1. Population Based Healthcare Delivery Design (II): Navy Catchment Area Birth Forecasting Tool Angie Cheng, MPH CNA, Health Research and Policy Analytics Community| Wednesday June 6, 2012 |11:00am-12:00pm e-mail: chengs@cna.org

2. FOR OFFICIAL USE ONLY 2 C, P, O 1)Context: Inadequate access to system-level perinatal data may lead to misalignment of resources and demand 2)Purpose: CNA created a data-driven analytical tool to help optimize perinatal product line efficiency 3)Outcome: Decision-makers can make more informed perinatal resource decisions using the Navy Catchment Area Birth Forecasting Tool to visualize historical birth volume trends, calculate population-based birth forecasts, and set birth volume targets across MTFs and Navy catchment areas

3. Outline Background Tasking and purpose Birth forecast tool contents Data source and methods Walk through the MS Excel tool Case scenarios Conclusions FOR OFFICIAL USE ONLY 3

4. 4 Background Highest utilization product line is Obstetrics MTF direct inpatient care for Obstetrics constitutes 36% of inpatient Navy healthcare costs 50% of inpatient workload (admissions)

5. Background Problems identified by Navy Perinatal community: No centralized oversight in practices and resourcing Misalignment of resources and demand Specialty leaders have difficulty accessing system level workload data Need data-driven analytical tools that even the playing field and optimize perinatal product line efficiency FOR OFFICIAL USE ONLY 5

6. Tasking and purpose BUMED M81 and the Perinatal Advisory Board tasked CNA to develop a tool that: Provides historic trends in birth volume Forecasts annual birth volume based on user entered population changes Helps users visualize seasonality of birth volume and set monthly birth volume targets Tool was presented to the PAB in August 2011 and disseminated to Obstetrics leaders across Navy MTFs Updated with FY2011 data in May 2012 (version 2.3) FOR OFFICIAL USE ONLY 6

7. Birth forecasting tool contents Annual Direct Care/Purchased Care Catchment Area Birth Volume Forecast Module Catchment Area Female Beneficiary Population Fertility Module Troop Movement Catchment Area Birth Volume Forecast Module Monthly Catchment Area Birth Volume Target Module Monthly Military Treatment Facility Birth Volume Target Module Annual Military Treatment Facility Birth Volume Module Accompanying worksheets and underlying data in the Excel document FOR OFFICIAL USE ONLY 7

8. Data sources MHS Data Repository Inpatient Admissions Standard Inpatient Data Record (SIDR) FY 2005-2011 Purchased Care Institutional (PCI) FY 2005-2011 Population M2 DEERS FY 2005-2011 Births are defined using Diagnosis Related Groups (DRGs) DRGs 370-375 (prior to 2007) MS-DRGs 765-768, 774,775 Births of multiples are counted as one delivery FOR OFFICIAL USE ONLY 8

9. Population concepts Catchment Areas| Multi-Service Market Areas (MSMAs) | MTFs National Capital Area (NCA) MSMA NNMC Bethesda (Walter Reed NMMC) 779 th Med Grp-Andrews Dewitt ACH- Ft. Belvoir Walter Reed AMC Tidewater MSMA NMC Portsmouth 633 rd Med Grp- JB Langley-Eustis McDonald AHC- Ft. Eustis San Diego MSMA NMC San Diego NH Camp Pendleton Puget Sound MSMA NH Bremerton NH Oak Harbor Madigan AMC- Ft. Lewis FOR OFFICIAL USE ONLY 9 CONUS Catchment Areas NH Beaufort NH Camp Lejeune NH Jacksonville NH Pensacola NH Lemoore NH Twentynine Palms OCONUS Catchment Areas NH Guam-Agana NH Guantanamo NH Naples NH Okinawa NH Rota NH Sigonella NH Yokosuka

