1. Older Adult Population Served by California’s Medi-Cal Specialty Mental Health Services Presented by BHC-CalEQRO at California Mental Health Planning Council Quarterly Meeting, San Jose, Ca April 20, 2017
Saumitra SenGupta, Ph.D., Executive Director
Rachel Phillips, MS, Reporting Manager

2. Older Adult Data Analysis
Population Analyzed
Methodology
Age Groupings
Overall Results CY15
Demographic Results CY15
Gender Results CY15
Service Category Results CY15
ACA Results CY15

3. POPULATION ANALYZED
Define SDMC, Age breakouts, Medi-Medi, ACA

4. Older Adult Age Groupings
55-59
60-64
65-69
70-74
75-79
80-84
85+

5. METHODOLOGY Data comes from the 2015 SDMC and IPC approved claims.
Overall population totals are unduplicated by client index number.
Results by Service Type are unduplicated by services; such that one person with multiple services are included. Results by Region and Size follow the same method as Service Type to account for beneficiaries receiving services in multiple regions or those who move throughout the year.

6. CY15 Medi-Medi Population
Total unduplicated count age 55 and over is 69,087.
Medi-Medi in the CY15 total is 30,956.
Medi-Cal in the CY15 total is 38,131.

7. CY15 Medi-Medi Younger than 65
Medi-Medi under age 65 is 15,347.
Medi-Cal under the age 65 is 35,172.

8. CY15 Medi-Medi Age 65 and Over
Medi-Medi age 65 and over is 15,609.
Medi-Cal age 65 over is 2,959.

9. OVERALL ANALYSIS Number of beneficiaries served aged 55 and older.
Average approved SDMC dollars for 55 and older.
Results at the Statewide, Region, and Size levels.

10. CY15 Older Adult Age Groups Served
55-59
60-64
65-69
70-74
75-79
80-84
85 +
30,000
Ages account for the majority of older adults who received mental health services funded by SDMC in 2015.
Age group had the largest number of individuals who received services.
Ages 80 and beyond had the fewest services compared to the other older adult age groups
28,854
25,000
21,660
Beneficiaries Served
20,000
15,000
10,429
10,000
5,000
4,315
2,167
996
664

11. Age group 55-59 had the highest average approved claims amount.
CY15 Average Approved Claims by Older Adult Group
$10,000
Age Group
55-59
60-64
65-69
70-74
75-79
80-84
85 +
The average approved claim amount between the age groups ranges from $3,188 to $4,574.
Age group had the highest average approved claims amount.
Age group 85+ had the lowest average approved claims amount.
Average Approved Claims
$5,000
$4,574
$4,481
$4,524
$4,110
$4,170
$3,786
$3,188 $0

12. The unduplicated number of older adults served in CY15 totals 69,087.
CY15 Older Adult Served by Region
The unduplicated number of older adults served in CY15 totals 69,087.
The number of older adults served across California’s regions is greatest in LA.
The Southern and Bay Area regions have comparable numbers of beneficiaries served.
Superior has the fewest number of older adults served.
Region
Los Angeles
Southern Bay Area Central Superior
25,000
23,606
20,000
16,861
15,923
Beneficiaries Served
15,000
10,000
9,508
5,000
2,889
Los Angeles Southern Bay Area Central Superior

13. The CY15 Statewide average approved claim amount is $4,023.
CY15 Older Adult Average Approved Claims by Region
The CY15 Statewide average approved claim amount is $4,023.
The Bay Area has the greatest amount of average approved claims for older adults, with the value of $6,131.
The Central region has the lowest amount of average approved claims for older adults, with the value of $3,012.
Region
Bay Area
Superior Los Angeles Southern Central
$6,131
$6,000
$5,000
Average Approved Claims
$4,021
$4,000
$3,562
$3,207
$3,012
$3,000
$2,000
$1,000 $0
Bay Area Superior Los Angeles Southern Central

14. Very-Large MHP (LA) served the second highest number of beneficiaries.
CY15 Older Adult Served by Size
35,000
MHP Size
Large
Very-Large Medium Small
Small-Rural
The number of older adults served is greatest in the Large Sized MHP’s.
Very-Large MHP (LA) served the second highest number of beneficiaries.
Small-Rural has the fewest number of older adults served.
31,147
30,000
25,000
23,606
20,000
15,000
10,000
9,767
5,000
3,297
968
Large Very-Large Medium Small Small-Rural

