Best Practices for Managing High-Risk Clinical Populations

Introductions: Jim Leonard, MHAVice President, West and South Sound MarketsGroup Health Cooperative

“Tahoma” Medicare – Ambulatory Sensitive Admits

• TAH’s ambulatory sensitive admits are significantly higher than the rest of Group Health• The 11.97 APT difference equated to 104 Tahoma hospital admissions in 2011.

Inpatient Utilization Analysis: Selected Ratios and DRG CategoriesGHC Medicare (Tacoma): 1/1/2011 - 12/31/2011

Member Months: 103,981Benchmark (Bmk) GHC Total = unfavorable variance, p<= 0.05

  Client days Admits/1000  

Title Admits Days TAH BmkTAH vs

GHXS

AdmitsAmbulatory Sensitive Total 375 1,638 43.28 31.31 138% 104

Angina 6 25 0.69 0.39 177% 3

Asthma in Younger Adults - - - -    

Bacterial Pneumonia 72 385 8.31 8.14 102% 1Chronic Obstructive Pulmonary Disease (COPD) or Asthma in Older Adults

57 243 6.58 4.04 163% 22

Congestive Heart Failure (CHF) 119 542 13.73 9.53 144% 36

Dehydration 13 34 1.50 1.92 78% (4)

Diabetes Long-Term Complications 15 46 1.73 0.73 236% 9

Diabetes Short-Term Complications - - - 0.24 0%  

Hypertension 7 19 0.81 0.37 218% 4

Lower-Extremity Amputation 2 22 0.23 0.22 104% 0

Perforated Appendix 2 8 0.23 0.23 102% 0

Uncontrolled Diabetes - - - 0.04 0%  

Urinary Tract Infections 82 314 9.46 5.45 174% 35

Managing high risk populations

•Tahoma population at-large

–26th (of 39) WA counties in socio-demographic standing

Moderator: Marc Mora, MDMedical Director, Consultative Specialty ServicesGroup Health Physicians

Source: Milliman USA Health Cost Guidelines – 2001 Claim Probability Guidelines

The Burden of Illness

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