Disclaimers

This is a population approach using most the CMS Medicaid Max Provider Characteristics file and other government data sources such as CDC and Medicare FFS Physician data.

This is a draft based on preliminary exploration. More specificity and output can be generated from current gov sources once the problem and approach is defined. Additional data may serve for further specificity.

The overall approach may apply to other questions (ACO location, new Pay-for-Value programs geographic risk and over/under coding assessment, etc.).

Understanding

Geographic Profiles Demand and Supply

Understand Practice Patterns of Physicians

Match Programs toGeographies and Doctors

Diabetes Prevalence – Cook County, IL

Tactics: People use this data to allocate providers and care management resources around condition-specific population needs by zip.

Locate retail clinics, RVs and health fairs based on chronic needs.

Income

Obesity

Depression

Geographic Profiles

Lots of diabetics but few PCPs

Lots of diabetics and lots of PCPs

What type of populations?

PCP Density –Cook County, IL

Chronic Prevalence

Medicaid Spending by Category

Medicaid MAX Provider Characteristicshttp://goo.gl/WPMuYm

Geographic Profiles

Medicaid MAX Provider Characteristicshttp://goo.gl/WPMuYm

Medicaid Spending by Category

Geographic Profiles

Medicaid Provider Supply

Medicaid Utilization

Size of Circle: Number of Claims

Medicaid MAX Provider Characteristicshttp://goo.gl/WPMuYm

Geographic Profiles

Provider Efficiency Medicare FFS Medicare/Medicaid

Performing worse than Medicare FFS Providers

Performing better than Medicare FFS Providers

Practice Pattern Intensity Profiles indicated unnecessary treatments or unnecessarily intense treatments of providers. The higher the unwarranted variation (cf. Dartmouth Atlas)

the less efficient at managing risk and the greater the FFS cost generation.) In some areas home visit providers out/under perform the national benchmark.

Medicaid MAX Provider Characteristics: http://goo.gl/WPMuYmMedicare FFS Part B:http://go.cms.gov/OCmyoy Medicare FFS Part D: http://bit.ly/1mGyBxkReferrals: http://1.usa.gov/1FzoEOV

Practice Patterns

Provider Efficiency by CountyLargest Illinois Counties

Medicare Only Benchmark

National Benchmark

Medicaid/Medicare Benchmark

In Illinois Providers accepting Both Medicare and Medicaid are

performing above National Benchmark, while Medicaid Only Providers are performing bellow

National Benchmark

Procedural Efficiency

Referral Efficiency

Prescription Efficiency

Visit Efficiency

Overall Efficiency

Medicare FFS Beneficiaries

Medicaid Beneficiaries

Practice Patterns

Match Programs

Individual Provider Scores Largest (by Medicaid Panel) in Cook County, IL

Low Unnecessary Spend / No Value Care

HighUnnecessary Spend / No Value Care

Procedural Efficiency

Referral Efficiency

Prescription Efficiency

Visit Efficiency

Overall Efficiency

Medicare FFS Beneficiaries

Medicaid Beneficiaries

Key Questions

Geographic Profiles Demand and Supply

Understand Practice Patterns of Physicians

Match Programs toGeographies and Doctors

Where should we target efforts given supply and demand?

Which providers generate no value care and what drives unnecessary spend?

What programs, policies and incentives will work best for which doctors?