Safety Net Success: Evaluation of the Illinois Medicaid Medical Home Program. Fourth National Medical Home Summit, February 27 29, 2012

Transcription

1 Safety Net Success: Evaluation of the Illinois Medicaid Medical Home Program Fourth National Medical Home Summit, February 27 29, 2012

2 History of Illinois Health Connect Implemented in 2006; driven by desire to control costs, improve access and quality, and expand eligibility. Primary Care Case Management Model: Hybrid model of healthcare delivery that combines emphasis on primary care and management through a medical home with fee for service payment Medical Home model preceded NCQA or other accreditation standards Blended payment model: PMPM, enhanced fee schedule and P4P In 2006, 1.2 million eligible pts, now 2.0 million eligible pts Parallels MCOs: 200,000 pts in Vol MCOs, 40,000 in mandatory MCOs Parallel DM program, Your Healthcare Plus, for

3 Provider Story Currently the IHC has a network of 5,700 participating Medical Homes including family doctors, pediatricians, internists, rural health clinics and FQHCs with capacity for 5.4 million clients. Must meet certain quality standards such as 24/7 coverage. Provider Service Representatives and QA nurses make approximately 350 visits to provider offices per week to assist with billing/coding; IHC administration; Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) standards; and clinical quality improvement. Four advisory subcommittees meet quarterly and create opportunity for stakeholder input. Information provided via quarterly newsletters, blast fax, IHC website, and weekly webinars. Nearly 90% of providers are satisfied with the administration of the program and 93% think that IHC is beneficial to patients. 3

4 IHC Quality Tools Claims History: Compilation of claims data available on every current Medicaid client Provider Profiles: semi annual report card on HEDIS measures Panel Rosters: registry of patients and preventive services, available online in Excel format. Bonus Payment Program: P4P on certain measures (e.g. immunizations, mammography) 4

5 Client Story Approximately 75% of all clients make an active choice for best fit medical home. Others are auto assigned. Clients must see their PCP/medical home for primary care. Specialists and other providers, who do not participate with IHC as a PCP, do not require a referral for care from the PCP. Call center assists with access to subspecialty care, making well child appointments, educates clients on the medical home concept. Sends reminder letters for both child and adult preventive care. For past 3 years, over 90% of all clients surveyed are satisfied or extremely satisfied with both PCP and IHC program. 5

6 Research Aims The Robert Graham Center conducted a rapid, external evaluation of IHC with the aim of answering the following question: How effective is Illinois Health Connect (IHC) in reducing costs, reducing inappropriate utilization, creating patient provider continuity, and improving outcomes and delivery of appropriate preventive care between 2004 and 2011? 6

7 Data Illinois Medicaid claims Detailed information for all services indicating dates of service, category of services, the rendering provider, type of provider, charges and payments. Patient and provider enrollment file Information on beneficiaries demographic characteristics as well as which type of programs the beneficiary was eligible for or enrolled in for each day. Covers both pre (2004, 2005) and post IHC implementation ( ) period 7

8 Method: eligibility Using enrollment data, we developed the IHC enrollment trends based on beneficiaries eligibility periods. Member months and year equivalent measures are derived using the beneficiaries eligible day counts during the corresponding calendar year. For pre program period 2004 and 2005, we use the hypothetical eligibility measure constructed by HFS applying the same IHC business criteria for 2006 to

9 Method : cost and utilization We studied costs and utilization trends by developing permember per month (PMPM) costs through the entire study period. Service utilization was further examined in both inpatient and outpatient settings to examine sources of cost saving. In the cost analysis, 2006 figures are treated as baseline year. Expected costs are developed using 2006 costs as baseline year and historical Medicaid costs increasing rate 3%. 9

10 Medicaid enrollee distribution 2006 FTE enrollees 2010 FTE enrollees age group Medicaid IHC YHP Other Medicaid IHC YHP Other 00to5 480, ,568 59,404 77, , ,373 72,618 68, to , ,223 31,493 69, , ,516 63,598 62,760 11to18 426, ,032 31, , , ,767 56, , , ,279 75, , , ,581 98, , ,227 61,800 77, , ,747 97,743 95, ,061 65andabove 156,609 9,244 1, , ,912 11,670 2, ,917 total 2,108,286 1,176, , ,596 2,705,291 1,622, , ,873 10

11 Medicaid program distribution trend Medicaid IHC YHP Other % 55.79% 13.12% 31.10% % 58.06% 13.15% 28.79% % 58.90% 13.98% 27.12% % 59.84% 14.25% 25.91% % 59.98% 14.37% 25.65% 11

12 IHC and YHP program costs Actual PMPM Costs Predicted PMPM Costs Cost savings IHC YHP IHC YHP IHC YHP 2004 $ $ $ $ $6.56 $ $ $ $ $ $1.47 $ $ $ $ $ $0.00 $ $ $ $ $ ($2.92) ($65.69) 2008 $ $ $ $ ($6.85) ($95.48) 2009 $ $ $ $ ($6.40) ($92.84) 2010 $ $ $ $ ($12.89) ($107.57) 12

