University of Missouri’s Center for Health Policy

11th Annual Health Policy Summit

October 25, 2013

Holy Grail of Health PolicymakingFind a model that aligns the interests of health care providers and patients.

Healthy Consumer

Continued Health Preventable Condition

No Hospitalization Acute Care Episode

High Cost and Successful Outcome

Efficient and Successful Outcome

Complications, Infections,

Readmissions

Missouri’s National Health Ranking Since 1990

Source: United Health Foundation, 2012 America’s Health Rankings

Life Expectancy and the Percent of the Population Who Are Uninsured and <138% FPL for Missouri Counties

Source: MO Dept. of Health and Senior Services and the U.S. Census Bureau

MO HealthNet Population Management Strategy

Well & Worried Well330,639 Patients80% of all Patients19.2% of ChargesNo Chronic Conditions

Functionally Chronically Ill61,995 Patients15% of all Patients28.5% of all Charges1 to 2 Chronic Conditions

Frail Ill & High Utilizers20,665 Patients5% of all Patients52.3% of Charges3 or more Chronic Conditions

Low

Stratification

Well & Worried Well (80%)

Functionally Chronically Ill

(15%)Frail Ill & High

Utilizers (5%)

Medicaid hospital charges by

cost group and number of

chronic conditions

Intermediate

High

Emergency Department Utilization Percent Change Since 2004 by Payer

Missouri Psychiatric and Substance Abuse ED Visits Percent Change Since 2004 by Payer

Zip Code 63857: Kennett, MO

• Hot Spot Rank: 3rd• 2011 Medicaid ED Visits: 5,708• Rate per 1,000: 461.7• Price: $2,706,106

Zip Code 64106: Forgotten Homes Neighborhood Kansas City, MO

• Hot Spot Rank: 2nd• Medicaid ED Visits: 3,473• Rate per 1,000: 526.1• Price: $2,661,331

Zip Code 63106: St. Louis Place Neighborhood

• Hot Spot Rank: 1st• Medicaid ED Visits: 5,879• Rate per 1,000: 537.2• Price: $3,938,385

*Ranked by 2011 Medicaid ED Visits per 1000 in MO Zips with over 500 Residents

51 Individuals 3,662 ED Visits (71.8)– $2,974,074 ($58,315)

366 IP Stays (8.3)– $1,932,536 ($43,921)

557 OP Visits (10.9)– $370,925 ($7,728)

Total 4,585 Encounters (90)– $5,277,535

($103,481)

Final Tally for 2011 (avg per beneficiary)

Encounters Costs

$3,662

$366$557

2011 Medicaid ED Fre-quent Fliers Encounters

and Costs by Place of Service

ED IP OP

$2,974,074

$1,932,536

$370,925

Thank YouQuestions?