Older Adult Population Served by California’s Medi-Cal Specialty Mental Health Services Presented by BHC-CalEQRO at California Mental Health Planning Council Quarterly Meeting, San Jose, Ca April 20, 2017 Saumitra SenGupta, Ph.D., Executive Director Rachel Phillips, MS, Reporting Manager

Older Adult Data Analysis Population Analyzed Methodology Age Groupings Overall Results CY15 Demographic Results CY15 Gender Results CY15 Service Category Results CY15 ACA Results CY15

POPULATION ANALYZED Define SDMC, Age breakouts, Medi-Medi, ACA

Older Adult Age Groupings 55-59 60-64 65-69 70-74 75-79 80-84 85+

METHODOLOGY Data comes from the 2015 SDMC and IPC approved claims. Overall population totals are unduplicated by client index number. Results by Service Type are unduplicated by services; such that one person with multiple services are included. Results by Region and Size follow the same method as Service Type to account for beneficiaries receiving services in multiple regions or those who move throughout the year.

CY15 Medi-Medi Population Total unduplicated count age 55 and over is 69,087. Medi-Medi in the CY15 total is 30,956. Medi-Cal in the CY15 total is 38,131.

CY15 Medi-Medi Younger than 65 Medi-Medi under age 65 is 15,347. Medi-Cal under the age 65 is 35,172.

CY15 Medi-Medi Age 65 and Over Medi-Medi age 65 and over is 15,609. Medi-Cal age 65 over is 2,959.

OVERALL ANALYSIS Number of beneficiaries served aged 55 and older. Average approved SDMC dollars for 55 and older. Results at the Statewide, Region, and Size levels.

CY15 Older Adult Age Groups Served 55-59 60-64 65-69 70-74 75-79 80-84 85 + 30,000 Ages 55-69 account for the majority of older adults who received mental health services funded by SDMC in 2015. Age group 55-59 had the largest number of individuals who received services. Ages 80 and beyond had the fewest services compared to the other older adult age groups 28,854 25,000 21,660 Beneficiaries Served 20,000 15,000 10,429 10,000 5,000 4,315 2,167 996 664 55-59 60-64 65-69 70-74 75-79 80-84 85 +

Age group 55-59 had the highest average approved claims amount. CY15 Average Approved Claims by Older Adult Group $10,000 Age Group 55-59 60-64 65-69 70-74 75-79 80-84 85 + The average approved claim amount between the age groups ranges from $3,188 to $4,574. Age group 55-59 had the highest average approved claims amount. Age group 85+ had the lowest average approved claims amount. Average Approved Claims $5,000 $4,574 $4,481 $4,524 $4,110 $4,170 $3,786 $3,188 $0 55-59 60-64 65-69 70-74 75-79 80-84 85 +

The unduplicated number of older adults served in CY15 totals 69,087. CY15 Older Adult Served by Region The unduplicated number of older adults served in CY15 totals 69,087. The number of older adults served across California’s regions is greatest in LA. The Southern and Bay Area regions have comparable numbers of beneficiaries served. Superior has the fewest number of older adults served. Region Los Angeles Southern Bay Area Central Superior 25,000 23,606 20,000 16,861 15,923 Beneficiaries Served 15,000 10,000 9,508 5,000 2,889 Los Angeles Southern Bay Area Central Superior

The CY15 Statewide average approved claim amount is $4,023. CY15 Older Adult Average Approved Claims by Region The CY15 Statewide average approved claim amount is $4,023. The Bay Area has the greatest amount of average approved claims for older adults, with the value of $6,131. The Central region has the lowest amount of average approved claims for older adults, with the value of $3,012. Region Bay Area Superior Los Angeles Southern Central $6,131 $6,000 $5,000 Average Approved Claims $4,021 $4,000 $3,562 $3,207 $3,012 $3,000 $2,000 $1,000 $0 Bay Area Superior Los Angeles Southern Central

Very-Large MHP (LA) served the second highest number of beneficiaries. CY15 Older Adult Served by Size 35,000 MHP Size Large Very-Large Medium Small Small-Rural The number of older adults served is greatest in the Large Sized MHP’s. Very-Large MHP (LA) served the second highest number of beneficiaries. Small-Rural has the fewest number of older adults served. 31,147 30,000 25,000 23,606 20,000 15,000 10,000 9,767 5,000 3,297 968 Large Very-Large Medium Small Small-Rural

