SIM Collaborative Learning Session Using Data to Drive Change

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Presentation transcript:

SIM Collaborative Learning Session Using Data to Drive Change Steve Melek, FSA, MAAA November 3, 2017

SIM Cost & Utilization Reports - CMMI Aggregate SIM cohort (Family Practice, Pediatric, Combined) Each individual practice Baseline Calendar Year (by quarter) + Quarterly Results thereafter Updated quarterly Results by Line of Business No Risk Adjustment (yet) New & improved matching algorithm improving attribution results November 3, 2017

Changes In response to feedback from practices, the following changes were made to the reports: Your individual practice data is now compared to practices like yours (pediatric, family, adult practices) Milliman and CIVHC identified an attribution issue with last quarter’s report that resulted in fewer beneficiaries being attributed to each practice. That issue has been resolved, and this report should capture more of your practice’s patient panel. The resolved attribution issue minimized the occurrence of Medicare beneficiaries being attributed to pediatric practices. As a reminder, attribution is based on the NPIs that practices self-reported in the SIM practice roster. November 3, 2017

CMMI SIM Cost & Utilization Report: Template Out of Pocket Expenditures for Consumers Follow-Up after Hospitalization for Mental Illness Total Cost of Care Population based Per member per-month (PMPM) Index Readmissions Psychiatric Admissions Admissions Psychiatric ED Rate Emergency Department (ED) Rate Psychiatric Readmissions November 3, 2017

Actuarial Cost & Utilization Reports Aggregate SIM cohort Each individual practice Baseline Calendar Year (by quarter) + Quarterly Results thereafter Informs cost projections, cost savings/avoided, ROI Updated semi-annually Results by Line of Business No Risk Adjustment (yet) New & improved matching algorithm improving attribution results November 3, 2017

Actuarial Cost & Utilization Reports Total Allowed Cost PMPM by Service Category Commercial Medicaid Medicare This allows for review of which types of services have costs that are increasing or decreasing for the attributed populations (e.g. ER, inpatient hospital, behavioral, etc.) Total Annual Utilization Rate Per 1,000 by Service Category Total Allowed Unit Cost by Service Category November 3, 2017

Proposed Cost Savings & ROI November 3, 2017

Proposed Cost Savings & ROI: Assumptions Healthcare utilization and cost reductions: Inpatient Physical, Inpatient Behavioral, Emergency Services, Ambulance, SNF Healthcare utilization and cost increases: primary and specialty medical professional, behavioral professional, diagnostic testing, imaging (non-complex), labs, prescription drugs – medical and behavioral Projected Savings: $17.3M (yr. 1), $42.2M (yr. 2), $67.1M (yr. 3) Savings translates to about $1.90 PMPM November 3, 2017

Contact steve.melek@milliman.com Milliman 1400 Wewatta St. Suite 300 Denver, CO 80202 303/672-9093