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

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

State of Delaware Hospital Inpatient Spend FY15 $60,000,000 $54,281,039 $50,000,000 $40,000,000 $30,000,000 $20,004,522 $20,000,000 $12,415,196 $9,576,203 $10,000,000 $2,182,459 $2,013,158 $0 A B C D E F BAYHEALTH ST FRANCIS CHRISTIANA CARE ALFRED I DUPONT NANTICOKE BEEBE MEDICAL HOSPITAL INC HLTH SVCS HOSPITAL FOR MEMORIAL CENTER CHILDREN HOSPITAL Paid FY15 (July 2014 through June 2015) 2

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 3

State of Delaware Hospital Outpatient Spend FY15 $60,000,000 $50,000,000 $47,528,126 $40,000,000 $32,421,603 $30,000,000 $20,000,000 $15,002,968 $11,454,435 $10,000,000 $4,642,063 $2,106,598 $0 A B C D E F BAYHEALTH ST FRANCIS CHRISTIANA CARE ALFRED I DUPONT NANTICOKE BEEBE MEDICAL HOSPITAL INC HLTH SVCS HOSPITAL FOR MEMORIAL CENTER CHILDREN HOSPITAL Paid FY15 (July 2014 through June 2015) 4

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 5

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. CHANGE IN % CHANGE % CHANGE IN HOSPITAL PERIOD # ADMITS IN ALOS 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%* * Includes Quality Blue Incentive Payments 6

State of Delaware Inpatient DRG Reimbursement Analysis 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. ANNUALIZED PRE DRG HOSPITAL CLAIM COUNT DRG ALLOWED 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. 7