Presentation to State Employees Health Plan Task Force November - - PowerPoint PPT Presentation

HIGHMARKBCBSDE.COM

Highmark Delaware Presentation to State Employees Health Plan Task Force November 17, 2015

2

State of Delaware Hospital Inpatient Spend FY15

Paid FY15 (July 2014 through June 2015)

$20,004,522 $2,182,459 $54,281,039 $12,415,196 $2,013,158 $9,576,203 $0 $10,000,000 $20,000,000 $30,000,000 $40,000,000 $50,000,000 $60,000,000 A B C D E F BAYHEALTH ST FRANCIS HOSPITAL INC CHRISTIANA CARE HLTH SVCS ALFRED I DUPONT HOSPITAL FOR CHILDREN NANTICOKE MEMORIAL HOSPITAL BEEBE MEDICAL CENTER

3

State of Delaware Facility Inpatient Spend FY15 Total Delaware Hospitals ─ $100,472,577 Total All Delaware Facilities* ─ $103,597,690 Total Out-of-State Facilities ─ $21,909,375 Total Inpatient Facility Spend FY15 ─ $125,507,065

* Includes SNF, Psych, Sub Abuse

4

State of Delaware Hospital Outpatient Spend FY15

Paid FY15 (July 2014 through June 2015)

$32,421,603 $2,106,598 $47,528,126 $11,454,435 $4,642,063 $15,002,968 $0 $10,000,000 $20,000,000 $30,000,000 $40,000,000 $50,000,000 $60,000,000 A B C D E F BAYHEALTH ST FRANCIS HOSPITAL INC CHRISTIANA CARE HLTH SVCS ALFRED I DUPONT HOSPITAL FOR CHILDREN NANTICOKE MEMORIAL HOSPITAL BEEBE MEDICAL CENTER

5

State of Delaware Facility Outpatient Spend FY15 Total Delaware Hospitals ─ $113,155,793 Total All Delaware Facilities* ─ $119,582,200 Total Out-of-State Facilities ─ $22,565,800 Total Outpatient Facility Spend FY15 ─ $142,148,000

* Includes SNF, Psych, Sub Abuse

6

HOSPITAL PERIOD CHANGE IN # ADMITS % CHANGE IN ALOS % CHANGE IN AVG $ / ADMIT

1 PRE TO POST 449 TO 315 2.4%

• 14.1%

2 PRE TO POST 154 TO 144 14.2%

• 5.5%

POST 2ND YEAR 144 TO 124

• 14.5%

0.6% 3 PRE TO POST 141 TO 128 25.6% 21.7%* POST 2ND YEAR 128 TO 108

• 3.0%

3.9%*

Inpatient DRG Reimbursement Analysis

CMAD METHODOLOGY: Represents change in Case Mix Adjusted Diagnosis across all DRGs. Does not exclude outliers. PERIOD PRE TO POST: Represents the immediate 12 months prior to the DRG implementation date. PERIOD POST 2ND YEAR: Represents the second period after the initial DRG implementation year. 2015 Data is year-to-date thru September, 2015.

* Includes Quality Blue Incentive Payments

State of Delaware Inpatient DRG Reimbursement Analysis

7 HOSPITAL CLAIM COUNT DRG ALLOWED ANNUALIZED PRE DRG AMOUNT CHANGE % CHANGE

TOTAL 514 $ 12,455,837 $ 13,955,821 $ (1,499,983)

• 10.7%

Does not reflect the change in behavior ie; change in ALOS or services rendered. DRG methodology drives different behaviors.

We took current year claims for all three hospitals and compared what was paid under the DRG to what would have been paid under the prior fee-for-service arrangement.