By Meghna Parthasarathy & Michele Mesiano 11/18/2018 Using SAS® to Identify and Stratify Members of Disease Management Programs at Community Care Behavioral Health Organization By Meghna Parthasarathy & Michele Mesiano Copyright © 2010, SAS Institute Inc. All rights reserved.

Community Care Behavioral Health Organization 11/18/2018 Community Care Behavioral Health Organization Pittsburgh, Pennsylvania Insurance Services Division of the University of Pittsburgh Medical Center 500 employees, 7 offices across PA Behavioral health managed care organization PA Medicaid – HealthChoices 35 of 67 PA counties 600,000 Medicaid managed care enrollees 2,000 BH providers #SASGF11 Copyright © 2010, SAS Institute Inc. All rights reserved.

Community Care Behavioral Health Organization 11/18/2018 Community Care Behavioral Health Organization The mission of Community Care is to improve the health and well being of the community through the delivery of effective and accessible behavioral health services Recovery focused New and innovative treatments Growth in treatment options Example – Implementation of Disease Management (DM) programs #SASGF11 Copyright © 2010, SAS Institute Inc. All rights reserved.

The Disease Management (DM) Program Steps of Hope (SOH) developed to enhance member self management Four targeted programs managed currently Recovery program For members diagnosed with Schizophrenia or Depression Opt out program Lifestyle programs For SMI members interested in Smoking Cessation and/or Weight Management Opt out for targets Opt in for only SMI

11/18/2018 NCQA - Requirements The National Committee for Quality Assurance (NCQA) is a private, not-for-profit organization that is dedicated to improving the quality of health care on a national level Community Care chose to submit their programs for accreditation and was accredited with a score of 100% NCQA has specific requirements with regards to data sources used to identify and stratify members for the DM programs Claims/Encounter data Pharmacy data Lab data Data collected through case management/care management processes Health Appraisals Referrals from health coaching programs/providers, etc. Information from Electronic Health records #SASGF11 Copyright © 2010, SAS Institute Inc. All rights reserved.

The Steps of Hope - Tobacco Cessation Program Process runs every 30 calendar days Identify target population from Pharmacy Data (data from past 90 days) Claims Data (data from past 60 days) Case Management Data (data from past 30 days) Authorization Data (data from past 30 days) Member is SMI only and does not have the required indicators to make him/her a part of the target population

The Steps of Hope - Tobacco Cessation Program Members are stratified into tiers and followed throughout the 2 year program Tier 0 – Lowest Intervention SMI but no target behavior – at risk group Invitation letter to join program No mailings unless member requested Tier B – Moderate Intervention Identified with target behavior (regardless of SMI diagnosis) Quarterly mailings - educational and motivational materials

The Steps of Hope - Tobacco Cessation Program Tier A – Highest Intervention Self-Identified readiness to change Member requests to actively participate Quarterly mailings - educational and motivational materials Monthly phone calls Review cessation progress Provider support and information Collect data *Members can opt-out at any time **Members can request Tier A at any time

Data Source Management Company Server Authorization Data Case Management Data Member Self Report Data Member Eligibility & Address Data Hosted Web Server Service Data Pharmacy Data Analyst PC

The Tobacco Cessation Program – ID Process HCAL, 18 – 64 & Open Authorization Smoking Dx on an Auth Smoking Cessation treatment Smoking cessation prescriptions SMI Dx on an Auth Smoking Dx on a Claim Self identified smokers SMI Dx on a Claim GROUP B - SMOKING CESSATION TARGET GROUP 0 – SMI POPULATION Not qualified for Systemic identification

Data Compilation MERGE statement combined with a sub-setting IF

The Final Lists

Conclusion & Next Steps Before Expansion # Members: Tier 0 N=8705 Tier B N=3214 Tier A N=88 Manual Conversion Rate is low but only because being a tier 0 does not prevent people from being systemically identified in the next round Program has been expanded to included another contract & members with Drug and Alcohol diagnoses Expansion complete as of March 2011 Additional: Tier 0 N=6545 Tier B N=720 Tier A N=3 Plans to continue to add contracts Plans to start additional DM programs – will require additional SAS programming!

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