1. claims data collection & analyses
Comparison of Draft CTC Rates for Contract Adjudication
March 7, 2017

2. Notes Onpoint analysis included medical eligibility data for:
Blue Cross Blue Shield of Rhode Island (BCBSRI)
Neighborhood Health Plan of Rhode Island (NHPRI)
Tufts (not included in RTI analysis)
UnitedHealthcare
UnitedHealthcare (New England) (Medicaid managed care)
Data are not risk adjusted
Maternity and behavioral health excluded
Onpoint’s standard attribution method uses a 24-month look-back and CMS Evaluation and Management (E&M) codes

3. Inpatient Admissions per 1,000 Member Months
Group
7/2013 – 6/2014
7/2014 – 6/2015
CTC Cohort 1
5.0
5.5
CTC Cohort 2
6.0
6.7
CTC Cohort 3
6.8
7.0
Comparison Group
5.1
5.6
Group
7/2013 – 6/2014
7/2014 – 6/2015
CTC Cohort 1
5.8
CTC Cohort 2
6.6
6.7
CTC Cohort 3
6.0
Comparison Group
6.9
7.4

4. ED Visits per 1,000 Member Months
Group
7/2013 – 6/2014
7/2014 – 6/2015
CTC Cohort 1
32.0
34.2
CTC Cohort 2
25.8
26.7
CTC Cohort 3
44.5
45.1
Comparison Group
28.0
29.2
Group
7/2013 – 6/2014
7/2014 – 6/2015
CTC Cohort 1
25.4
27.8
CTC Cohort 2
19.1
21.4
CTC Cohort 3
33.0
36.8
Comparison Group
20.1
22.5

5. CTC Cohort 1 & Comparison Inpatient Admissions per 1,000 Member Months
Changes
Group
July 2013 – June 2014
July 2014 – June 2015
Difference
% Difference
(A)
(B)
(B-A)
Onpoint
(1) CTC Cohort 1
5.0
5.5
0.6
11.6%
(2) Comparison
5.1
5.6
0.5
9.5%
Difference (1-2)
0.1
2.1%
RTI
5.8
0.0
0.0%
6.9
7.4
7.0%
-0.5
-7.0%

6. CTC Cohort 1 & Comparison ED Visits per 1,000 Member Months
Changes
Group
July 2013 – June 2014
July 2014 – June 2015
Difference
% Difference
(A)
(B)
(B-A)
Onpoint
(1) CTC Cohort 1
32.0
34.2
2.1
6.6%
(2) Comparison
28.9
29.2
1.2
4.4%
Difference (1-2)
0.9
2.2%
RTI
25.4
27.8
2.5
9.8%
20.1
22.5
2.3
11.6%
0.2
-1.8%

7. CTC Cohort 2 & Comparison Inpatient Admissions per 1,000 Member Months
Changes
Group
July 2013 – June 2014
July 2014 – June 2015
Difference
% Difference
(A)
(B)
(B-A)
Onpoint
(1) CTC Cohort 2
6.0
6.7
0.6
10.6%
(2) Comparison
5.1
5.6
0.5
9.5%
Difference (1-2) .1
1.1%
RTI
6.6
0.1
1.0%
6.9
7.4
7.0%
-0.4
-6.0%

8. CTC Cohort 2 & Comparison ED Visits per 1,000 Member Months
Changes
Group
July 2013 – June 2014
July 2014 – June 2015
Difference
% Difference
(A)
(B)
(B-A)
Onpoint
(1) CTC Cohort 2
25.8
26.7
0.8
3.2%
(2) Comparison
28.0
29.2
1.2
4.4%
Difference (1-2)
-0.4
-1.2%
RTI
19.1
21.4
2.3
12.1%
20.1
22.5
11.6%
-0.0
0.5%

9. CTC Cohort 3 & Comparison Inpatient Admissions per 1,000 Member Months
Changes
Group
July 2013 – June 2014
July 2014 – June 2015
Difference
% Difference
(A)
(B)
(B-A)
Onpoint
(1) CTC Cohort 3
6.8
7.0
0.2
3.1%
(2) Comparison
5.1
5.6
0.5
9.5%
Difference (1-2)
-0.3
-6.5%
RTI
5.8
6.0
3.3%
6.9
7.4
7.3%
-4.0%

10. CTC Cohort 3 & Comparison ED Visits per 1,000 Member Months
Changes
Group
July 2013 – June 2014
July 2014 – June 2015
Difference
% Difference
(A)
(B)
(B-A)
Onpoint
(1) CTC Cohort 3
44.5
45.1
0.6
1.4%
(2) Comparison
28.0
29.2
1.2
4.4%
Difference (1-2)
-0.6
-3.1%
RTI
33.0
36.8
3.7
11.3%
20.1
22.5
2.3
11.6%
1.4
-0.3%

11. Potential reasons for differences
Different data consolidation methods
Patients linked across carriers
Providers are mastered, NPI/Name errors eliminated
Rules around valid claims- (duplicate, orphan)
Inclusion of Tufts
Potentially different runout periods
Minor differences in attribution methodology
Others?