Care Management Technologies

Transcription

1 Care Management Technologies Insight and Action in Behavioral Health Role of MH/DD SA Provider in Improving Care and Lowering Costs: Using Data to Demonstrate Your Value North Carolina Providers Council 2014 Annual Conference October 1, 2014 Unlocking Value Throughout the Population Pyramid Population Stratification Resource Consumption 5% 25% 70% Poly-chronic I/DD & BH comorbidities Elderly and disabled At risk for major intervention Healthy/minor issues ED visits 45%-50% Avoidable events Readmissions Higher volume of preventable 30%-35% acute episodes Complications and readmissions 20% Unmanaged and unengaged Opportunities for integrated care Opportunities to enhance and demonstrate value of specialty care delivery Opportunities for dramatically enhanced efficiency and consistency in care delivery # 2 Source: Blended MarketScan Commercial, Medicare 5% LDS, and representative payer Medicare data Dramatic Healthcare Cost Increases Associated with Behavioral Health Comorbidity Increased Cost of Chronic Disease w/mental Illness Comorbidity 1 # 3 1

2 Behavioral Health as a Cost Driver Many individuals with chronic medical conditions experience behavioral health disorders. In a commercial study, costs for these co-morbid patients averaged $512 pmpm higher 80% of the costs were medical. Seven of the top ten highest cost co-morbidities in a Medicaid population include a behavioral health disorder. # 4 Source: Melek S, Norris D. Chronic conditions and comorbid psychological disorders. Milliman Research Report. Seattle: Milliman; Center for Health Care Strategies Faces of Medicaid Data Brief: Clarifying Multimorbidity Patterns to Improve Targeting and Delivery of Clinical Services for Medicaid Populations. Cynthia Boyd, Bruce Leff, Carlos Weiss, Jennifer Wolff, Allison Hamblin and Lorie Martin. December 2010 Impact of I/DD on Costs and Service Utilization In a Midwestern state Medicaid system, persons with I/DD have 11% more ER visits per capita and 57% more hospitalizations per capita. Table: Hospitalizations and ER visits Hospitalizations ER Visits Patients SUM Rate / 1000 SUM Rate / 1000 #1: 2+ claims with ICD-9 Mild MR - IQ ,862 2, , #2: 2+ claims with ICD-9 MR - IQ , , #3: 2+ claims with ICD-9 Severe MR - IQ , , #4: 2+ claims with ICD-9 Profound MR IQ < 20 1, # 5: 2+ claims with ICD Unspecified I/DD 3,457 1, , All Unique Individuals (Any I/DD) 17,292 5, , Group 7: non I/DD population 10,000 2, , Ratio between the two # 5 Ambulatory Care-Sensitive Conditions* Urinary tract infections Congestive heart failure Hypertension Adult asthma Chronic obstructive pulmonary disease Uncontrolled diabetes Diabetes, short-term complications Diabetes, long-term complications *conditions for which good outpatient care can potentially prevent the need for hospitalization. *I/DD Population overrepresented with these conditions. # 6 2

3 North Carolina Medicaid Data 2013 IDD and No IDD Comparison of Utilization Risk Ratios Utilization No IDD MCO 1 MCO 2 MCO 3 MCO 4 MCO 5 MCO 6 MCO 7 MCO 8 MCO 9 Hosp per cap Risk Ratio LOS per cap Risk Ratio ER Visits per cap RR # 7 Top 10 Highest Total Spend for Hospitalizations CMT-Contracted MCOs Diagnosis N Unique Patients Total Hospital Admits Total Hospital Spend Avg Hospital Spend Per Admit Mental Retardation, Profound (IQ <20) $9,447,625 $31,703 Schizophrenia 888 1,172 $4,864,913 $4,151 Administrative Encounter 1,740 1,773 $4,687,384 $2,644 Mood Disorder NOS $3,968,951 $5,467 Lung Disease, Other 1,351 1,655 $3,478,273 $2,102 Pneumonia, Organism Unspec 1,235 1,301 $2,925,375 $2,249 Bipolar Disorder $2,916,462 $3,096 Major Depressive Disorder 927 1,030 $2,870,311 $2,787 Mental Retardation, Severe (IQ 20-34) $2,844,288 $22,754 Respiratory/Chest Symptoms 1,763 1,885 $2,804,284 $1,488 # 8 Fact: Behavioral Health Impacts Adherence to Medications Of all medication-related hospital admissions in the United States, 33 to 69% are due to poor medication adherence, with a resultant cost of approximately $100 billion a year 1. Patients with chronic conditions, such as depression, are less likely to follow prescription orders than those with acute conditions 2. Patients with mental illness who are nonadherent also are at risk for homelessness, incarceration, and violence 3. Overall, the estimated cost of nonadherence is $290 billion 3. 1Osterberg L, Blaschke T. Adherence to Medication. N Engl J Med 2005; 353: Lee J, Riley, K. The Effects of Pharmacist Intervention on Depression Medication Adherence: A Systematic Review. University of Florida, October Improving medication adherence in patients with severe mental illness, Pharmacy Today, June # 9 3