CY15 Older Adult Average Approved Claims by Size The average approved claims amounts ($5,423) for older adults is greatest in the in the Medium Sized MHP’s. Large MHP has the second greatest amount of approved claims dollars ($4,242). Small-Rural has the lowest average approved claim amount ($2,890) for older adults served. MHP Size Medium Large Very Large Small Small-Rural $5,500 $5,423 $5,000 $4,500 $4,242 $4,000 $3,562 Average Approved Claims $3,500 $3,427 $3,000 $2,890 $2,500 $2,000 $1,500 $1,000 $500 $0 Medium Large Very Large Small Small-Rural

RACE/ETHNICITY ANALYSIS Total Served Age 55+ by Race Group Average Approved Claims Age 55+ by Race Group Total Served in each Older Age Group by Race Group Average Approved Claims in each Older Age Group by Race Group Age groups 75-79, 80-84, and 85+ have been removed from this section’s analysis to due HIPAA regulations.

The number of White older adults served in CY15 was 26,713. The number of African American older adults served in CY15 was 11,092. The number of Hispanic older adults served in CY15 was 10,709. The number of Asian Pacific Islander older adults served in CY15 was 7,669. The number of Native American older adults served in CY15 was 429. CY15 Older Adults Served by Race/Ethnicity 30,000 Racegrp White Other African-American Hispanic Asian-Pacific Islander Native American 26,713 25,000 20,000 Beneficiaries Served 15,000 12,473 11,092 10,709 10,000 7,669 5,000 429 White Other African-Amer.. Hispanic Asian-Pacific Islander Native American

Others’ had an average approved claim amount of $4,447. CY15 Older Adult Average Approved Claims by Race/Ethnicity African American and White Race/Ethnicity groups have the highest and similar average approved claim amounts; $4,749 and $4,701. Native American’s had an average approved claim amount comparable to African-Americans and Whites at a value of $4,623. Asian Pacific Islander’s had an average approved claim amount of $3,220. Hispanic’s had the lowest average approved claim amount at a value of $3,108. Others’ had an average approved claim amount of $4,447. $5,000 Racegrp African-American White Other Native American Asian-Pacific Islander Hispanic $4,749 $4,701 $4,623 $4,500 $4,447 $4,000 $3,500 Average Approved Claims Amount $3,220 $3,108 $3,000 $2,500 $2,000 $1,500 $1,000 $500 $0 African-Am.. White Other Native American Asian- Pacific.. Hispanic

CY15 Beneficiaries Served by Age Group and Race/Ethnicity Age Group Racegrp Racegrp White Other African-American Hispanic Asian-Pacific Islander Native American 55-59 White Other African-American Hispanic Asian-Pacific Isla.. Native American 10,749 5,447 5,595 4,269 2,613 181 60-64 White Other African-American Hispanic Asian-Pacific Isla.. Native American 8,410 4,035 3,436 3,005 2,607 167 65-69 White Other African-American Hispanic Asian-Pacific Isla.. Native American 54 4,347 1,855 1,333 1,639 1,201 70-74 White Other African-American Hispanic Asian-Pacific Isla.. Native American 12 1,789 671 449 835 559 2,000 4,000 6,000 8,000 Beneficiaries Served 10,000 12,000 14,000 In all age groups, White beneficiaries received the highest number of services. In the age groups between 55-64, African-American beneficiaries received more services than Hispanic, and in age groups 65-74 Hispanics received more services than African-Americans. Native-Americans received the fewest number of services in all age groups. Asian Pacific Islander beneficiaries received the second to last number of services across all age groups.

CY15 Beneficiaries Served by Age Group and Race/Ethnicity Age Group Racegrp Age Group 55-59 60-64 65-69 70-74 55-59 White Native American African-American Other Hispanic Asian-Pacific Islander $5,046 $4,915 $4,601 $4,896 $3,833 $3,088 60-64 White Native American African-American Other Hispanic Asian-Pacific Islander $4,949 $5,222 $4,584 $4,863 $3,973 $2,782 65-69 White Native American African-American Other Hispanic Asian-Pacific Islander $5,372 $4,700 $4,642 $4,693 $2,926 $3,235 70-74 White Native American African-American Other Hispanic Asian-Pacific Islander $4,671 $4,555 $4,883 $4,202 $2,966 $3,286 $0 $500 $1,000 $1,500 $2,000 $2,500 $3,000 Average Approved Claims $3,500 $4,000 $4,500 $5,000 $5,500 In age group 55-59 Whites accounted for the highest average approved claim amount at $4,915. Age group 60-64 Native Americans accounted for the highest average approved claim amount at $5,222. Age group 65-69 Whites accounted for the highest average approved claim amount at $5,372. Age group 70-74 African Americans accounted for the highest average approved claim amount at $4,883.

