CIVHC and CO APCD Overview Pete Sheehan VP, Client Solutions & - - PowerPoint PPT Presentation

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CIVHC and CO APCD Overview Pete Sheehan VP, Client Solutions & - - PowerPoint PPT Presentation

Jan 10, 2023 191 likes •610 views

CIVHC and CO APCD Overview Pete Sheehan VP, Client Solutions & State Initiatives Our Mission We strive to empower individuals, communities, and organizations through collaborative support services and health care information to advance

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CIVHC and CO APCD Overview

Pete Sheehan VP, Client Solutions & State Initiatives

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Our Mission

We strive to empower individuals, communities, and

  • rganizations through collaborative support services

and health care information to advance the Triple Aim: Better Health, Better Care, Lower Cost We are:

  • Non-profit
  • Independent
  • Objective
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Who We Serve

Change Agents Individuals, communities, or

  • rganizations

working to lower costs, improve care, and make Colorado healthier.

Consumers Researchers Government Clinicians Employers Hospitals Non-Profits Health Plans Pharmacy

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Focus Areas

Public CO APCD Data

Identify opportunities for improvement in your community through interactive reports and publications

Custom CO APCD Data

License data from the most comprehensive claims database in CO to address your specific project needs

Data Literacy

Attend data academies to learn how to use available data resources across the state and country

Turning Data into Actionable Information

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What’s in the CO APCD

Health Insurance Payers

We receive claims from Medicaid, Medicare, Medicare Advantage, and over 40 commercial payers

Claims

The Colorado APCD has over 875+ million claims (Medical, Pharmacy, and Dental)

Unique Lives

The Colorado APCD represents over 4.3 million unique lives, and over 80% of insured Coloradans

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Emergency Department Utilization Project

  • Goals Of The Project:
  • Better understanding of the top reasons for outpatient

ED utilization in Northern Colorado.

  • What is the cost associated with these ED visits?
  • How does the outpatient ED utilization and cost vary

between the commercial and Medicaid population?

  • What outpatient ED visits could be classified as

avoidable

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Emergency Department Utilization Project

  • High Level Description Of Data Analyzed:
  • Service dates 2015 – 2018
  • Claims flagged as ER visits
  • Classified diagnoses using ICD-9 or ICD-10 coding system
  • Commercial and Medicaid claims
  • Geography Examined:
  • Member zip code at month of admission used to categorize

into various geographic regions

  • Community Level (Fort Collins, Greeley, Loveland)
  • County Level (Boulder, Larimer, Weld)
  • Regional Accountable Entity (RAE) #2
  • State of Colorado
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Emergency Department Utilization Project

  • Two methods used to determine whether an ED visit could

be classified as avoidable:

  • NIH Guidelines: subjective and based on NIH guidelines for

when to use the emergency room. Ability to categorize visits into:

  • Emergency, Avoidable or Unknown
  • NYU Algorithm: categorizes ED visits into several groups

using information such as procedures, mortality, and hospitalizations.

  • Able to categorize visits by severity level and identify some visits as

“non-emergent”

  • Also identifies carve out categories for visits that may be justifiably

emergent, but were less clearly associated with hospitalization or

  • mortality. These include ED visits due to injury, mental health issues,

alcohol or drugs

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ED Utilization in Northern Colorado

Cindy Kronauge MPH PhD Weld County Department of Public Health and Environment

11/6/2019

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Key Questions

What do the data tell us about ED utilization in Northern Colorado?

What are the top reasons for

  • utpatient ED utilization?

TOP REASONS What are the costs associated with these outpatient ED visits? COSTS What does outpatient ED utilization look like in Northern Colorado? ED UTILIZATION What outpatient ED visits were avoidable? AVOIDABLE REASONS

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What does outpatient ED utilization look like in Northern Colorado?

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121.8 140.4 135.2 106.7 102.0 132.2 164.1 95.0 467.3 488.5 473.3 433.9 376.4 461.5 571.1 434.0 State RAE #2 Weld Larimer Boulder Loveland Greeley Fort Collins

ED Visits per 1,000 Members per Year (2015 - 2018)

Commercial Medicaid

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97.8 101.5 105.5 103.1 95.0 107.5 114.6 109.2 133.5 137.7 132.9 136.5 118.7 122.9 124.8 120.8 75 85 95 105 115 125 135 145 2015 2016 2017 2018

Commercial Outpatient ED Visit Trends

Boulder Larimer Weld State

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81.0 94.8 105.7 98.4 169.5 165.0 159.1 163.9 126.1 134.5 136.1 131.1 20 40 60 80 100 120 140 160 180 2015 2016 2017 2018

Commercial Outpatient ED Visit Trends by Municipality

Fort Collins Greeley Loveland

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Mental Health 1% Alcohol 1% Emergent 12% Injury 26% Non-Emergent 29% Indeterminant 9% Unclassified 3% Other 19%

Outpatient ED Visits, Larimer and Weld, 2015-2018

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Mental Health 1% Alcohol 1% Emergent 15% Injury 32% Non-Emergent 36% Indeterminant 11% Unclassified 4%

Commerical Outpatient ED Visits, Larimer and Weld, 2015-2018

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Commercial Outpatient ED Visits

Mental Health 1% Emergent 16% Injury 29% Non-Emergent 41% Indeterminant 8% Unclassified 5%

Greeley, 2015-2018

Mental Health 1% Alcohol 2% Emergent 15% Injury 33% Non-Emergent 36% Indeterminant 11% Unclassified 2%

Fort Collins, 2015-2018

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Takeaways - I

  • Outpatient ED utilization is higher in the Medicaid population
  • Utilization varies by where members live with rates being generally higher in

Weld County and Greeley compared to other areas

  • At least 3 out of 10 outpatient ED visits are avoidable, non-emergent
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What are the top reasons for

  • utpatient ED utilization?
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Diseases of the heart

were the most common outpatient ED visit diagnoses in each geographic region except Boulder County.