13 IHC PMPM cost savings PMPM costs Actual and predicted costs for IHC Year ihc ihc_predicted PMPM: per member pre month 13

14 YHP PMPM cost savings Actual and predicted costs for YHP PMPM costs Year yhp yhp_predicted PMPM: per member pre month 14

15 IHC and YHP program cost savings Cost savings pmpm # of member months Program cost savings IHC YHP IHC YHP IHC YHP 2004 $6.56 $ ,625,745 3,283,268 82,795,581 26,584, $1.47 $ ,098,865 3,448,614 20,672,623 53,078, $0.00 $ ,113,757 3,318, ($2.92) ($65.69) 15,816,956 3,583,092 (46,142,708) (235,376,340) 2008 ($6.85) ($95.48) 16,999,345 4,036,241 (116,479,596) (385,389,495) 2009 ($6.40) ($92.84) 18,413,922 4,384,537 (117,880,646) (407,073,704) 2010 ($12.89) ($107.57) 19,471,805 4,665,207 (250,945,300) (501,814,627) (531,448,250) (1,529,654,166) 15

16 IHC cost savings IHC cost savings -30,000-20,000-10, ,000 IHC annual cost savings unit: 10,000 dollars 16

17 YHP cost savings YHP cost savings -60,000-40,000-20, ,000 YHP annual cost savings unit: 10,000 dollars 17

18 Cost savings by category of services 2010 Costs Actual Predicted IHC YHP IHC YHP CLINIC $10.17 $17.50 $7.71 $14.48 INP $25.56 $ $37.18 $ LAB/XRAY $1.53 $3.24 $1.47 $3.33 OTP $12.33 $54.20 $13.22 $52.03 PHYS $21.28 $64.32 $23.24 $68.63 RX $21.94 $ $23.05 $

19 Proportion of cost savings 2010 Costs Savings % Savings IHC YHP IHC YHP CLINIC $2.46 $ % 21% INP ($11.62) ($62.63) 31% 28% LAB/XRAY $0.06 ($0.09) 4% 3% OTP ($0.89) $2.17 7% 4% PHYS ($1.96) ($4.31) 8% 6% RX ($1.11) ($7.99) 5% 5% 19

20 IHC Hospitalization IHC hospitalizations Hospitalization Year units: 1000 full time (year) equivalent enrollee 20

21 YHP hospitalization YHP hospitalizations Hospitalization Year units: per 1000 full time (year) equivalent enrollee 21

22 IHC inpatient bed days IHC inpatient days per 1000 FTE IHC inpatient days year unit: per 1000 full time (year) equivalent enrollee 22

23 YHP inpatient bed days YHP inpatient days YHP inpatient days per 1000 FTE year unit: per 1000 full time (year) equivalent enrollee 23

24 IHC ER counts Emergency room visits IHC ER visits and IHC non-flu ER visits YEAR ihc ihc_nonflu unit: 1000 full time (year) equivalent enrollee 24

25 YHP ER counts YHP ER visits and non-flu ER visits Emergency room visits YEAR yhp yhp_01 unit: 1000 full time (year) equivalent enrollee 25

26 Avoidable & ER resulted hospitalization IHC IHC ER resulted/avoidable hospitalization hospitalization year ERINP AVOIDINP unit: per 1000 full time equivalent enrollee 26

27 Avoidable & ER resulted hospitalization YHP YHP ER resulted/avoidable hospitalization hospitalization year ERINP AVOIDINP unit: per 1000 full time equivalent enrollee 27

28 Flu ER counts IHC Emergency room visits IHC Flu ER visits per 1000 FTE YEAR FTE: full time (year) equivalent enrollee 28

29 Flu ER counts YHP Emergency room visits YEAR FTE: full time (year) equivalent enrollee YHP Flu ER visits per 1000 FTE 29

30 Takeaways We found significant reductions in cost for PCCM program: $531 million for IHC, $1.53 billion for YHP. The rate of annual savings since 2006 increased from about 2.5% per year in 2007 to nearly 10% in The largest savings in 2010, actual vs predicted (based on 2006), within IHC, come from reductions in inpatient services ( 31.3%), physician services ( 8.4%), and outpatient hospital services. IHC hospitalization rates fall by nearly 20% between 2006 and Over the same period, bed days also fell by 22.0% (21.5% for IHC, 19.2% for YHP). IHC beneficiary emergency department visits declined by 8% as of

31 Future Work Outpatient visits cost: PC vs Non PC visits cost Primary care provider engagement patterns in PCCM program: patient panel size and composition Practice pattern transformation among providers considering: continuity, comprehensiveness and coordinated care Variation of cost saving performance among different types of primary care providers 31

32 Presenters: Meiying Han, PhD The Robert Graham Center Center for Policy Studies in Family Medicine and Primary Care, Washington DC Margaret Kirkegaard, MD, MPH Illinois Health Connect, Medical Director health.com) 32