Health Indicator System For Rhode Islanders On Medicaid Presented by: Jane Griffin, MPH Project Director, RI Medicaid Research and Evaluation project RI Department of Human Services Presented to: Academy Health – State Health, Research and Policy Interest Group June 25, 2005

Purpose of RI Health Indicator System To assess, design, monitor and evaluate health services and program interventions for Rhode Islanders on Medicaid using existing public health data sets, statewide surveys, and Medicaid program data.

Design of Health Indicators Review policy studies, performance measure projects and research literature for recommended health outcome measures for an age-specific program population. Program staff selects priority measures.

TABLE 1: RECOMMENDED HEALTH INDICATORS FOR CHILDREN WITH DISABILITIES Accreditation groups/ Consensus panels Policy/Government groups Published in Journals FACCT/ NCQA NACHRITitleV- MCHB Johns Hopkins KuhlthauNewa- check PowePantel UtilizationX Preventive visit (well child) XXXXX Acute visitsXX DentalXX Emergency *XX Mental health *XX Pharmacy/RXXX Hospital Readmits * X * Program staff priority

 Identify Health Indicator Data Sets Data set that collects health outcome/measures on an ongoing annual basis Includes health coverage so analysis can be made comparing privately insured with Medicaid Data sets collected on Medicaid recipients including MMIS and surveys

 Data Sets in RI Medicaid Data Archive Vital Statistics Birth/Death File Behavioral Risk Factor Surveillance System (BRFSS) RI Health Interview Survey 1996, 2001 Hospital Discharge Data Set Public Health Data Sets :

 Data Sets in RI Medicaid Data Archive Children with Disabilities Adults with Disabilities Children with Insurance Gaps Foster Children Program Data: Medicaid Management Information System (MMIS) Surveys on RI Medicaid Population:

 Examples of Health Indicators by Medicaid Population Group: Healthy Children and Families Children with Disabilities Adults with Disabilities Uninsured

 Health Indicators for Healthy Children and Families: Short Interbirth Interval Infant Mortality Repeat Teen Births

Figure 1 Health Indicator – Short Interbirth Interval Percent of Women with Short Interbirth Interval (<18 months) by Insurance Status Data Source: Medicaid Research & Evaluation Project, Health Indicator Project Vital Statistics Birth File – (n=111,865)

Figure 2 Health Indicator - Infant Mortality Rhode Island Infant Mortality by Insurance Status Data Source: Medicaid Research & Evaluation Project, Health Indicator Project Linked Birth Death File , Division of Family Health, Department of Health (n=905) Deaths per 1000 births to Infants days – 3 year moving average

Figure 3 Health Indicator – Teen Repeat Births Percent of Teen Mothers with Previous Live Births by Insurance Status Data Source: Medicaid Research & Evaluation Project Vital Statistics birth File (n=11,748)

 Health Indicators for Children with Special Health Care Needs: Leading Cause of Hospitalizations Repeat Hospitalizations

Figure 4 Health Indicator – Mental Health Leading Causes of Hospitalizations by Principal Diagnosis by CSHCN Group Respiratory V-Code Factors Injury Mental Data Source: Medicaid Data Archive MMIS CY 2000, Children <21 on FFS Medicaid

Figure 5 Health Indicator - Percent of Children and Adolescents with Repeat Hospitalizations by Diagnoses 1 : Physical vs. Mental Fee-For-Service Medicaid Recipients 2, Ages 21 and Under Calendar Year 2000 At least 1 diagnosis of Mental Disorder 1.Includes Principal, Secondary or Tertiary Diagnosis 2.Total Recipients =12,062 Physical Diagnosis Only (n=448) (n=415)

 Health Indicators for Adults with Disabilities Leading Cause of Hospitalizations Repeat Hospitalizations

Figure 6 Health Indicator – Mental Health Hospitalizations for Adults Leading Causes of Hospitalization by Principal Diagnosis for Fee-For-Service Medicaid Recipients Ages Data Source: Health Indicator Project, Medicaid Data Archive, ICD-9 Groupings MMIS Extract (1998 n = 6,423 hospitalizations; 2000 n = 7,397)

Figure 7 Health Indicator - Percent of Working-Age Adults with Repeat Hospitalizations by Diagnoses 1 : Physical vs. Mental Fee-For-Service Medicaid Recipients 2, Ages 21 to 64 Calendar Year 2000 At least 1 diagnosis of Mental Disorder 1.Includes Principal, Secondary or Tertiary Diagnosis 2.Total Recipients =25,485 Physical Diagnosis Only (n=1,984)(n=2,377)

 Health Indicators for Uninsured Rhode Islanders Changes in Type of Insurance Coverage Uninsured Rhode Islanders by Age Group Uninsured Rhode Islanders by Income

Figure 8 Changes in Type of Insurance Coverage For Rhode Islanders <65 Years Old Data Source: Medicaid Research and Evaluation Project; RI Access Project US Bureau of the Census, Current Population Surveys (September estimate, 2004)

Figure 9 Percent Uninsured Rhode Islanders by Age Group Ages – Data Source: Medicaid Research and Evaluation Project; RI Access Project Behavioral Risk Factor Surveillance System , RI Department of Health

Figure 10 Percent Uninsured Rhode Islanders by Income Level Ages – Data Source: Medicaid Research and Evaluation Project; RI Access Project Behavioral Risk Factor Surveillance System , RI Department of Health

Creating Health Indicators from the Medicaid Management Information System (MMIS)

List of Health Indicators by Population Type Recommended from Expert Panels /Policy Literature* and can be designed from MMIS Measures found in 3 or more policy studies Healthy Adolescents Children with Disabilities Healthy Adults Adults with Disabilities Physical exams, checkupsPreventive visitsCVD ScreeningAssisted Living Facilities Dental visitsAcute visitsBreast Cancer ScreeningSpecialists Family Planning VisitsDental VisitsCervical Cancer Screening Nursing Home (stays & days) Mental health visits/readmitsEmergency Department VisitsColorectal Cancer Screening Hospital (stays & days) Immunization (HepB)Mental HealthDiabetic Retinal ExamsEmergency Department Visits AIDS/HIVPharmacy/RX Influenza/pneumonia vaccinationRehab Services (PT, OT, ST) Motor Vehicle AccidentHospital ReadmitsDental visitsReadmits (7,14,30 days) Violence/HomicideSpecialty care appointments ACS Hospitalizations Depression/Suicide Durable medical equipment/assistive tech Primary Care Doctor Visits Asthma Physical, speech, occupational therapy Unmet Need for Care DiabetesMental health counseling Average Costs Respite care Length of time with PCP Total annual $ spent on child

Conclusion Health Indicator System is an effective program evaluation model that state Medicaid programs can use to identify unmet needs and evaluate program initiatives