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* avoidable, non-emergent; **avoidable, indeterminant

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  • Ft. Collins

Greeley Loveland Diseases of the heart Diseases of the heart Diseases of the heart Open wounds Respiratory infections* Diseases of the urinary system** Diseases of the urinary system** Diseases of the urinary system** Open wounds Respiratory infections* Open wounds Respiratory infections* Fractures Sprains and strains Fractures

* avoidable, non-emergent; **avoidable, indeterminant

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Takeaways - II

  • Diseases of the heart were the most common diagnosis. Although classified
  • verall as emergent, some of these visits may be avoidable
  • Respiratory infections is the most common avoidable reason seen in the
  • utpatient ED, treated and released
  • Diseases of the urinary system were harder to classify; some diagnoses may also

be avoidable

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What outpatient ED visits were avoidable?

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Headache, including migraine Respiratory Infections Ear conditions Spondylosis, disc disorders, other back problems Other connective tissue disease

T

  • p Avoidable

Visits

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T

  • p Avoidable Visits by County

Boulder Larimer Weld Respiratory infections 6.4% 5.7% 7.0% Headaches, including migraine 3.2% 3.6% 3.9% Ear conditions 2.8% 2.9% 3.1% Spondylosis; disc disorders, other back problems 2.8% 2.9% 3.3% Other connective tissue diseases 2.1% 2.1% 2.1% Total 17.3% 17.2% 19.4%

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On average there are about 600 avoidable visits per year in each

county for respiratory infections.

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Takeaways - III

  • Treatment for respiratory infections in the outpatient ED result in about 1,200

avoidable visits in Larimer and Weld counties.

  • Headaches including migraines also account for a substantial number of avoidable

visits.

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What are the costs associated with these outpatient ED visits?

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$ 33.9 M total

10.3 7.4 6.2 16.9 19.9 20.8 25.3 3.2 2.7 1.7 4.8 5.7 7.0 8.6 Fort Collins Greeley Loveland Boulder Larimer Weld RAE #2

Average Annual Outpatient ED Costs in Millions, Commercial Payers

All Other Avoidable

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* avoidable, non-emergent; **avoidable, indeterminant

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T

  • tal Cost of Heart Disease ED

Visits per Year, Commercial Payers

Note: T

  • tal costs were defined as the combined allowed amount paid by payer and member. Costs based on commercial claims only.

Fort Collins

$1.6 million

Loveland

$0.9 million

Greeley

$1.2 million

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T

  • tal Cost of ED

Visits for Diseases of Urinary System / Year

Fort Collins

$1.1 million

Loveland

$0.7 million

Greeley

$0.9 million

Note: T

  • tal costs were defined as the combined allowed amount paid by payer and member. Costs based on commercial claims only.
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T

  • p Outpatient ED Avoidable

Visit Costs

6.2 7.2 8.8 10.5 11.8 10.2 21.1 17.3 9.5 9.8 14.6 15.7 5 10 15 20 25 Back problems Ear conditions Respiratory infections Headaches

Per Member Per Year Cost

Loveland Greeley Fort Collins

11/5/2019

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T

  • tal Cost of ED

Visits for Respiratory Infections per Year

Fort Collins

$0.4 million

Loveland

$0.3 million

Greeley

$0.5 million

Note: T

  • tal costs were defined as the combined allowed amount paid by payer and member. Costs based on commercial claims only.
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Takeaways -IV

  • Outpatient ED visits for diseases of the heart account for $6.3 million per year

in costs in Larimer and Weld counties.

  • In Larimer and Weld counties, between 2015 and 2018, there were about $13

million per year in outpatient ED avoidable costs.

  • Respiratory infections account for over $2 million per year in Larimer and Weld.
  • Outpatient ED visits for headaches, ear conditions, and back problems are also

avoidable and costly.

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Summary

#1 At least 3 out of 10 outpatient ED visits are avoidable, non-emergent. #2 Diseases of the heart were the most common diagnoses for being treated in the outpatient ED. Some

  • f these visits may be avoidable.

#3 Respiratory infections and headaches account for a substantial number of avoidable visits. #4 Avoidable outpatient ED visits are

  • costly. In Larimer and Weld counties,

about $13 million per year could be avoided if solutions were found to reduce unnecessary ED use.

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Recommendations

♦Consider strategies to reduce avoidable ED use that:

♦Decrease ED visits for one or more of the top avoidable reasons – respiratory

infections, headaches, back problems, etc.

♦Work on solutions together across counties, communities, and health systems

♦Further examine ED use related to heart disease and whether there

may be ways to reduce unnecessary visits

♦Continue to broaden access to primary care services ♦At the system level, consider implementing a project focused on the top

reasons for outpatient ED use

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Questions?

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Pete Sheehan VP Client Solutions & State Initiatives psheehan@civhc.org 303.204.5898 Cindy Kronauge Data Specialist ckronauge@weldgov.com 970.400.2221