) Disability (26%) Disability (68%) Medically Needy (26%) Aged (43%) Medically Needy (27%) Disability (59%) Medically Needy (33%) 13
14 Limitations in ADLs among HCBS Users, Mean # ADL Limitations Total Medi Cal HCBS HH only IHSS only IHSS + HH IHSS + ADHC IHSS + TCM IHSS + HCBS Waivers IHSS + ADHC & Waivers Other Combos 14
15 Mortality and Nursing Facility Admissions among HCBS Users 20% 18% 16% 14% 12% HCBS Users 10% 8% 6% 4% 2% 0% Total HH only Medi Cal HCBS IHSS only IHSS + HH IHSS + ADHC IHSS + TCM IHSS + HCBS Waivers IHSS + ADHC + Waivers ADHC only TCM only HCBS Waivers only Other Combos % Died in Year % Admitted to a Nursing Facility 15
16 Medicaid and Medicare Costs on Acute, Post Acute & Long Term Services and Supports in California Forthcoming
17 LTSS Study Population Persons age 18 and older Received Medi Cal funded LTSS in 2008 Nursing Facility (NF) Home Health (HH) In Home Supportive Services (IHSS) Adult Day Health Care (ADHC) Targeted Case Management (TCM) Any section 1915(c) HCBS waiver Excluded populations Individuals who qualify for Medi Cal based on a diagnosis of developmental disability Individuals enrolled in Medi Cal or Medicare managed care 17
18 Medi Cal and Medicare Spending for Acute and Other Medical, Post Acute and LTSS, 2008 Medicare Post Actue 8.1% Medi Cal Acute & Other Medical 11.5% Total Spending $18.8 Billion Medicare Acute & Other Medical 47.5% Medi Cal LTSS 32.9% Average Spending per person on LTSS was $14,445 Dual Eligibles = $15,541 Medi Cal Only = $10,950 18
19 Medi Cal Spending on LTSS, 2008 HH 0.2% MSSP Waiver 0.5% Other Waivers 0.8% Total LTSS Spending $6.2 Billion TCM 0.4% ADHC 5.4% Nursing Facility 48.1% In Home Supportive Services 44.6% 19
20 Future Opportunities Develop and maintain analytic strategies for using administrative data to monitor LTSS Evaluate regional differences in costs and growth of costs for LTSS Users by type of services Evaluate interventions to improve quality and lower costs for LTSS recipients Free and expand the data by developing a deidentified user friendly website to support multiple users of the data on LTSS users 20
21 Acknowledgments California Department of Health Care Services The SCAN Foundation 21
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