Care Transitions Network Medicaid Utilization: Services and Cost - - PowerPoint PPT Presentation

Care Transitions Network

Medicaid Utilization: Services and Cost Reports

National Council for Behavioral Health Montefiore Medical Center Northwell Health New York State Office of Mental Health Netsmart Technologies

Your Presenters Today

Zana Fejza Provider Relations Analyst Montefiore Care Management Frederick Stanley Assistant Director, Behavioral Health Reporting and Analytics Montefiore Care Management Maura Gaswirth, LICSW Director, Training and Technical Assistance The National Council for Behavioral Health

Total Healthcare Costs of Your Behavioral Health Medicaid Population

3

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

Report Methodology

July 2017 Report

• Medicaid Data Warehouse

(MDW)

• Clients with 1+ paid service
• Organization level
• RY’s: 2016, 2015, 2014
• Report threshold
• Population 150+ clients
• Redactions < 30 clients

Current April 2018 Report

• Medicaid Data Warehouse

(MDW)

• Clients with 1+ BH paid service
• Practice setting/NPI level
• RY: 2016
• Report threshold
• Population 100+ clients
• Redactions < 30 clients

*Practice setting logic is closely aligned with PSYCKES (OMH)

Introduction to Report

• Organization & practice name (might not be site-specific)
• Practice setting:
• Rate code driven (i.e., Clinic-MH based on OMH rate codes)
• NPI’s: in practice and affiliate providers
• Inclusions: Medicaid active adults 18-64 years old with at least one

paid BH service in 2016

• Exclusions: Minors, age 65+, dual eligible (Medicare/Medicaid),

primary diagnosis of dementia and developmental disabilities

Report Review

Population, Health Plans, Total Outpatient MH & SU Visits at Provider

• Population
• Client count
• Months of active Medicaid
• Behavioral Health Programs
• Client counts
• Rate code
• Health Plan
• Fee-for-Service in “Other HP”
• Total MH & SU Visits
• MH: includes PROS
• SU: methadone visits

undercounted

Report Population

Report Review

Outpatient Services

• Outpatient services by

categories of service

• Visits per 1000 members
• Benchmarking
• Clinic-MH, Clinic-SU, Inpatient-

MH and Inpatient-SU

• Network-wide mean
• PMPM: Per Member Per

Month

• Top 3 providers
• Medical
• Behavioral health

Outpatient Services

Report Review

Hospitalization

• Hospitalization by category
• Average LOS
• Discharges per 1000

members

• Days per 1000 members
• Benchmark
• Top 3 providers
• Medical
• Behavioral health

Hospitalization

Pharmacy and ER Visits

• Pharmacy – RX per 1000 members
• Includes refills
• ER Visits – exclude conversions
• Visits per 1000 members
• Medical and BH costs
• Proportion of costs for medical and BH
• Clients with > ED visits for medical and BH

Additional Services

PMPM Breakdown

Questions?

What’s Next

• Review your report and reference guide with your team
• Schedule a call with your Practice Coach
• Review Upcoming Technical Assistance to Support your

Work

• MTM Services Free Consultation Packages
• Same-Day Access and Just-in-Time Prescribing
• Cost and Revenue Analysis
• SPQM Quality Management
• Value-based Payment Arrangement Contracting Webinar Series
• Practice Transformation Academy
• Increased Incentive Payment

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.