Health Indicator System For Rhode Islanders On Medicaid Presented by: Jane Griffin, MPH

1. Health Indicator System For Rhode Islanders On Medicaid Presented by: Jane Griffin, MPH Project Director, RI Medicaid Research and Evaluation project RI Department of Human Services Presented to: Academy Health – State Health, Research and Policy Interest Group June 25, 2005

2. Purpose of RI Health Indicator SystemTo assess, design, monitor and evaluate health services and program interventions for Rhode Islanders on Medicaid using existing public health data sets, statewide surveys, and Medicaid program data.

3. Design of Health IndicatorsReview policy studies, performance measure projects and research literature for recommended health outcome measures for an age-specific program population. Program staff selects priority measures.

4. * Program staff priority

5. Identify Health Indicator Data Sets • Data set that collects health outcome/measures on an ongoing annual basis • Includes health coverage so analysis can be made comparing privately insured with Medicaid • Data sets collected on Medicaid recipients including MMIS and surveys

6. Data Sets in RI Medicaid Data Archive Public Health Data Sets: • Vital Statistics Birth/Death File 1993-2003 • Behavioral Risk Factor Surveillance System (BRFSS) 1996-2003 • RI Health Interview Survey 1996, 2001 • Hospital Discharge Data Set 1992-2003

7. Data Sets in RI Medicaid Data Archive Surveys on RI Medicaid Population: • Children with Disabilities • Adults with Disabilities • Children with Insurance Gaps • Foster Children • Program Data: • Medicaid Management Information System (MMIS)

8. Examples of Health Indicators by Medicaid Population Group: • Healthy Children and Families • Children with Disabilities • Adults with Disabilities • Uninsured

9. Health Indicators for Healthy Children and Families: • Short Interbirth Interval • Infant Mortality • Repeat Teen Births

10. Figure 1 Health Indicator – Short Interbirth Interval Percent of Women with Short Interbirth Interval (<18 months) by Insurance Status 1993-2001 Data Source: Medicaid Research & Evaluation Project, Health Indicator Project Vital Statistics Birth File 1993-2001 – (n=111,865)

11. Figure 2 Health Indicator - Infant Mortality Rhode Island Infant Mortality by Insurance Status 1990-1999 Data Source: Medicaid Research & Evaluation Project, Health Indicator Project Linked Birth Death File 1990-99, Division of Family Health, Department of Health (n=905) Deaths per 1000 births to Infants 0-364 days – 3 year moving average

12. Figure 3 Health Indicator – Teen Repeat Births Percent of Teen Mothers with Previous Live Births by Insurance Status 1993-2001 Data Source: Medicaid Research & Evaluation Project Vital Statistics birth File 1993-2001 (n=11,748)

13. Health Indicators for Children with Special Health Care Needs: • Leading Cause of Hospitalizations • Repeat Hospitalizations

14. Figure 4Health Indicator – Mental Health Leading Causes of Hospitalizations by Principal Diagnosis by CSHCN Group Respiratory Injury Mental V-Code Factors Data Source: Medicaid Data Archive MMIS CY 2000, Children <21 on FFS Medicaid

15. Figure 5Health Indicator - Percent of Children and Adolescents with Repeat Hospitalizations by Diagnoses 1: Physical vs. Mental Fee-For-Service Medicaid Recipients 2, Ages 21 and UnderCalendar Year 2000 Physical Diagnosis Only At least 1 diagnosis of Mental Disorder (n=448) (n=415) • Includes Principal, Secondary or Tertiary Diagnosis • Total Recipients =12,062

16. Health Indicators for Adults with Disabilities • Leading Cause of Hospitalizations • Repeat Hospitalizations

17. Figure 6Health Indicator – Mental Health Hospitalizations for AdultsLeading Causes of Hospitalization by Principal Diagnosis for Fee-For-Service Medicaid Recipients Ages 21-64 Data Source: Health Indicator Project, Medicaid Data Archive, ICD-9 Groupings MMIS Extract (1998 n = 6,423 hospitalizations; 2000 n = 7,397)

18. Figure 7 Health Indicator - Percent of Working-Age Adults with Repeat Hospitalizations by Diagnoses 1: Physical vs. MentalFee-For-Service Medicaid Recipients 2, Ages 21 to 64Calendar Year 2000 Physical Diagnosis Only At least 1 diagnosis of Mental Disorder (n=2,377) (n=1,984) • Includes Principal, Secondary or Tertiary Diagnosis • Total Recipients =25,485

19. Health Indicators for Uninsured Rhode Islanders • Changes in Type of Insurance Coverage • Uninsured Rhode Islanders by Age Group • Uninsured Rhode Islanders by Income

20. Figure 8 Changes in Type of Insurance Coverage For Rhode Islanders <65 Years Old 1996-2003 Data Source: Medicaid Research and Evaluation Project; RI Access Project US Bureau of the Census, Current Population Surveys 1996-2003 (September estimate, 2004)

21. Figure 9 Percent Uninsured Rhode Islanders by Age Group Ages 18-64 – 1996-2003 Data Source: Medicaid Research and Evaluation Project; RI Access Project Behavioral Risk Factor Surveillance System 1996-2003, RI Department of Health

22. Figure 10 Percent Uninsured Rhode Islanders by Income Level Ages 18-64 – 1996-2003 Data Source: Medicaid Research and Evaluation Project; RI Access Project Behavioral Risk Factor Surveillance System 1996-2003, RI Department of Health

23. Creating Health Indicators from the Medicaid Management Information System (MMIS)

24. List of Health Indicators by Population Type Recommended from Expert Panels /Policy Literature* and can be designed from MMIS Measures found in 3 or more policy studies Healthy Adolescents Children with Disabilities Healthy Adults Adults with Disabilities Physical exams, checkups Preventive visits CVD Screening Assisted Living Facilities Dental visits Acute visits Breast Cancer Screening Specialists Family Planning Visits Dental Visits Cervical Cancer Screening Nursing Home (stays & days) Mental health visits/readmits Emergency Department Visits Colorectal Cancer Screening Hospital (stays & days) Immunization (HepB) Mental Health Diabetic Retinal Exams Emergency Department Visits AIDS/HIV Pharmacy/RX Influenza/pneumonia vaccination Rehab Services (PT, OT, ST) Motor Vehicle Accident Hospital Readmits Dental visits Readmits (7,14,30 days) Violence/Homicide Specialty care appointments ACS Hospitalizations Depression/Suicide Durable medical equipment/assistive tech Primary Care Doctor Visits Asthma Physical, speech, occupational therapy Unmet Need for Care Diabetes Mental health counseling Average Costs Respite care Length of time with PCP Total annual $ spent on child

25. ConclusionHealth Indicator System is an effective program evaluation model that state Medicaid programs can use to identify unmet needs and evaluate program initiatives