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Ivory Towers, Golden Domes, and Healthcare April 22, 2008 Caroline Carney Doebbeling, MD, MSc Director of Health Quality, Policy Research, and Strategic.

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Presentation on theme: "Ivory Towers, Golden Domes, and Healthcare April 22, 2008 Caroline Carney Doebbeling, MD, MSc Director of Health Quality, Policy Research, and Strategic."— Presentation transcript:

1 Ivory Towers, Golden Domes, and Healthcare April 22, 2008 Caroline Carney Doebbeling, MD, MSc Director of Health Quality, Policy Research, and Strategic Planning Indiana Office of Medicaid Planning and Policy Research Scientist Regenstrief Institute, Adult Health Services Research Associate Professor of Internal Medicine and Psychiatry, Indiana University School of Medicine

2 Both Sides of the Fence

3 Today’s Talk Brief overview of Medicaid Brief overview of Medicaid Quality Program and Directions Quality Program and Directions Policy Program and Directions Policy Program and Directions Research Opportunities Research Opportunities

4 OMPP Organizational Chart

5 Current FSSA Coverage Vehicles for MH Services In 2008, 100% FPL for a family of four is $21,200. FPL 200% 185% 150% 133% 100% 70-80%* * Aged, Disabled, and Blind income eligibility is driven by SSI standards rather than FPL Age < Pregnant *Disabled Blind* 23% Hoosier Healthwise Healthy Indiana Plan Traditional Medicaid Care Select SCHIP 1 SCHIP 2 Expansion Pregnancy Services Only Medicare - Medicaid Dual Eligible MEDWorks MEDWorks Buy-in Medicare Parents of CHIP Children & Childless Adults Parents of traditional Medicaid Children & Childless Adults Under CMS Review 250% HAP SMI or SED

6 Home & Community Based Waivers Indiana has eight home and community based waivers:Indiana has eight home and community based waivers: Developmentally DisabledDevelopmentally Disabled Aged and DisabledAged and Disabled Medically Fragile ChildrenMedically Fragile Children AutismAutism Traumatic Brain InjuryTraumatic Brain Injury Assisted LivingAssisted Living Support ServicesSupport Services Seriously Emotionally Disturbed (Children)Seriously Emotionally Disturbed (Children)

7 Indiana OMPP Quality History Focus based on financial outcomes Focus based on financial outcomes Little governance of policy process Little governance of policy process Quality programs limited to Hoosier Healthwise membership Quality programs limited to Hoosier Healthwise membership Data driven decisions limited by lack of encounter claims data Data driven decisions limited by lack of encounter claims data External consultants charged with development and implementation of quality programs External consultants charged with development and implementation of quality programs Pregnant women smoking cessation Pregnant women smoking cessation Behavioral health/physical health communication form Behavioral health/physical health communication form

8 Where Were We? “If we are to learn to improve the quality of decisions we make, we need to accept the mysterious nature of our snap judgments” Malcom Gladwell from Blink: The Power of Thinking Without Thinking, 2005 Vision of new leadership at FSSA and OMPP Vision of new leadership at FSSA and OMPP Data driven, not emotional or reactive decisions Data driven, not emotional or reactive decisions Annual HEDIS reports Annual HEDIS reports Quarterly process measures Quarterly process measures

9 The Way Forward Institute of Medicine’s Crossing the Quality Chasm report Institute of Medicine’s Crossing the Quality Chasm report Safe Safe Effective Effective Patient-centered Patient-centered Timely Timely Efficient Efficient Equitable Equitable

10 Critical Appraisal Team Building Approach Team Building Approach Health plans Health plans Other government agencies Other government agencies Stakeholders Stakeholders Academics Academics Data Structure Data Structure Encounter claim study and rehabilitation of process Encounter claim study and rehabilitation of process Linking OMPP Units Linking OMPP Units Reorganization placed Data, Strategic Policy, Policy Research and Program Evaluation with Quality and Outcomes unit Reorganization placed Data, Strategic Policy, Policy Research and Program Evaluation with Quality and Outcomes unit Target areas of Concern to State Target areas of Concern to State Cross-cutting throughout all of OMPP Cross-cutting throughout all of OMPP Neonatal and child health Neonatal and child health Behavioral Health Behavioral Health Preventive Care Preventive Care Chronic Disease Chronic Disease

11 Encounter Claims and the Attempt to Measure Quality Limited delivery of encounter claims by plan Limited delivery of encounter claims by plan <5% estimated behavioral health <5% estimated behavioral health Sporadic pharmacy claims Sporadic pharmacy claims Efforts of data group led by Ryan McCartney, Operations by Randy Miller, and Quality to correct Efforts of data group led by Ryan McCartney, Operations by Randy Miller, and Quality to correct

12 Life of a Claim: Fee for Service

13 Life of a Claim: Capitation

14 Benchmark MEAN20.68% 10th Percentile 7.59% 25th Percentile 14.84% 50th Percentile 21.37% 75th Percentile 27.74% 90th Percentile 32.56% Frequency: Members 18 years of age and older diagnosed with a new episode of depression and treated with antidepressant medication, and who had at least three follow-up contacts with a practitioner coded with a mental health diagnosis during the 84- day (12-week) Acute Treatment Phase. Exposure: Patients 18 years and older with continuous enrollment 120 days prior to the Index Episode Start Date through 245 days after the Index Episode Start Date. Benchmarks: Benchmark data based off of NCQA/HEDIS percentiles, ranking 139 Medicaid health plans. Previous Year Performance: 7.8% April 2007 May 2007 June 2007 July 2007 August 2007 September 2007 Freq.Expo.Freq.Expo.Freq.Expo.Freq.Expo.Freq.Expo.Freq.Expo. MHS Anthem MDwise Antidepressant Medication Management Optimal Practitioner Contacts for Medication Management