GENDER ANALYSIS Total Served Age 55+ by Gender Average Approved Claims Age 55+ by Gender Total Served in each Older Age Group by Gender Average Approved Claims in each Older Age Group by Gender

The number of Female older adults served in CY15 was 40,807. CY15 Older Adult Beneficiaries Served by Gender 50,000 Gender Female Male 45,000 40,807 40,000 The number of Female older adults served in CY15 was 40,807. The number of Male older adults served in CY15 was 28,278. 35,000 30,000 Beneficiaries Served 28,278 25,000 20,000 15,000 10,000 5,000 Female Male

CY15 Adult Average Approved Claims by Gender Female Male $4,500 $4,331 $4,000 $3,968 The average approved claim amounts for Female older adults served in CY15 was $3,968. The average approved claim amounts for Male older adults served in CY15 was $4,331. Male beneficiaries had a greater average approved claim amount than Females. $3,500 $3,000 Average Approved Claims $2,500 $2,000 $1,500 $1,000 $500 $0 Female Male

Females in most age groups received more services than males. CY15 Older Adults Served by Age Group and Gender Female Male Gender Female Male 16,181 16,000 14,000 12,671 12,673 12,000 Beneficiaries Served 10,000 8,989 8,000 6,470 6,000 3,959 4,000 2,832 2,000 1,483 1,483 679 491 684 317 173 55-59 60-64 65-69 70-74 75-79 80-84 85 + 55-59 60-64 65-69 70-74 75-79 80-84 85 + Females in most age groups received more services than males. The number of Males and Females receiving SDMC funded services decline around age 65.

CY15 Average Approved Claims by Age Group and Gender Female Male Gender Female Male $10,000 $5,105 $5,101 $5,000 $4,959 $4,158 $4,142 $4,171 $4,258 $4,201 $4,033 $4,156 $3,948 $3,437 $3,165 $3,253 $0 55-59 60-64 65-69 70-74 75-79 80-84 85 + 55-59 60-64 65-69 70-74 75-79 80-84 85 + The average approved claim amounts between age groups are slightly higher in Male beneficiaries.

SERVICE TYPE ANALYSIS Total Served Age 55+ by Service Type Average Approved Claims Age 55+ by Service Type Total Served in each Older Age Group by Service Type Average Approved Claims in each Older Age Group by Service Type

Residential Services and Day Treatment had the lowest utilization. CY15 Older Adults Served by Service Type 55,000 Service Group Medication Support Mental Health Services Case Management Crisis Intervention Crisis Stablization Inpatient Services Residential Services Day Treatment 49,884 50,000 47,812 45,000 40,000 35,000 Beneficiaires Served 29,881 30,000 25,000 20,000 15,000 10,000 6,270 5,000 4,576 4,134 816 163 Medication Support Mental Health Services Case Management Crisis Intervention Crisis Stablization Inpatient Services Residential Services Day Treatment The top three types of services in CY15 for older adults were Med Support, Mental Health Services, and Case Management. Residential Services and Day Treatment had the lowest utilization.

CY15 Average Approved Claims by Service Type Service Group Inpatient Services Residential Services Day Treatment Crisis Stablization Mental Health Services Medication Support Case Management Crisis Intervention Inpatient Services had the highest average approved claim amount in older adults, with a value of $12,259. Residential Services and Day Treatment had were the second highest cost, though they were the least utilized. Mental Health Services ($2,480), Medication Support ($1,491) and Case Management ($1,235) had lower cost though higher use. $12,259 $12,000 $10,000 $8,761 $8,000 $7,861 $6,000 $4,000 $2,507 $2,480 $2,000 $1,491 $1,235 $1,106 $0 Inpatient Residential Day Crisis Stab Services Services Treatment lization Mental Medication Case Mana Crisis Inter Health .. Support gement vention

Medication Support had the highest amount of beneficiaries. CY15 Beneficiaries Served by Service Type and Age Group Case Management Medication Support Mental Health Services Age Group 55-59 60-64 65-69 70-74 75-79 80-84 85 + 25,000 21,787 20,000 19,766 16,169 15,054 Beneficiaries Served 15,000 12,024 10,000 9,026 7,036 7,292 5,065 5,000 2,747 3,002 2,050 1,282 1,541 1,017 431 268 318 545 706 451 55-59 60-64 65-69 70-74 75-79 80-84 85 + 55-59 60-64 65-69 70-74 75-79 80-84 85 + 55-59 60-64 65-69 70-74 75-79 80-84 85 + The top three services were reported for this analysis in compliance with HIPAA. Medication Support had the highest amount of beneficiaries. Case Management was the third highest.