15. CY15 Older Adult Average Approved Claims by Size
The average approved claims amounts ($5,423) for older adults is greatest in the in the Medium Sized MHP’s.
Large MHP has the second greatest amount of approved claims dollars ($4,242).
Small-Rural has the lowest average approved claim amount ($2,890) for older adults served.
MHP Size
Medium
Large Very Large Small
Small-Rural
$5,500
$5,423
$5,000
$4,500
$4,242
$4,000
$3,562
Average Approved Claims
$3,500
$3,427
$3,000
$2,890
$2,500
$2,000
$1,500
$1,000
$500 $0
Medium Large Very Large Small Small-Rural

16. RACE/ETHNICITY ANALYSIS
Total Served Age 55+ by Race Group
Average Approved Claims Age 55+ by Race Group
Total Served in each Older Age Group by Race Group
Average Approved Claims in each Older Age Group by Race Group
Age groups 75-79, 80-84, and 85+ have been removed from this section’s analysis to due HIPAA regulations.

17. The number of White older adults served in CY15 was 26,713.
The number of African American older adults served in CY15 was 11,092.
The number of Hispanic older adults served in CY15 was 10,709.
The number of Asian Pacific Islander older adults served in CY15 was 7,669.
The number of Native American older adults served in CY15 was 429.
CY15 Older Adults Served by Race/Ethnicity
30,000
Racegrp
White
Other
African-American Hispanic
Asian-Pacific Islander Native American
26,713
25,000
20,000
Beneficiaries Served
15,000
12,473
11,092
10,709
10,000
7,669
5,000
429
White
Other
African-Amer.. Hispanic
Asian-Pacific Islander
Native American

18. Others’ had an average approved claim amount of $4,447.
CY15 Older Adult Average Approved Claims by Race/Ethnicity
African American and White Race/Ethnicity groups have the highest and similar average approved claim amounts; $4,749 and $4,701.
Native American’s had an average approved claim amount comparable to African-Americans and Whites at a value of $4,623.
Asian Pacific Islander’s had an average approved claim amount of $3,220.
Hispanic’s had the lowest average approved claim amount at a value of $3,108.
Others’ had an average approved claim amount of $4,447.
$5,000
Racegrp
African-American
White Other
Native American Asian-Pacific Islander Hispanic
$4,749
$4,701
$4,623
$4,500
$4,447
$4,000
$3,500
Average Approved Claims Amount
$3,220
$3,108
$3,000
$2,500
$2,000
$1,500
$1,000
$500 $0
African-Am..
White
Other
Native American
Asian- Pacific..
Hispanic

19. CY15 Beneficiaries Served by Age Group and Race/Ethnicity
Age Group Racegrp
Racegrp
White
Other
African-American Hispanic
Asian-Pacific Islander Native American
55-59
White Other
African-American Hispanic
Asian-Pacific Isla.. Native American
10,749
5,447
5,595
4,269
2,613
181
60-64
White Other
African-American Hispanic
Asian-Pacific Isla.. Native American
8,410
4,035
3,436
3,005
2,607
167
65-69
White Other
African-American Hispanic
Asian-Pacific Isla.. Native American 54
4,347
1,855
1,333
1,639
1,201
70-74
White Other
African-American Hispanic
Asian-Pacific Isla.. Native American 12
1,789
671
449
835
559
2,000
4,000
6,000
8,000
Beneficiaries Served
10,000
12,000
14,000
In all age groups, White beneficiaries received the highest number of services.
In the age groups between 55-64, African-American beneficiaries received more services than Hispanic, and in age groups Hispanics received more services than African-Americans.
Native-Americans received the fewest number of services in all age groups.
Asian Pacific Islander beneficiaries received the second to last number of services across all age groups.

