california children’s services (ccs) redesignhealthpolicy.ucla.edu/documents/spotlight/data...
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California Children’s Services
(CCS) Redesign
Data Technical Workgroup
Kick-off Webinar
February 20, 2015
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CCS Redesign Technical Workgroups
The Data Technical Workgroup (TWG) is one of six
workgroups created to facilitate and inform the CCS Redesign
process. The other TWGs are:
Eligibility / Health Conditions;
Outcome Measures / Quality;
Provider Access and Provider Network;
County / State Roles and Responsibilities; and
Health Homes / Care Coordination / Transitions.
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Data Technical Workgroup Description
The Data TWG will be responsible for providing the RSAB and
other TWGs with descriptive data regarding the CCS program,
for example:
cost utilization data for diagnostic and treatment services;
utilization data by provider type and diagnosis
analysis by region;
administrative costs;
to the extent possible, data regarding other services provided to CCS-
eligible children such as Medical Therapy Program, behavioral health, in
home support service costs, etc.
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Data Technical Workgroup Description
Other TWGs will communicate and work in collaboration with
the Data TWG to ensure that data needed to inform their
research and recommendations are made available, if such
information is accessible and analysis is possible.
The Data TWG will also assess potential for further data
development in the future, based on unmet information needs
they or other TWGs identify.
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Data TWG Potential Topics
The final list of topics will be identified and prioritized by the Data TWG in
conversation with the RSAB and other TWGs. Suggestions include:
Identifying and prioritizing specific data needs in issue areas determined by TWGs.
Accessing and including denied and unpaid claims in the aggregate CCS claims data to
better understand variations in eligible diagnoses and claims authorizations across county
CCS programs.
Assess potential for future development of a provider-sourced data warehouse (similar to
Cincinnati Children’s Hospital’s i2b2) for CCS providers to share de-identified data and
compare and track outcomes over time.
Analyze potential for cost containment based on utilization of services.
Make projections about potential impacts on cost and utilization of any prospective
changes to the program proposed by other technical workgroups.
Data TWG Members
Co-Chairs:
Brian Kentera - Chief, Information
Technology Section (DHCS)
Dylan Roby - Senior Research
Scientist, UCLA CHPR
Lee Sanders, MD, MPH –
Stanford Center for Policy
Outcomes and Prevention (CPOP)
Members:
Anand Chabra, MD - CCS
Medical Director, San Mateo
Athena Chapman - Director,
Legal and Regulatory Affairs,
California Association of Health
Plans
Members, continued:
Thomas Klitzner, MD - Director,
CCS Programs Mattel Children’s
Hospital at UCLA
Ann Kuhns - President & CEO,
California Children’s Hospital
Association
Chris Perrone - Deputy Director,
California HealthCare Foundation
Anthony Rose - CCS Director,
Orange County
Ed Schor, MD - Senior VP, Lucile
Packard Foundation for Children’s
Health
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Data TWG Role & Process
Key Priority Areas
Obtaining Input
Need for Evidence to Guide Decisions
Relationship with other technical workgroups
Resources & Capacity
Timeline
California CCS Data
Brian Kentera, DHCS
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State CCS Data Overview
Provide overview of State-owned CCS data
Areas of Discussion
Claims
Eligibility
Authorization
Provider
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Claims and Encounters
Standard 35C – paid claims and encounters
Department of Health Care Services (DHCS) Website:
http://www.dhcs.ca.gov/dataandstats/data/Pages/MMCDClmsEncDataRpt.aspx
35C Data Dictionary- 132 Data Elements:
http://www.dhcs.ca.gov/dataandstats/data/DocumentsOLD/MMCDState
Reporting/35C-File+Data+Element+Dictionary.pdf
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Claims and Encounters
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Claims and Encounters
What DHCS Receives on the Standard 35C?
CCS authorized and non-authorized Fee-For-Service (FFS)
CCS/Medi-Cal primary care FFS claims
CCS/Medi-Cal managed care encounters
CCS claims from other sources (mixed results)
Departments of Social Services, Mental Health, Developmental
Services
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Claims and Encounters
What the Standard 35C does NOT include?
Accurate costs for managed care encounters
Healthy Families clients primary care claims
Some inpatient ancillary services
Details associated with Diagnosis-related Grouping
(DRG) inpatient billing
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Eligibility
Medi-Cal Eligibility Data System (MEDS)
Medi-Cal eligibility data elements for CCS\Medi-Cal
Dates of eligibility, aid code, health plan, etc…
Does include indicator flag for CCS
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More Eligibility
Children’s Medical Services Network (CMS Net),
the CCS statewide case management system
All CCS eligibility records
CCS eligible conditions
County or geographic region
Financials, language, reason for case closure
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CCS Authorizations
CCS Authorization Service Authorization Request
(SAR)
Client
Service code or grouping
CCS diagnosis
Inpatient admit date or approved days prior to DRG
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Provider
Provider Master File (PMF)
NPI, Name, Location, DBA, Provider Type, etc…
CCS Paneled Providers
CCS Special Care Centers (SCC)
CCS Approved Facilities
Findings from CCS Administrative Data
Lee M. Sanders, MD, MPH
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Essential Questions
1. How do CCS children use healthcare services?
2. How can we assess the quality (or appropriateness) of
care?