CY15 Average Approved Claims by Service Type and Age Case Management Medication Support Mental Health Services Service Group Case Management Medication Support Mental Health Services $3,000 $2,671 $2,658 $2,487 $2,514 $2,500 $2,392$2,387 $2,248 $2,000 Average Approved Claims $1,574$1,549 $1,541 $1,500 $1,480$1,464$1,457 $1,351$1,331 $1,375 $1,336 $1,276 $1,222 $1,107 $1,023 $1,000 $500 $0 70-74 75-79 8 0-84 60-64 55-59 65-69 85 + 70-74 75-79 80-84 60-64 55-59 65-69 85 + 70-74 75-79 80-84 60-64 55-59 65-69 85 + The top three services were reported for this analysis in compliance with HIPAA. Mental Health Services had the highest average approved claim per beneficiary. Medication Support had the second highest average approved claim per beneficiary across all age groups.

ACA POPULATION Overall total ACA beneficiaries served, ACA Average Approved Claims , ACA population served by Service Type.

CY15 ACA Older Adults Served CY15 ACA Older Adult population had the largest amount of beneficiaries who received services in the age range 55-59. The age group 60-64 had 6,609 beneficiaries receive SDMC funded services. The age group 65-69 have 380 beneficiaries receive SDMC funded services. Age groups 70 and beyond were not reported in compliance with HIPAA regulations. Age Group 55-59 60-64 65-69 12,387 12,000 10,000 8,000 Beneficiaries Served 6,609 6,000 4,000 2,000 380 55-59 60-64 65-69

The age group 60-64 had an average approved claim amount of $3,478. CY15 ACA Older Adult Average Approved Claims Age Group 55-59 60-64 65-69 CY15 ACA Older Adult population had the highest average approved claim amount of $3,601 in the age range 55-59. The age group 60-64 had an average approved claim amount of $3,478. The age group 65-69 have an average approved claim amount of $2,518. Age groups 70 and beyond were not reported in compliance with HIPAA regulations $3,601 $3,500 $3,478 $3,000 $2,518 $2,500 Average Approved Claims $2,000 $1,500 $1,000 $500 $0 55-59 60-64 65-69

Mental Health Services had the highest amount of beneficiaries from the ACA population at 14,212. Medication Support and Case Management had the second and third largest amount of beneficiaries served, 12,455 and 7,161.

Discussion based on Questions from the Planning Council

Questions How do you define "older population"? What data do you collect that directly relates to the older population? Have you identified any counties that are providing exemplary programs for the older population? Have you identified any programs in the state that focus on providing specifically older adults with mental health and/or substance use disorders? Based on your research, what do you identify as the significant (mental health and substance use) issues for older adults?

Questions If EQRO does not collect data specific to the older adult population, is this an opportunity to introduce such data collection? Does BHC do any amalgamation of the data they gather from each county and analyze it for trends across the state? If BHC does notice trends, do they issue an annual report, and if so, who receives it? Is it available on line on their website? Are there in fact any trends that the Planning Council might want to be aware of? Does BHC do mentoring or technical support to counties to assist them in gathering date that is accurate and ultimately useful?

Questions If in the development of the American Health Care Act, if Medicaid is block granted to the States, will the EQRO still be an activity that the State might promote? Do you have targeted data information for specific age subgroups in the older adult population; e.g., ages 60-64; 65-69; 70-74; 75- 79, etc. Do you gather any information for single older males who may have a higher risk of suicide ideation/attempts? Is there any way to further break out data for Older Adults by age groupings 60- 65, 65-70, etc.? For example, variation between Older Adults at any given age range. With Children's data, we can break the data for 0-5, 5-11, etc. This is very helpful because there are more consistent developmental stages associated with Children's age ranges. And that doesn't exist with Older Adults.