20. CY15 Beneficiaries Served by Age Group and Race/Ethnicity
Age Group Racegrp
Age Group
55-59
60-64
65-69
70-74
55-59
White
Native American African-American Other
Hispanic
Asian-Pacific Islander
$5,046
$4,915
$4,601
$4,896
$3,833
$3,088
60-64
White
Native American African-American Other
Hispanic
Asian-Pacific Islander
$4,949
$5,222
$4,584
$4,863
$3,973
$2,782
65-69
White
Native American African-American Other
Hispanic
Asian-Pacific Islander
$5,372
$4,700
$4,642
$4,693
$2,926
$3,235
70-74
White
Native American African-American Other
Hispanic
Asian-Pacific Islander
$4,671
$4,555
$4,883
$4,202
$2,966
$3,286 $0
$500
$1,000
$1,500
$2,000
$2,500 $3,000
Average Approved Claims
$3,500
$4,000
$4,500
$5,000
$5,500
In age group Whites accounted for the highest average approved claim amount at $4,915.
Age group Native Americans accounted for the highest average approved claim amount at $5,222.
Age group Whites accounted for the highest average approved claim amount at $5,372.
Age group African Americans accounted for the highest average approved claim amount at $4,883.

21. GENDER ANALYSIS Total Served Age 55+ by Gender
Average Approved Claims Age 55+ by Gender
Total Served in each Older Age Group by Gender
Average Approved Claims in each Older Age Group by Gender

22. The number of Female older adults served in CY15 was 40,807.
CY15 Older Adult Beneficiaries Served by Gender
50,000
Gender
Female
Male
45,000
40,807
40,000
The number of Female older adults served in CY15 was 40,807.
The number of Male older adults served in CY15 was 28,278.
35,000
30,000
Beneficiaries Served
28,278
25,000
20,000
15,000
10,000
5,000
Female Male

23. CY15 Adult Average Approved Claims by Gender
Female
Male
$4,500
$4,331
$4,000
$3,968
The average approved claim amounts for Female older adults served in CY15 was $3,968.
The average approved claim amounts for Male older adults served in CY15 was $4,331.
Male beneficiaries had a greater average approved claim amount than Females.
$3,500
$3,000
Average Approved Claims
$2,500
$2,000
$1,500
$1,000
$500 $0
Female Male

24. Females in most age groups received more services than males.
CY15 Older Adults Served by Age Group and Gender
Female
Male
Gender
Female
Male
16,181
16,000
14,000
12,671
12,673
12,000
Beneficiaries Served
10,000
8,989
8,000
6,470
6,000
3,959
4,000
2,832
2,000
1,483
1,483
679
491
684
317
173
Females in most age groups received more services than males.
The number of Males and Females receiving SDMC funded services decline around age 65.

25. CY15 Average Approved Claims by Age Group and Gender
Female
Male
Gender
Female
Male
$10,000
$5,105
$5,101
$5,000
$4,959
$4,158
$4,142
$4,171
$4,258
$4,201
$4,033
$4,156
$3,948
$3,437
$3,165
$3,253 $0
The average approved claim amounts between age groups are slightly higher in Male beneficiaries.

26. SERVICE TYPE ANALYSIS Total Served Age 55+ by Service Type
Average Approved Claims Age 55+ by Service Type
Total Served in each Older Age Group by Service Type
Average Approved Claims in each Older Age Group by Service Type

27. Residential Services and Day Treatment had the lowest utilization.
CY15 Older Adults Served by Service Type
55,000
Service Group
Medication Support
Mental Health Services Case Management Crisis Intervention Crisis Stablization Inpatient Services Residential Services Day Treatment
49,884
50,000
47,812
45,000
40,000
35,000
Beneficiaires Served
29,881
30,000
25,000
20,000
15,000
10,000
6,270
5,000
4,576
4,134
816
163
Medication Support
Mental Health Services
Case Management
Crisis Intervention
Crisis Stablization
Inpatient Services
Residential Services
Day Treatment
The top three types of services in CY15 for older adults were Med Support, Mental Health Services, and Case Management.
Residential Services and Day Treatment had the lowest utilization.