15 March Data prepared by OMPP DMA Breast Cancer Screening Benchmark MEAN % 10th Percentile % 25th Percentile % 50th Percentile % 75th Percentile % 90th Percentile % Frequency: Women 40–69 years of age who had a mammogram to screen for breast cancer. Exposure: Women 42–69 years of the measurement year. With continuous enrollment for the measurement year and the year prior to the measurement year. Each reported date contains 12 calendar months of experience. July 2007 August 2007 September 2007 October 2007 November 2007 December 2007 Freq.Expo.Freq.Expo.Freq.Expo.Freq.Expo.Freq.Expo.Freq.Expo. MHS , , ,844 Anthe m , , ,086 MDwis e 1,0363,2191,0363,2131,0273, , , ,040 Notes Continuously enrolled in Medicaid. Administrative Data. Source: MedInsight.

16 CMHC per Capita Spend Medicaid Rehabilitation Option Mean = $3,778 Source: Medicaid Incurred Claims Data SFY2007

17 Medicaid Mental Health Spend by Category of Service and Age Source: Medicaid Incurred Claims Data 2007.

18 Core-PAC & E-PAC 360 degrees of policy review Core-PAC Core-PAC Internal working group and invited external reviewers Internal working group and invited external reviewers Issues sent from OMPP executive team or Policy Evaluation Team for further research and context Issues sent from OMPP executive team or Policy Evaluation Team for further research and context Should this be implemented? If so, what are implications Should this be implemented? If so, what are implications Evidence, populations, intended and unintended consequences, economic analyes Evidence, populations, intended and unintended consequences, economic analyes E-PAC E-PAC Community and Government Stakeholders Community and Government Stakeholders Health Plans Health Plans Academics Academics OMPP and other state agency officials OMPP and other state agency officials Charge to “sign-off” on policy for statewide implementation Charge to “sign-off” on policy for statewide implementation

19 Current Topics The Never List The Never List Hospital Acquired Conditions Hospital Acquired Conditions Autism Services Autism Services HPV Vaccination for y/o HPV Vaccination for y/o Intensive Feeding Programs Intensive Feeding Programs Medication Reminder Systems Medication Reminder Systems ER Diversion Grant ER Diversion Grant

20 Regenstrief Institute Projects Making Use of Indiana Medicaid Data Clinical Use in INPC Clinical Use in INPC Point-of Care Applications (McDonald, Overhage) Point-of Care Applications (McDonald, Overhage) OMPP Projects OMPP Projects Various Projects by new Quality/Outcomes/Statistical Analysis team (Carney Doebbeling, Rosenman, Jones) Various Projects by new Quality/Outcomes/Statistical Analysis team (Carney Doebbeling, Rosenman, Jones) Public Health Use Public Health Use Indiana State Department of Health / Indiana Joint Asthma Coalition (Rosenman) Indiana State Department of Health / Indiana Joint Asthma Coalition (Rosenman)

21 Regenstrief Institute Projects Continued Research Use Research Use Improving Laboratory Follow- up by Delivering an Enhanced Medication List to Outpatient Physician Practices (Simonaitis, et al) Improving Laboratory Follow- up by Delivering an Enhanced Medication List to Outpatient Physician Practices (Simonaitis, et al) Does Collaborative Care for Vulnerable Elders Delay Institutionalization?—GRACE and PREVENT studies (Callahan et al) Does Collaborative Care for Vulnerable Elders Delay Institutionalization?—GRACE and PREVENT studies (Callahan et al) Measuring the Effect of Pharmacy Co-Pays on Health Utilization for Persons with Serious Mental Illness (Carney Doebbeling, et al) Measuring the Effect of Pharmacy Co-Pays on Health Utilization for Persons with Serious Mental Illness (Carney Doebbeling, et al) Health Care Access for Delinquent Youth (Aalsma, et al) Designated Medical Events Associated with Medication Use, in a Community-Wide Database (Rosenman, Overhage) Estimating Prenatal Syphilis Screening Rates In Indiana (Rosenman, et al) Structured Project Labeling Improves Detection of Drug Intolerance Issues (Schadow)

22 Purdue and Other Collaborations Laura Sands Laura Sands Joseph Thomas Joseph Thomas Butler University Butler University Will you be next?? Will you be next??

23 Next Steps Research that benefits the citizens of Indiana and beyond Research that benefits the citizens of Indiana and beyond Research that is timely to the needs of OMPP Research that is timely to the needs of OMPP Research conducted in the proper context of OMPP, the data being used, and the healthcare climate Research conducted in the proper context of OMPP, the data being used, and the healthcare climate Administrative data studies to implementation Administrative data studies to implementation Partners in Research Partners in Research Prenatal Care, Early Childhood Prenatal Care, Early Childhood Preventive Care Preventive Care Chronic Disease Chronic Disease Waiver Populations Waiver Populations Behavioral Health Behavioral Health New policy outcomes New policy outcomes

24 The How Emily Hancock Emily Hancock Manager of Policy Research Manager of Policy Research Directs the Core PAC and E-PAC meetings and initiatives Directs the Core PAC and E-PAC meetings and initiatives Liaison with Medicaid Medical Advisory Cabinet Liaison with Medicaid Medical Advisory Cabinet External Research Liaison External Research Liaison Advise, review, write, edit Advise, review, write, edit Publication with OMPP approval and authorship, as appropriate Publication with OMPP approval and authorship, as appropriate

25 Questions?


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