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Uses of NH’s Claims Database: Comprehensive Health Care Information System (CHIS)
Christine ShannonOffice of Medicaid Business & Policy, NH DHHSJuly 31, 2009
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NH CHIS Uses
Medicaid program analysis, program and policy development and decision making;
NHID efforts to increase information available on cost to consumers and purchasers; and
Other groups focused on getting information to consumers, purchasers and communities.
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Program Analysis, Policy Development and Decision Making
Primary Care Depression Children in Out-of-Home Placement ED Use Chronic Respiratory Disease CV Diseases and Circulatory Disorders Q-CHIP
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Cont.
Prevalence/Utilization Mental Health Disorders in Children’s Health Insurance Programs
Diabetes Health Plan Performance Summary Adult Preventive Payment Rate Benchmarking
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Q-CHIP… once is not enough
What is going on with adolescents? What is driving mental health utilization? Are findings consistent across geographic
areas? How does clinical status affect utilization and
cost?
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“So What Factor”
Plan a statewide effort to improve adolescent use of preventive care.
Shape an Enhanced Care Coordination Program. Perform a Primary Care Study. Target efforts to decrease ED utilization by Medicaid
beneficiaries. Decide whether to pursue risk-based managed care
contract. Pilot Medical Home.
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Cont.
Incorporate age standardization, CRG and statistical significant testing into future studies.
Report to legislative committee – and make public – Medicaid payment rates relative to commercial.
Dispel some myths.
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Primary Care Study
25% of NH Medicaid beneficiaries go to 2 types of provider groups (FQHCs and Dartmouth-Hitchcock Clinic).
FQHCs see a higher proportion of adults; DHC sees more children.
FQHCs had higher ED utilization. Evaluation of Medical Home Pilot.
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Payment Rate Benchmarking
Procedure Code Health Plan 1 Health Plan 2 Health Plan 3 NH Medicaid99203 Office/Outpatient Visit New Patient, 30min $124 $115 $130 $4299212 Office/Outpatient Visit Established Patient, 10min $51 $48 $52 $3099391 Preventive Medicine Visit Established Patient Age <1 $111 $102 $107 $6190806 Individual psychotherapy in office/outpatient, 45-50min $72 $71 $71 $61
Average Payment Including Patient Share, 2006
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NHID Cost Information
NH Acute Care Hospital Comparison: A Commercial Insurance Relative Cost Comparison
www.nh.gov/insurance/consumers/documents/nh_ac_hosp_comp.pdf
Analyzed 26 NH hospitals on inpatient and outpatient basis using NH CHIS and Hospital Discharge Data Set.
Created relative cost index.
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Cont.
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NH Health Cost
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Information to Consumers, Purchasers and Communities
NH Hospital Scorecardwww.nhpghscorecard.org
Patient experience Patient safety Clinical quality Cost
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Information to Consumers, Purchasers and Communities
CDC Community Health Assessment Initiative: Health Care Claims Module
Claims module will add information on disease prevalence and health care access for <65 insured (Medicaid and commercial).
Town/zip level code user defined geographic areas to support community health assessment.
1st efforts directed to cardiovascular, mental health and ED and primary care use.
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Conclusion
Be patient. Involve Medicaid program and clinical staff in
report development/review. Budget/allocate funds for analysis. Publicize who is using data. NH is in good shape for health care reform.
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Contact Information
www.nhchis.org
http://www.dhhs.state.nh.us/DHHS/OMBP/LIBRARY/Financial+Report/rate_benchmarks.
htm