CSI CLAIMS DATA COLLECTION AND ANALYSES UPDATE CSI Steering Committee

April 11, 2014

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CSI Multi-payer, Multi-year Dataset• RI covered lives (residents and nonresidents)

• Three health plans (Tufts not included)

• Receiving quarterly data from the health plans • 2009 through June, 2013• Non-residents excluded (by RTI) if they receive primary

care services out of state• Adults only (claims for kids received but not in any

analyses)

2

CSI Cohort 1: 15 practice sites

• Blackstone Valley Community Health Care, Inc. • Coastal Medical, Inc. - Greenville • Coastal Medical, Inc. - Hillside • Coastal Medical, Inc. - Narragansett • Coastal Medical, Inc. - Wakefield • Family Health and Sports Medicine • Kristine Cuniff • Memorial Hospital Family Care Center• South County Hospital Family Medicine • South County Internal Medicine • Stuart Demirs • Thundermist CHC - Wakefield • Thundermist CHC - Woonsocket • University Family Medicine • University Medicine - Governor Street Primary Care

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CSI Cohort 2: 21 practice sites

• Anchor Medical Associates - Lincoln • Anchor Medical Associates - Providence • Anchor Medical Associates - Warwick • Aquidneck Medical Associates - Newport • Aquidneck Medical Associates - Portsmouth • Associates in Primary Care Medicine • East Bay Community Action Program - East Providence • East Bay Community Action Program - Newport • Medical Associates of RI - Bristol • Medical Associates of RI - East Providence • Ocean State Medical, LLC • Tri Town Community Action Program • University Internal Medicine • University Medicine - 909 North Main Street • University Medicine - Barrington • University Medicine - East Ave • University Medicine - Plain Street • University Medicine - Warwick Family Medicine • WellOne Primary Medicine - Foster • WellOne Primary Medicine - North Kingstown • WellOne Primary Medicine - Pascoag

4

Metrics

For Today• Inpatient admissions (all-cause and ambulatory care

sensitive)• ED (all cause and preventable)

Available• Observation stays • 30-day readmissions• Stratifications

• payer type (Medicaid, Medicare, Commercial)• Medical versus surgical procedures

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Default: Rate for Rolling Years(Trailing Four Quarters)

Numerator

Number of measure-specified events (e.g., ED visits) in the trailing four quarters.

Denominator

Sum of all time with coverage (in monthly chunks) in the trailing year across the covered population, expressed as 1000 member-months.

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CSI Cohort 1 and Comparison Changes

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Changes 2012 - 2013

GroupJuly '11 – June '12

July '12 – June '13 Difference % Difference

(A) (B) (B-A) (B-A)/A

All-cause inpatient admissions per 1000 member months:

(1) CSI Cohort 1 7.72 7.35 -0.37 -4.8%

(2) Comparison 9.81 10.05 0.24 2.4%

Difference (1-2)     -0.61 -7.2%

All-cause ED visits per 1000 member months: 

(1) CSI Cohort 1 25.15 28.74 3.59 14.3%

(2) Comparison 22.11 24.31 2.20 10.0%

Difference (1-2)     1.39 4.3%

Inpatient Stays(per 1,000 member-months)

Jun-

09

Aug-0

9

Oct-0

9

Dec-0

9

Feb-1

0

Apr-1

0

Jun-

10

Aug-1

0

Oct-1

0

Dec-1

0

Feb-1

1

Apr-1

1

Jun-

11

Aug-1

1

Oct-1

1

Dec-1

1

Feb-1

2

Apr-1

2

Jun-

12

Aug-1

2

Oct-1

2

Dec-1

2

Feb-1

3

Apr-1

3

Jun-

130.00

2.00

4.00

6.00

8.00

10.00

12.00

7.727.35

9.8110.05

CSI

Comparison

ED Visits(per 1,000 member-months)

Jun-

09

Aug-0

9

Oct-0

9

Dec-0

9

Feb-1

0

Apr-1

0

Jun-

10

Aug-1

0

Oct-1

0

Dec-1

0

Feb-1

1

Apr-1

1

Jun-

11

Aug-1

1

Oct-1

1

Dec-1

1

Feb-1

2

Apr-1

2

Jun-

12

Aug-1

2

Oct-1

2

Dec-1

2

Feb-1

3

Apr-1

3

Jun-

130.00

5.00

10.00

15.00

20.00

25.00

30.00

35.00

40.00

45.00

25.15

28.74

22.1124.31 CSI

Comparison

CSI Cohort 2 and Comparison Changes

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Changes 2012 - 2013

GroupJuly '11 – June '12

July '12 – June '13 Difference % Difference

(A) (B) (B-A) (B-A)/A

All-cause inpatient admissions per 1000 member months:

(1) CSI Cohort 2 8.65 9.07 0.42 4.9%

(2) Comparison 9.81 10.05 0.24 2.4%

Difference (1-2)     0.18 2.4%

All-cause ED visits per 1000 member months: 

(1) CSI Cohort 2 17.75 21.23 3.48 19.6%

(2) Comparison 22.11 24.31 2.20 10.0%

Difference (1-2) 1.28 9.7%

CSI Cohort 2: Inpatient Stays(per 1,000 member-months)

Jun-

09

Aug-0

9

Oct-0

9

Dec-0

9

Feb-1

0

Apr-1

0

Jun-

10

Aug-1

0

Oct-1

0

Dec-1

0

Feb-1

1

Apr-1

1

Jun-

11

Aug-1

1

Oct-1

1

Dec-1

1

Feb-1

2

Apr-1

2

Jun-

12

Aug-1

2

Oct-1

2

Dec-1

2

Feb-1

3

Apr-1

3

Jun-

130

2

4

6

8

10

12

8.659.07

9.8110.05

CSI

Comparison

Cohort 2: ED Visits(per 1,000 member-months)

Jun-

09

Aug-0

9

Oct-0

9

Dec-0

9

Feb-1

0

Apr-1

0

Jun-

10

Aug-1

0

Oct-1

0

Dec-1

0

Feb-1

1

Apr-1

1

Jun-

11

Aug-1

1

Oct-1

1

Dec-1

1

Feb-1

2

Apr-1

2

Jun-

12

Aug-1

2

Oct-1

2

Dec-1

2

Feb-1

3

Apr-1

3

Jun-

130

5

10

15

20

25

30

35

17.75

21.23

22.11

24.31

CSI

Comparison

Limitations• Attributing people to practice sites is imperfect• Results are sensitive to sample sizes• Changes in rates are relatively small• Differential case-mix over time• Secular trends affect the rates

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Current Status and Next Steps• Includes standardized rates (adjusted for age, gender,

and payer type)• Adding Medicare and Medicaid FFS claims now • Working on risk adjustment methodology• Program Evaluation Committee focusing on developing a

more robust evaluation plan for CSI • Comparison groups• Risk adjustment• Meaningful subgroups

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