1. By Meghna Parthasarathy & Michele Mesiano
11/18/2018
Using SAS® to Identify and Stratify Members of Disease Management Programs at Community Care Behavioral Health Organization By
Meghna Parthasarathy & Michele Mesiano
Copyright © 2010, SAS Institute Inc. All rights reserved.

2. Community Care Behavioral Health Organization
11/18/2018
Community Care Behavioral Health Organization
Pittsburgh, Pennsylvania
Insurance Services Division of the University of Pittsburgh Medical Center
500 employees, 7 offices across PA
Behavioral health managed care organization
PA Medicaid – HealthChoices
35 of 67 PA counties
600,000 Medicaid managed care enrollees
2,000 BH providers
#SASGF11
Copyright © 2010, SAS Institute Inc. All rights reserved.

3. Community Care Behavioral Health Organization
11/18/2018
Community Care Behavioral Health Organization
The mission of Community Care is to improve the health and well being of the community through the delivery of effective and accessible behavioral health services
Recovery focused
New and innovative treatments
Growth in treatment options
Example – Implementation of Disease Management (DM) programs
#SASGF11
Copyright © 2010, SAS Institute Inc. All rights reserved.

4. The Disease Management (DM) Program
Steps of Hope (SOH) developed to enhance member self management
Four targeted programs managed currently
Recovery program
For members diagnosed with Schizophrenia or Depression
Opt out program
Lifestyle programs
For SMI members interested in Smoking Cessation and/or Weight Management
Opt out for targets
Opt in for only SMI

5. 11/18/2018
NCQA - Requirements
The National Committee for Quality Assurance (NCQA) is a private, not-for-profit organization that is dedicated to improving the quality of health care on a national level
Community Care chose to submit their programs for accreditation and was accredited with a score of 100%
NCQA has specific requirements with regards to data sources used to identify and stratify members for the DM programs
Claims/Encounter data
Pharmacy data
Lab data
Data collected through case management/care management processes
Health Appraisals
Referrals from health coaching programs/providers, etc.
Information from Electronic Health records
#SASGF11
Copyright © 2010, SAS Institute Inc. All rights reserved.

6. The Steps of Hope - Tobacco Cessation Program
Process runs every 30 calendar days
Identify target population from
Pharmacy Data (data from past 90 days)
Claims Data (data from past 60 days)
Case Management Data (data from past 30 days)
Authorization Data (data from past 30 days)
Member is SMI only and does not have the required indicators to make him/her a part of the target population

7. The Steps of Hope - Tobacco Cessation Program
Members are stratified into tiers and followed throughout the 2 year program
Tier 0 – Lowest Intervention
SMI but no target behavior – at risk group
Invitation letter to join program
No mailings unless member requested
Tier B – Moderate Intervention
Identified with target behavior (regardless of SMI diagnosis)
Quarterly mailings - educational and motivational materials

8. The Steps of Hope - Tobacco Cessation Program
Tier A – Highest Intervention
Self-Identified readiness to change
Member requests to actively participate
Quarterly mailings - educational and motivational materials
Monthly phone calls
Review cessation progress
Provider support and information
Collect data
*Members can opt-out at any time
**Members can request Tier A at any time

9. Data Source Management
Company Server
Authorization Data
Case Management Data
Member Self Report Data
Member Eligibility & Address Data
Hosted Web Server
Service Data
Pharmacy Data
Analyst PC

10. The Tobacco Cessation Program – ID Process
HCAL, 18 – 64 &
Open Authorization
Smoking Dx
on an Auth
Smoking Cessation
treatment
Smoking cessation
prescriptions
SMI Dx
on an Auth
Smoking Dx
on a Claim
Self identified
smokers
SMI Dx
on a Claim
GROUP B - SMOKING
CESSATION TARGET
GROUP 0 – SMI
POPULATION
Not qualified for
Systemic identification

11. Data Compilation
MERGE statement combined with a sub-setting IF

12. The Final Lists

13. Conclusion & Next Steps
Before Expansion # Members:
Tier 0 N= Tier B N= Tier A N=88
Manual Conversion Rate is low but only because being a tier 0 does not prevent people from being systemically identified in the next round
Program has been expanded to included another contract & members with Drug and Alcohol diagnoses
Expansion complete as of March 2011
Additional: Tier 0 N= Tier B N= Tier A N=3
Plans to continue to add contracts
Plans to start additional DM programs – will require additional SAS programming!

14. THANK YOU