Center for State Health Policy

BEHAVIORAL HEALTH CONDITIONS IN AVOIDABLE HOSPITALUSE AND COST

Pre-release Briefing Webinar November 18, 2014

Sujoy Chakravarty, Ph.D.Joel C. Cantor, Sc.D. Jamie Walkup, Ph.D.

Jian Tong, M.S.

Presented by Rutgers Center for State Health Policy

Center for State Health Policy

Acknowledgements

Generously supported by

Gratefully acknowledge the assistance of …Ping Shi of the NJ Dept. of Health, Center for Health Statistics and Daisuke Goto of Rutgers CSHP for assistance in data linkage. Additional support from CSHP colleagues Derek DeLia, Jose Nova, Kristen Lloyd, Oliver Lontok and Dorothy Gaboda

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Center for State Health Policy

Motivating issues

• Our previous research identified substantial cost saving opportunities from reducing high hospital use

• Such avoidable and frequent hospitalizations may arise from barriers to ambulatory care, inadequate care coordination and presence of behavioral health conditions

• Effective management of behavioral health conditions and integration of behavioral and physical healthcare may be critical to reducing avoidable hospitalizations and costs

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Center for State Health Policy

Study questions & data

• To what extent are behavioral health (BH) conditions associated with:– Preventable hospitalizations and costs?– Inpatient and ED high use and costs?

• Data from NJ Discharge Data Collection System and Charity Care Claims, 2008-2011

• Focus on 13 low income regions in New Jersey

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Center for State Health Policy

13 Low-Income NJ AreasCamdenGreater Newark*Trenton**Asbury Park-NeptuneAtlantic City-PleasantvilleElizabeth-LindenJersey City-BayonneNew Brunswick-FranklinPaterson-Passaic-CliftonPerth Amboy-HopelawnPlainfield, North PlainfieldUnion City-W. NY- Guttenberg-N. BergenVineland-Millville

*Newark zip codes (07102,07103,07104, 07105, 07106, 07107,07108, 07112, & 07114)East Orange zip codes (07017,07018)Irvington zip code (07111)Orange zip code (07050)

* *Trenton zip codes (08608, 08609, 08611, 08618, 08629, & 08638)

Source: Kathe Newman, Rutgers University5

Center for State Health Policy

Behavioral Health Problems by Preventable Inpatient (IP) Hospitalizations13 Low-Income NJ Areas, 2008-2011

21.9% 16.7%

13.8%12.4%

4.4%5.9%

0%

20%

40%

60%

80%

100%Mental Health Substance Use Both Severe Mental Illness

Preventable IP Stays Non-preventable IP Stays

40%35%

7% 10%

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Center for State Health Policy

Medicaid Beneficiary Behavioral Health Problems by Preventable IP Hospitalization Status13 Low-Income NJ Areas, 2008-2011

16.7% 12.9%

22.3%

11.6%

8.9%

9.7%

0%

20%

40%

60%

80%

100%Mental Health Substance Use Both Severe Mental Illness

Preventable IP stays Non-Preventable IP stays

48%

14%

34%

17%

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Center for State Health Policy

Behavioral Health Problems by Inpatient High User Status13 Low-Income NJ Areas, 2008-2011

36.9%

14.6%

11.0%

12.0%

26.9%

5.6%

0%

20%

40%

60%

80%

100%Mental Health Substance Use Both Severe Mental Illness

Non-High Users

75%

26%

32%

8%

High Users

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Center for State Health Policy

22.6%10.0%

14.6%

8.4%

43.7%

6.8%

0%

20%

40%

60%

80%

100%Mental Health Substance Use Both Severe Mental Illness

81%

44%

25%

10%

Medicaid Beneficiary Behavioral Health Problems by Inpatient High User Status13 Low-Income NJ Areas, 2008-2011

High Users Non-High Users

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Center for State Health Policy

Behavioral Health Problems by ED High User Status13 Low-Income NJ Areas, 2008-2011

15.3%6.1%

22.3%

10.1%

18.4%

1.9%

0%

20%

40%

60%

80%

100%Mental Health Substance Use Both Severe Mental Illness

High Users Non-High Users

18%14%

2%

56%

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Center for State Health Policy

Annual Inpatient Cost Associated with Behavioral Health Problems

$127 $261 $103 $191 $131 $65

0 100 200 300 400 500 600 700 800 900 1,000

13 L

ow-In

com

e N

J Are

as

Dual Eligible Other Medicare Medicaid Private Charity Care Self Pay

In Million Dollars

$880 m

34.8% of total cost

13 low-income areas

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Center for State Health Policy

Annual Inpatient Cost Related to Behavioral Health Problems13 Low-Income NJ Areas and All NJ

$127

$307

$261

$1,492

$103

$200

$191

$969

$131

$275

$65

$165

0 500 1,000 1,500 2,000 2,500 3,000 3,500 4,000

13 L

ow-In

com

e N

J Are

asAl

l NJ

Dual Eligible Other Medicare Medicaid Private Charity Care Self Pay

In Million Dollars

$880 m

34.8% of total cost

$3,458 m

36.4% of total cost

All NJ

13 low-income areas

Percentages reflect BH-related costs as a percent of total IP costs

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Center for State Health Policy

Conclusions: Behavioral Health and Avoidable Use and Cost

• Higher prevalence of BH conditions among avoidable hospitalizations– Differences are higher for Medicaid beneficiaries for both preventable

hospitalizations, and also hospitalizations by high users

• Substantially higher prevalence of BH conditions among high users– Overall three out of four inpatient high users are diagnosed with BH conditions– 44% of Medicaid inpatient high users have a serious mental illness

• BH-related costs comprise a substantial proportion of total IP costs across regions and payers

– In the 13 low-come regions, annual BH-related costs amount to $880 m, 34.8% of overall IP costs

– Statewide, BH-related costs amount to $3.5 b, 36.4% of overall IP costs

• Findings underscore the importance of current NJ policy initiatives including the Medicaid ACOs, Medicaid Managed Behavioral Health Organization, Behavioral Health Homes.

• Special focus may be needed for the Medicaid expansion population which is also likely to have significant behavioral health involvement along with housing and other social challenges. 13

Center for State Health Policy

Methods Appendix

• New Jersey All-Payer Uniform Billing Hospital Discharge data– Public use discharge-level data and patient-level linked data prepared by the NJ Dept. of Health– Patient demographics, clinical information, patient residence, hospital charge amounts and

hospital information

• Avoidable Hospitalizations and Emergency Department (ED) Visits– Population-based rates of ambulatory-care sensitive/preventable inpatient and ED visits

• High Users of Hospital Resources– ‘High user’ of inpatient care equal to 4 or more inpatient stays (96th percentile of statewide

distribution) 2008-2011– ‘High user’ of ED care equal to 6 or more visits over 2008-2010 (94th percentile of statewide

distribution) 2008-2011

• Cost estimates based on discharge-based charges– Charge data deflated by cost-to-charge ratios, annualized for 2008-11, and adjusted to 2011

dollars using the Consumer Price Index for medical care

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