4 Fact: Behavioral Health Status Affects Mortality Behavioral health diagnoses are strongly implicated in morbidity and mortality of many chronic medical conditions. Depression increases all-cause mortality by a factor of 1.7 Depression 12 month prevalence = 6.7% Panic disorder increases all-cause mortality by a factor of 1.9 Panic disorder 12 month prevalence = 2.7% Alcohol abuse/dependence doubles all-cause mortality Alcohol abuse/dependence 12 month prevalence = 4.4% Bipolar disorder increases all-cause mortality by a factor of 2.6 Bipolar disorder 12 month prevalence = 2.6% # 10 I/DD Slide Approximately 1/3 of the I/DD population has a co-occurring mental illness. Approximately 50% if children with intellectual disorders have a co-occurring behavioral health disorder. NADD Position Statement The mission of NADD is to advance mental wellness for persons with developmental disabilities through the promotion of excellence in mental health care. # 11 A Need Exists for Experts in Specialty I/DD and BH Care # 12 4

5 Integrated Healthcare: Evidence-based Practice Collaborative Care Model SAMHSA recognized evidencebased practice Recommended as a best practice by the Surgeon General s Report on Mental Health 1 Medicaid could save an estimated $15 billion per year from effective implementation of Collaborative Care for all eligible members 2. # 13 1 Mental Health Report of the Surgeon General, Collaborative Care for Primary/Co-Morbid Mental Disorders, J Unutzer, M Schoenbaum, Fact: Care Integration Models Work # 14 Source: Can We Live Longer? Integrated Healthcare s Promise. SAMHSA. Fact: Care Integration Models Work # 15 Source: Can We Live Longer? Integrated Healthcare s Promise. SAMHSA. 5

6 Fact: Opportunities for Care Improvements for the I/DD Population Higher rates of obesity Poorer physical fitness Higher rates of cardiovascular disease Higher early mortality Greater disparities in access to basic care Higher rates of aspiration More complicated medication regimens # 16 Using Data to Support Integrated Care Models # 17 Unlocking Value Throughout the Population Pyramid Population Stratification Resource Consumption 5% 25% 70% Poly-chronic I/DD & BH comorbidities Elderly and disabled At risk for major intervention Healthy/minor issues ED visits 45%-50% Avoidable events Readmissions Higher volume of preventable 30%-35% acute episodes Complications and readmissions 20% Unmanaged and unengaged Opportunities for integrated care Opportunities to enhance and demonstrate value of specialty care delivery Opportunities for dramatically enhanced efficiency and consistency in care delivery # 18 Source: Blended MarketScan Commercial, Medicare 5% LDS, and representative payer Medicare data 6

7 What is Advanced Analytics # 19 Adler, D. How Technology Can Reduce Costs and Promote Accountable Care. Optum Behavioral Solutions, 10/24/13. Traditional Reporting and Data Analytics Process EHR Human Error Time Drain No Standardization # 20 RISK Our Solution: ProAct EHR Portal Web Services Application # 21 RISK SCORE Reports 7

8 Created from Evidence-based Research BEHAVIORAL HEALTH EXPERTISE BEHAVIORAL HEALTH ALGORITHMS BEHAVIORAL HEALTH SPECIALISTS Programmatic, Operational and Clinical Consultation # 22 Core Foundation Knowledge Dissemination Cohort Studies Published Research Expert Consensus Guidelines Expert Opinion / Editorial Board # 23 Decision Support System What gets measured, gets done. Big Data Engine Clinical lnsights # 24 8

9 CMT I/DD Health Content Early 2015 Physical health exam/dental exam/flu shot Use of psychotropics with no MI diagnoses Use of antipsychotics without metabolic screening Basic care gaps for: cardiac disease, diabetes, seizures, constipation, thyroid monitoring Specific conditions Displayed in a specific I/DD registry # 25 Aims Core Principles of Effective Care DATA DRIVEN CLOUD-BASED WEB SERVICES CLINICAL INTEGRATION PATIENT ENGAGEMENT & OUTREACH POPULATION HEALTH MANAGEMENT CARE MANAGEMENT/ COORDINATION REPORTING & MEASURING EVIDENCE-BASED # 26 ACTIONABLE INFORMATION Prove Your Value Creation Customer MOHealthNet 2012 Governor s Pinnacle Award: estimated $345 pmpm reduction CMT Role Data Analytics # 27 9

10 Delivering Value to Payers & Providers Leveraging Resources Aggregating Needs Reduce Hospitalizations Touching More Patients CMT Touchstones Touching High Risk/Complex Needs Patients Clinical Expertise Workforce Efficiency Document Value Improve Outcomes Lower Costs Extend Life Expectancy Improve Adherence # 28 Data Analytics Support to I/DD Providers Ohio Opportunity Analysis North Carolina Missouri Data Analytics support for the First I/DD Health Home Data Analytics Portal to support Nurse Care Manager in each of the 11 I/DD regions # 29 10