August Data Jam: Understanding Your Organizations Cost and - - PowerPoint PPT Presentation

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- Centered Care Design 1.1 Patient & family engagement 1.2 Team-based relationships 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- Driven Quality Improvement 2.1 Engaged and committed leadership 2.2 QI strategy supporting a culture of quality and safety 2.3 Transparent measurement and monitoring 2.4 Optimal use of HIT Sustainable Business Operations 3.1 Strategic use of practice revenue 3.2 Staff vitality and joy in work 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.