28. CY15 Average Approved Claims by Service Type
Service Group
Inpatient Services
Residential Services Day Treatment Crisis Stablization
Mental Health Services Medication Support Case Management Crisis Intervention
Inpatient Services had the highest average approved claim amount in older adults, with a value of $12,259.
Residential Services and Day Treatment had were the second highest cost, though they were the least utilized.
Mental Health Services ($2,480), Medication Support ($1,491) and Case Management ($1,235) had lower cost though higher use.
$12,259
$12,000
$10,000
$8,761
$8,000
$7,861
$6,000
$4,000
$2,507
$2,480
$2,000
$1,491
$1,235
$1,106 $0
Inpatient Residential Day Crisis Stab Services Services Treatment lization
Mental Medication Case Mana Crisis Inter Health .. Support gement vention

29. Medication Support had the highest amount of beneficiaries.
CY15 Beneficiaries Served by Service Type and Age Group
Case Management Medication Support
Mental Health Services
Age Group
55-59
60-64
65-69
70-74
75-79
80-84
85 +
25,000
21,787
20,000
19,766
16,169
15,054
Beneficiaries Served
15,000
12,024
10,000
9,026
7,036
7,292
5,065
5,000
2,747
3,002
2,050
1,282
1,541
1,017
431
545
706
451
The top three services were reported for this analysis in compliance with HIPAA.
Medication Support had the highest amount of beneficiaries.
Case Management was the third highest.

30. CY15 Average Approved Claims by Service Type and Age
Case Management Medication Support
Mental Health Services
Service Group
Case Management
Medication Support Mental Health Services
$3,000
$2,671
$2,658
$2,487
$2,514
$2,500
$2,392$2,387
$2,248
$2,000
Average Approved Claims
$1,574$1,549 $1,541
$1,500
$1,480$1,464$1,457
$1,351$1,331
$1,375
$1,336
$1,276
$1,222
$1,107
$1,023
$1,000
$500 $0
The top three services were reported for this analysis in compliance with HIPAA. Mental Health Services had the highest average approved claim per beneficiary. Medication Support had the second highest average approved claim per beneficiary across all age groups.

31. ACA POPULATION
Overall total ACA beneficiaries served, ACA Average Approved Claims , ACA population served by Service Type.

32. CY15 ACA Older Adults Served
CY15 ACA Older Adult population had the largest amount of beneficiaries who received services in the age range
The age group had 6,609 beneficiaries receive SDMC funded services.
The age group have 380 beneficiaries receive SDMC funded services.
Age groups 70 and beyond were not reported in compliance with HIPAA regulations.
Age Group
55-59
60-64
65-69
12,387
12,000
10,000
8,000
Beneficiaries Served
6,609
6,000
4,000
2,000
380

33. The age group 60-64 had an average approved claim amount of $3,478.
CY15 ACA Older Adult Average Approved Claims
Age Group
55-59
60-64
65-69
CY15 ACA Older Adult population had the highest average approved claim amount of $3,601 in the age range
The age group had an average approved claim amount of $3,478.
The age group have an average approved claim amount of $2,518.
Age groups 70 and beyond were not reported in compliance with HIPAA regulations
$3,601
$3,500
$3,478
$3,000
$2,518
$2,500
Average Approved Claims
$2,000
$1,500
$1,000
$500 $0

34. Mental Health Services had the highest amount of beneficiaries from the ACA population at 14,212.
Medication Support and Case Management had the second and third largest amount of beneficiaries served, 12,455 and 7,161.

35. Discussion based on Questions from the Planning Council

36. Questions
How do you define "older population"? What data do you collect that directly relates to the older population? Have you identified any counties that are providing exemplary programs for the older population? Have you identified any programs in the state that focus on providing specifically older adults with mental health and/or substance use disorders? Based on your research, what do you identify as the significant (mental health and substance use) issues for older adults?

37. Questions
If EQRO does not collect data specific to the older adult population, is this an opportunity to introduce such data collection? Does BHC do any amalgamation of the data they gather from each county and analyze it for trends across the state? If BHC does notice trends, do they issue an annual report, and if so, who receives it? Is it available on line on their website? Are there in fact any trends that the Planning Council might want to be aware of? Does BHC do mentoring or technical support to counties to assist them in gathering date that is accurate and ultimately useful?

38. Questions
If in the development of the American Health Care Act, if Medicaid is block granted to the States, will the EQRO still be an activity that the State might promote? Do you have targeted data information for specific age subgroups in the older adult population; e.g., ages 60-64; 65-69; 70-74; , etc. Do you gather any information for single older males who may have a higher risk of suicide ideation/attempts? Is there any way to further break out data for Older Adults by age groupings , 65-70, etc.? For example, variation between Older Adults at any given age range. With Children's data, we can break the data for 0-5, 5-11, etc. This is very helpful because there are more consistent developmental stages associated with Children's age ranges. And that doesn't exist with Older Adults.