1. Colorado Medicaid Medicaid Readmissions Judy Zerzan, MD, MPH Colorado Department of Health Care Policy and Financing 1Zerzan

2. Colorado Medicaid 2 Overview Medicaid Medical Directors Learning Network Readmission Project Colorado Readmissions Next Steps Zerzan

3. Colorado Medicaid Medicaid Medical Directors Learning Network Funded by AHRQ and supported by Academy Health 45 States represented Focused on use of evidence based medicine, measurement and improvement of healthcare quality, and healthcare system redesign Projects –Atypical antipsychotics –Re-hospitalizations –Peri-natal Outcomes Zerzan3

4. Colorado Medicaid MMDLN Readmission Project Benchmarks for Medicaid readmissions –Excluded duals –Medicare/Medicaid Compare differences in readmits –Demographics –Health plan type Compare variation in readmits Policy collections and development Zerzan4

5. Colorado Medicaid Project Methods Event-based rates (as opposed to person- based) Age Range: –<1 –1-12 –13-20 –21-44 –44-64 Obstetrics/ Non-Obstetrics Gender Race/Ethnicity Physical Health/Behavioral Health Fee-for-Service/Managed Care 5Zerzan

6. Colorado Medicaid Draft Results PopulationRate Pediatrics (0-20)5.0% OB3.3% non-OB5.7% Adults (21-64)10.6% OB3.6% non-OB16.6% Overall7.9% Zerzan 6 Range Adult Non-OB 7.5%-23%

7. Colorado Medicaid 30 Day Readmission Age 45-64 Draft Fee-for-service = 18% Primary care case management = 21% Managed care organization 11% Zerzan7

8. Colorado Medicaid Top 10 MDC for Readmissions Category name Share of All Readmissions Readmission Rate Mental Disorders17% Diseases of the Digestive System11%16% Diseases of the Respiratory System10%14% Complications of Pregnancy & Childbirth9%5% Injury & Poisoning8%15% Diseases of the Circulatory System7%16% Symptoms, Signs, & Ill-Defined Conditions7%21% Endocrine, Nutritional & Metabolic, & Immunity5%19% Diseases of the Blood & Blood-Forming Organs4%19% Infectious and Parasitic Diseases4%20% 8Zerzan

9. Colorado Medicaid Colorado 2009 Data Age Total # of events Total Paid 30 day #% Paid <14,949 $34,859,9053326.7% $2,737,328 1-125,417 $32,949,1613967.3% $4,206,909 13-207,317 $34,302,8324596.3% $2,640,409 21-4427,158 $131,244,7882,2398.2% $3,906,704 45-647,182 $60,929,7751,67823.4% $12,724,939 9Zerzan

10. Colorado Medicaid Readmissions Over Time Age20092010 % readmissionamount paid% readmissionamount paid <16.7% $2,737,3285.9% $2,653,071 1-127.3% $4,206,9097.2% $4,230,779 13-206.3% $2,640,4096.9%$3,177,554 21-448.2% $13,906,7047.5% $11,568,865 45-6423.4% $2,724,93923.8% $2,725,212 Total $36,216,289$34,355,481 10Zerzan

11. Colorado Medicaid Next Steps Dive into data –Top 10 hospitals and nursing homes –Top 10 diagnoses for age group Have 48 hr non-payment policy Potentially preventable readmissions Develop transition program? Develop capacity of nursing home to treat early? 11Zerzan

12. Colorado Medicaid Thank You! Questions? Judy.Zerzan@state.co.us 12Zerzan