3. What is the distribution of healthcare costs?
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Methods
Retrospective, population-based analysis of all paid
claims for the CCS Program (2007-2012)
Use of care: Total capture
Costs:
Total capture of CCS-related costs
Partial capture of non-CCS-related costs (FFS)
N = 323,922 children
Patterns of Care by Age
0
10
20
30
40
50
60
70
80
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
Ageatfirstvisit
Medianencounterrateperyear
0
10000
20000
30000
40000
50000
60000
70000
80000
90000
100000
Numberofchildren
HospitalBedDays EmergencyDepartmentVisitsEarlyPeriodicScreening,Diagnosis&Treatment DentalVisitsHomeHealthVisits OutpatientclinicvisitsOtheroutpatientvisits PharmacyprescriptionsfilledNumberofchildren
Patterns of Care by Medical Complexity
0
5
10
15
20
25
30
35
40
45
50
Complex Chronic Non-Chronic
Outpatient pharmacy fills
Other outpatient visits
Home health visits
ED visits
Outpatient physician visits
Bed days
Mea
n e
nco
un
ter
rate
per
yea
r
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Patterns of Care by Diagnostic Category
0
10
20
30
40
50
60
70
80
90
100
Neurolo
gy
Hemato
logy
Oncolo
gy
Cardio
logy
Otola
ryngo
logy
Gastro
entero
logy
Pulmonary
Inju
ry
CCS eligible diagnosis
Pe
rce
nt
of
tota
l exp
en
dit
ure
Inpatient Home health PharmacyOutpatient clinic Other outpatient DME% total expenditures % children
% o
f to
tal v
isit
s
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Outpatient: Inpatient Patterns by
Diagnostic Category
CARD
ENT
ENDO
INJ
GASTRO
DEVT
HEME
NEONATAL
NEUR
ONC
OPTH
ORTH
URO
0 5 10 15 20
Mean bed day rate
6
8
10
12M
ean o
utp
atient
vis
it r
ate
Scatter plot by diagnosis group, Outpatient versus total LOS
Bubble sized based on number of children in each diagnosis group
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Quality of Care:
No Care After Hospital Discharge
78.9
51.9
67.8
39
61.1
33.6
56.3
30.3
0 10 20 30 40 50 60 70 80 90
No MD visits within 7 days Post-hospitalization
No Outpatient Visit of any kind within 7 days Post-Hospitalization
No MD visits within 14 days Post-hospitalization
No Outpatient Visit of any kind within 14 days Post-Hospitalization
No MD visits within 21 days Post-Hospitalization
No Outpatient Visit of any kind within 21 days Post-Hospitalization
No MD visits within 28 days Post-Hospitalization
No Outpatient Visit of any kind within 28 days Post-Hospitalization
Percent of hospitalized CCS enrollees
(Overall Readmission Rate: 9.6%)
Regional Variability
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Cost Distribution By Child
50
2
40
26
5
15
4
32
1
25
0
10
20
30
40
50
60
70
80
90
100
Children Annual expenditures
Pe
rce
nt
Chart Title
Cost Distribution By Type of Care Chart Title
36%
21%
9%
17%
1%
14%
2%
0%
0%
Inpatient Home healthPharmacy Residential facilityOutpatient clinic Other outpatientDME DentalED
Chart Title
36%
21%
9%
17%
1%
14%
2%
0%
0%
Inpatient Home healthPharmacy Residential facilityOutpatient clinic Other outpatientDME DentalED
Chart Title
36%
21%
9%
17%
1%
14%
2%
0%
0%
Inpatient Home healthPharmacy Residential facilityOutpatient clinic Other outpatientDME DentalED
Hospital
Home Health
Outpatient (non MD)
Residential Facility
Pharmacy
DME Emergency Care
Outpatient (MD)
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Costs Distribution by Diagnostic Category
$0
$20,000,000
$40,000,000
$60,000,000
$80,000,000
$100,000,000
$120,000,000
$140,000,000
$160,000,000
Neu
rolo
gy
Hem
atol
ogy
EN
T
Onco
logy
Car
diolo
gy
Pulmon
ary
Gas
troe
ntero
logy
Inju
ry
Endoc
rinol
ogy
Tota
l ex
pen
dit
ure
s
Inpatient Outpatient pharmacy Residential facility Home health
Outpatient physician DME ED Other outpatient
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“High Cost Children” Over Time
Summary of Findings to Date
Distinct patterns of care use –by age, medical
complexity, and diagnostic category.
Regional variability in care patterns, particularly
before and after hospitalization.
Costs are highly skewed, driven by inpatient care,
and persistently high over time for a subsample of
children.
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Stanford CPOP Data Analysis
CPOP’s presentation at RSAB Meeting #1:
http://healthpolicy.ucla.edu/programs/health-
economics/projects/ccs/Pages/past-meeting-archive.aspx
CPOP policy briefs:
https://cpopstanford.wordpress.com/reports-and-policy-briefs/
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Data TWG Needs & Next Steps
Data Needs
To inform the redesign, and assess performance afterward
Identifying and analyzing high priority questions
Reporting progress at next RSAB meeting (March
20, 2015 in Sacramento)
Disseminating results/findings
Communicating with other TWGs
Delegating tasks and responsibilities
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Questions?
Michaela Ferrari: [email protected]
Dylan Roby: [email protected]
Brian Kentera: [email protected]
Lee Sanders: [email protected]
http://www.healthpolicy.ucla.edu/ccs