1. SIM Collaborative Learning Session Using Data to Drive Change
Steve Melek, FSA, MAAA
November 3, 2017

2. SIM Cost & Utilization Reports - CMMI
Aggregate SIM cohort (Family Practice, Pediatric, Combined)
Each individual practice
Baseline Calendar Year (by quarter) + Quarterly Results thereafter
Updated quarterly
Results by Line of Business
No Risk Adjustment (yet)
New & improved matching algorithm improving attribution results
November 3, 2017

3. Changes
In response to feedback from practices, the following changes were made to the reports:
Your individual practice data is now compared to practices like yours (pediatric, family, adult practices)
Milliman and CIVHC identified an attribution issue with last quarter’s report that resulted in fewer beneficiaries being attributed to each practice. That issue has been resolved, and this report should capture more of your practice’s patient panel.
The resolved attribution issue minimized the occurrence of Medicare beneficiaries being attributed to pediatric practices. As a reminder, attribution is based on the NPIs that practices self-reported in the SIM practice roster.
November 3, 2017

4. CMMI SIM Cost & Utilization Report: Template
Out of Pocket Expenditures for Consumers
Follow-Up after Hospitalization for Mental Illness
Total Cost of Care Population based Per member per-month (PMPM) Index
Readmissions
Psychiatric Admissions
Admissions
Psychiatric ED Rate
Emergency Department (ED) Rate
Psychiatric Readmissions
November 3, 2017

5. Actuarial Cost & Utilization Reports
Aggregate SIM cohort
Each individual practice
Baseline Calendar Year (by quarter) + Quarterly Results thereafter
Informs cost projections, cost savings/avoided, ROI
Updated semi-annually
Results by Line of Business
No Risk Adjustment (yet)
New & improved matching algorithm improving attribution results
November 3, 2017

6. Actuarial Cost & Utilization Reports
Total Allowed Cost PMPM by Service Category
Commercial
Medicaid
Medicare
This allows for review of which types of services have costs that are increasing or decreasing for the attributed populations (e.g. ER, inpatient hospital, behavioral, etc.)
Total Annual Utilization Rate Per 1,000 by Service Category
Total Allowed Unit Cost by Service Category
November 3, 2017

7. Proposed Cost Savings & ROI
November 3, 2017

8. Proposed Cost Savings & ROI: Assumptions
Healthcare utilization and cost reductions: Inpatient Physical, Inpatient Behavioral, Emergency Services, Ambulance, SNF
Healthcare utilization and cost increases: primary and specialty medical professional, behavioral professional, diagnostic testing, imaging (non-complex), labs, prescription drugs – medical and behavioral
Projected Savings: $17.3M (yr. 1), $42.2M (yr. 2), $67.1M (yr. 3)
Savings translates to about $1.90 PMPM
November 3, 2017

9. Contact steve.melek@milliman.com Milliman 1400 Wewatta St. Suite 300
Denver, CO 80202
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