AHCCCS Data Sets Improve Population Heath Management Rene Q. Lizarraga, B.S. Thomas M. Ball, M.D., M.P.H. The University of Arizona Health Plans

Population Health Management Identify At-Risk Members Analytics Apply Effective Intervention Interventions Have Members Participate Engagement 1

Data Provided by AHCCCS to Support Our Analytic Efforts 2 Behavioral Health Tribal Health Medicare

Significant Delay Policy Moderate Delay Program Development & Monitoring Real Time Member Care The University of Arizona Health Plans Primary Use of AHCCCS Blind Spot Data Sets Pharmacy 3 Translating Data into Action: Timing is Critical

Behavioral Health Variables Of Interest  From 834 Enrollment File: RBHA indicator  From DBHS in Blind Spot Database: ICD-9/DSM diagnostic codes SMI determination identifier Behavioral health utilization 4

Key Variable: Use of RBHA indicator in 834 Enrollment File Health Disparities Among Those With Behavioral Health Conditions Maricopa Health Plan Yearly Cost Per Diagnosed Member CY 2012CY 2013% Change CY13 vs CY12 BHNon-BHBHNon-BHBHNon-BH Diabetes $ 9,747 $ 7,228 $ 9,293 $ 6,093-5%-16% COPD $ 7,172 $ 4,763 $ 5,537 $ 3,571-23%-25% Asthma $ 7,366 $ 4,229 $ 5,403 $ 3,063-27%-28% 5

SMI Qualifying Diagnosis in Pima County - Adult Members Less than 35 y.o.50 y.o. or olderP value Female57.8%67.6%.002 Spanish speaker4.6%8.3%.033 Diabetes6.8%29.4% (20.1%)<.001 Hypertension7.4%40.5% (29.1%)<.001 CHF0.8%4.1% (3.5%)<.001 Asthma16.3%16.0% (5.4%).927 COPD0.8%7.9% (2.9%)<.001 PMPM medical expense$641$ ED/PCP spend8.3:14.2:1.001 Used BH services61%72%  Younger population need Member Engagement  Older population need Care Coordination Key Variable: ICD-9/DSM Diagnoses in Blind Spot Database

7 Physical Health Medical Expense & Hospitalizations by Behavioral Health Category BH GroupPMPM Cost No BH utilizationComparison Group BH utilization by non-SMI+ 47% SMI qualifying diagnosis+ 78% SMI diagnosis in Pima County Where do they get admitted? BH facility only13% PH facility only82% Both BH & PH facilities 5%  Use of behavioral health services and an SMI qualifying diagnosis incrementally increase physical health medical expense  Behavioral health issues need to be addressed during care transitions from PH facilities Key Variables: Use of both RBHA indicator, SMI qualifying diagnoses & admission data P<.001

Determined v. Non-determined Adults (≥18) with SMI SMI- Determined Use of RBHA SMI- Qualifying Diagnosis 4.6% 1.3% 6.1% 1.4% Not in a group – 86.5% Key Variables: Use of both RBHA indicator, SMI qualifying diagnoses & SMI determination information 8

Total Admissions by Whether Member with SMI has Completed Determination Process 9 P=0.36 *No significant differences for PH or BH Admissions, Readmissions or ED use

Tribal Claims Data  Of >120,000 UFC members, 2.8% (3,618) report their Race as NA/AI  Of UFC members, 0.3% (370) have IHS as a secondary FSC (Payer)  Of UFC members, 56 members received a service paid for by IHS Represents 454 claims 6 ED visits 1 inpatient hospital stay  Consequences outside of Maricopa County are: 75.4% of those with an IHS FSC are over 18 years of age compared to 56.5% of those without an IHS FSC 10 Hypothesis: receiving services from both Health Plan and IHS is only likely for members living geographically close to both IHS services within their service delivery area and Health Plan services outside of their service delivery area.

Next Steps  Continue use of data sets provided by AHCCCS for population health management Identify opportunities to target care coordination efforts most effectively Develop new programs for specific high risk subgroups  Utilize pharmacy data for member-specific interventions Identify members needing metabolic monitoring Identify members with dangerous utilization patterns  Review patterns of care between AHCCCS and IHS within Maricopa County  Investigate potential uses of Medicare (Part C and Part D) data 11

Summary  AHCCCS provided data sets allow identification of vulnerable populations to guide program development initiatives.  These data sets can be used to monitor impact of interventions focused on whole- person care, such as Super Utilizer initiatives.  October 1, 2015 provides the opportunity to assess the value of integrated care for members with SMI determination and co-morbid chronic physical health conditions by comparison to members with SMI qualifying diagnoses without determination who will remain with their chosen health plan.  NA/AIs (living outside of Maricopa County in Southern or Central Arizona) with UFC are unlikely to utilize IHS services.  AHCCCS provided supplementary data sets serve a critical function until completion of a well functioning state-wide HIE. 12

Questions? 13