claims data collection & analyses

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Presentation transcript:

claims data collection & analyses Comparison of Draft CTC Rates for Contract Adjudication March 7, 2017

Notes Onpoint analysis included medical eligibility data for: Blue Cross Blue Shield of Rhode Island (BCBSRI) Neighborhood Health Plan of Rhode Island (NHPRI) Tufts (not included in RTI analysis) UnitedHealthcare UnitedHealthcare (New England) (Medicaid managed care) Data are not risk adjusted Maternity and behavioral health excluded Onpoint’s standard attribution method uses a 24-month look-back and CMS Evaluation and Management (E&M) codes

Inpatient Admissions per 1,000 Member Months Group 7/2013 – 6/2014 7/2014 – 6/2015 CTC Cohort 1 5.0 5.5 CTC Cohort 2 6.0 6.7 CTC Cohort 3 6.8 7.0 Comparison Group 5.1 5.6 Group 7/2013 – 6/2014 7/2014 – 6/2015 CTC Cohort 1 5.8 CTC Cohort 2 6.6 6.7 CTC Cohort 3 6.0 Comparison Group 6.9 7.4

ED Visits per 1,000 Member Months Group 7/2013 – 6/2014 7/2014 – 6/2015 CTC Cohort 1 32.0 34.2 CTC Cohort 2 25.8 26.7 CTC Cohort 3 44.5 45.1 Comparison Group 28.0 29.2 Group 7/2013 – 6/2014 7/2014 – 6/2015 CTC Cohort 1 25.4 27.8 CTC Cohort 2 19.1 21.4 CTC Cohort 3 33.0 36.8 Comparison Group 20.1 22.5

CTC Cohort 1 & Comparison Inpatient Admissions per 1,000 Member Months Changes 2013 - 2015 Group July 2013 – June 2014 July 2014 – June 2015 Difference % Difference (A) (B) (B-A) Onpoint (1) CTC Cohort 1 5.0 5.5 0.6 11.6% (2) Comparison 5.1 5.6 0.5 9.5% Difference (1-2) 0.1 2.1% RTI 5.8 0.0 0.0% 6.9 7.4 7.0% -0.5 -7.0%

CTC Cohort 1 & Comparison ED Visits per 1,000 Member Months Changes 2013 - 2015 Group July 2013 – June 2014 July 2014 – June 2015 Difference % Difference (A) (B) (B-A) Onpoint (1) CTC Cohort 1 32.0 34.2 2.1 6.6% (2) Comparison 28.9 29.2 1.2 4.4% Difference (1-2) 0.9 2.2% RTI 25.4 27.8 2.5 9.8% 20.1 22.5 2.3 11.6% 0.2 -1.8%

CTC Cohort 2 & Comparison Inpatient Admissions per 1,000 Member Months Changes 2013 - 2015 Group July 2013 – June 2014 July 2014 – June 2015 Difference % Difference (A) (B) (B-A) Onpoint (1) CTC Cohort 2 6.0 6.7 0.6 10.6% (2) Comparison 5.1 5.6 0.5 9.5% Difference (1-2) .1 1.1% RTI 6.6 0.1 1.0% 6.9 7.4 7.0% -0.4 -6.0%

CTC Cohort 2 & Comparison ED Visits per 1,000 Member Months Changes 2013 - 2015 Group July 2013 – June 2014 July 2014 – June 2015 Difference % Difference (A) (B) (B-A) Onpoint (1) CTC Cohort 2 25.8 26.7 0.8 3.2% (2) Comparison 28.0 29.2 1.2 4.4% Difference (1-2) -0.4 -1.2% RTI 19.1 21.4 2.3 12.1% 20.1 22.5 11.6% -0.0 0.5%

CTC Cohort 3 & Comparison Inpatient Admissions per 1,000 Member Months Changes 2013 - 2015 Group July 2013 – June 2014 July 2014 – June 2015 Difference % Difference (A) (B) (B-A) Onpoint (1) CTC Cohort 3 6.8 7.0 0.2 3.1% (2) Comparison 5.1 5.6 0.5 9.5% Difference (1-2) -0.3 -6.5% RTI 5.8 6.0 3.3% 6.9 7.4 7.3% -4.0%

CTC Cohort 3 & Comparison ED Visits per 1,000 Member Months Changes 2013 - 2015 Group July 2013 – June 2014 July 2014 – June 2015 Difference % Difference (A) (B) (B-A) Onpoint (1) CTC Cohort 3 44.5 45.1 0.6 1.4% (2) Comparison 28.0 29.2 1.2 4.4% Difference (1-2) -0.6 -3.1% RTI 33.0 36.8 3.7 11.3% 20.1 22.5 2.3 11.6% 1.4 -0.3%

Potential reasons for differences Different data consolidation methods Patients linked across carriers Providers are mastered, NPI/Name errors eliminated Rules around valid claims- (duplicate, orphan) Inclusion of Tufts Potentially different runout periods Minor differences in attribution methodology Others?