10. Birth forecasting method General Fertility Rate= # Births # Female population (15-45) Birth Forecast=Forecasted Female Population x Fertility Rate Annual DC/PC Catchment Area Module uses FY2011 catchment area-specific fertility rates as baseline Forecast error bounds incorporate variation of rates over time Female population changes based on projected changes in active military end strength 1 using catchment area specific gender and martial status statistics Troop Movement Module uses specific beneficiary category and rank population and fertility rates to forecast births FOR OFFICIAL USE ONLY 10 1.FY2013 Defense Budget: http://comptroller.defense.gov/budget.html

11. Annual direct care and purchased care births from FY 2005-2011 and forecasts for FY 2012-2014 FOR OFFICIAL USE ONLY 11 Click on cell for a drop down arrow to select catchment Select whether you want to use the baseline for % direct care, population change and fertility rate. If not, select No and enter data in blue cells Forecast Results

12. Birth volume, population counts, and fertility rates for AD females, AD family, and other FOR OFFICIAL USE ONLY 12 Click on cell for a drop down arrow to select catchment area/ MSMA Forecast results for 2012-2014 based on population change rate from DoD end strength projections FY2011fertility rate used to forecast

13. Birth volume and female population data forecasts based on AD enlisted and officer movement FOR OFFICIAL USE ONLY 13 Enter expected increase or decrease in AD enlisted and officer populations (male and female combined) for the catchment area/MSMA Forecast Results Select whether you want to use the baseline for % Female and % Married by Rank. If not, select No and enter data in blue cells

14. Graph of monthly catchment area birth volume from FY 2005-2011 FOR OFFICIAL USE ONLY 14 Enter a target monthly birth volume based on an estimate from the graph where the historical seasonal variation is lowest Red Target volume line adjusts based on what user enters October 2004-September 2011 Gray dashed line is set automatically at the minimum volume

15. Graph of monthly MTF birth volume from FY 2005-2011 FOR OFFICIAL USE ONLY 15 Red Target volume line adjusts based on what user enters October 2004-September 2011 Gray dashed line is set automatically at the minimum volume Enter a target monthly birth volume based on an estimate from the graph where the historical seasonal variation is lowest

16. Graph of annual MTF birth volume from 2005-2011 FOR OFFICIAL USE ONLY 16

17. Case scenarios DoD reduction of end strength by 2017 202,100 to 182,100 Marines and 570,000 to 490,000 Army soldiers 1 What impact will a decline of 100,000 troops have on birth volume across the system? Decline of 6,083 births (~18%) across the system Marine Corps relocation from Okinawa to Guam by 2014 9,000 Marines are moving out of Okinawa, where 4,700 Marines are moving to Guam and about 4,300 will be rotated through Australia, the Philippines and Hawaii 2 What impact will this relocation have on NH Okinawa and NH Guam on perinatal workload? Okinawa will lose 591 births (~50%), and Guam will gain 260 births (~62%) FOR OFFICIAL USE ONLY 17 1. FY2013 Defense Budget: http://comptroller.defense.gov/budget.html 2. http://www.military.com/news/article/us-to-remove-9000-marines-from-okinawa.html

18. DoD reduction of end strength FOR OFFICIAL USE ONLY 18 20,000 broken down using 1:8.5 ratio and 80,000 using 1:5 ratio

19. Marine Corps relocation from Okinawa FOR OFFICIAL USE ONLY 19 9,000 broken down using 1:8.5 ratio Use Marine Corp specific marital status and gender statistics

20. Marine Corps relocation to Guam FOR OFFICIAL USE ONLY 20 4,700 broken down using 1:8.5 ratio Use Marine Corp specific marital status and gender statistics

21. Conclusions Simple and easy to use tool allows decision makers to make more informed perinatal resource decisions based on data trends and user knowledge Potential next steps include capturing and integrating staffing requirements into the tool and creating similar analytic tools for other product lines Most recent version of tool available on the BUMED SharePoint site: https://bumedportal.med.navy.mil/bumed/m8/m81/ BirthForecast/default.aspx https://bumedportal.med.navy.mil/bumed/m8/m81/ BirthForecast/default.aspx FOR OFFICIAL USE ONLY 21