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
Kim Bimestefer
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August 21, 2019
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May 2018 to April 2019
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May 2018 to April 2019
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4.4% of members are responsible for 51% of cost
Members $25,000+ 57,605 4.4% Members Less than $25,000 1,249,524 95.6%
Members
$25,000+ $3,878,571,891 51.1% Less than $25,000 $3,714,241,165 48.9%
Expenditures
Manage Trajectory
Specialized programs manage complex conditions
Improve Trajectory
Targeted care coordination and disease management programs improve acute and chronic conditions Proven population health programs promote health and well being
Prevent Trajectory
Impactable priorities and program referrals continuously informed by clinical stratification
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CY 2018
Adults Under 65 Children Adult w/ Disabilities Under 65 Children w/ Disabilities Pregnant Women and Newborns
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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
Average Total Paid per Member per Year
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Condition Condition Condition Client Count Average Total Paid per Member per Year Total Paid per 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 Top 10 Comorbidity Total Spend
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# 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 - - - - - - - - Average Total Paid per Member per Year
1. Maternity 2. Complex Newborns 3. Diabetes 4. Hypertension 5. Cardiovascular Disease
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6. COPD 7. Anxiety/Depression 8. Chronic Pain 9. SUD 10. Transplants
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
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