1 / 25

A Study of Critical Access to HCBS in Minnesota Presentation to the HCBS Partners Panel

A Study of Critical Access to HCBS in Minnesota Presentation to the HCBS Partners Panel August 15, 2014. Purpose. Examine Minnesota residents’ critical access to HCBS at both the local and community level, by;

dalton
Download Presentation

A Study of Critical Access to HCBS in Minnesota Presentation to the HCBS Partners Panel

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. A Study of Critical Access to HCBS in Minnesota Presentation to the HCBS Partners Panel August 15, 2014

  2. Purpose • Examine Minnesota residents’ critical access to HCBS at both the local and community level, by; • Working with DHS and the HCBS Partners Panel to more accurately define and quantify “critical access” using service planning, assessment, claims and county survey data; and • Examining access issues among certain subpopulations who may face particular access challenges(e.g., persons with dementia, persons with complex physical and behavioral health needs) who likely “cut across” broader service recipient and disability categories • Suggest strategies for addressing these gaps.

  3. Relationship to Other Projects • Abt will be coordinating with the service access study contractor to complement, not duplicate, their work • Critical access is one component of larger access study • Critical access analyses may include broader population and services focus • Abt will also be coordinating with the Gaps Analysis contractor responsible for the county survey • Initial analyses to inform topic areas for survey in 2015 • Previous survey results provide direction and data for examining critical access • Analysis will build off of the MA Reform Study findings when relevant

  4. DHS Areas of Interest 1) The relationship between the number of people receiving publicly-funded HCBS with potential total demand for these services; 2) The size and nature of the population eligible for HCBS waiver programs who do not currently receive these services; 3) More granular geographic (regional) and community-level service utilization trends, including specific subpopulations; and 4) Critical access correlates, such as provider mix and geographic and political configuration.

  5. DHS Populations Included in Study • Categories of Recipients: • Older adults; • Children and adults with disabilities (physical, behavioral and cognitive); • Children and youth with mental health conditions; and • Adults living with mental illness.

  6. DHS Populations Included in Study • Additional subpopulations of interest • Individuals with dementia/Alzheimers • “Frequent flyers” (e.g., high use of emergency/crisis services) • Racial/ethnic groups • Individuals with sensory deprivation • Deaf, blind, hard-of-hearing • “High need” users (e.g., individuals eligible for HCBS who also have co-occurring mental or behavioral health conditions) • Individuals not eligible for Community First Services and Supports but with a mental health diagnosis

  7. Defining Relevant Services Could include: • Services covered by a Medicaid 1915c/HCBS waiver, including community residential • State plan services, e.g., PCA, PDN and CSG • Alternative Care • Essential Community Supports • Community First Services and Supports • Mental and behavioral health services • CTSS, IRTS, ARMHS, Rule 5, ACT • Other related services • Primary health care, inpatient, ER

  8. Analytic Approach • Data Sources • MN Base File (MMIS, MAXIS and assessment data) • Provider File • Service Agreement data • Gaps and other county data • American Community Survey • Expert input • DHS programmatic and subject matter experts • HCBS Partners Panel

  9. Analytic Approach • Assess critical access issues through examination of both HCBS supply and demand. (Focus Areas 1 and 2) Potential Demand Factors • The extent to which individuals eligible for MA HCBS waiver services are“taking-up” services • The number of individuals currently served by MA HCBS programs (i.e., actual demand) relative to potential demand (as culled from existing data sources) • Waiting list information

  10. Analytic Approach Potential Supply Factors: • Geographic distribution of key provider types, stratified by various subpopulations • Self-assessments of “preparedness” to provide HCBS services from Gaps Survey data from county-level providers

  11. Analytic Approach • Create definition(s) of critical access to more accurately capture the key services and “bundle of providers” needed to provide comprehensive services for each subpopulation (Focus Areas 3 and 4) • Other potential measures of critical access gaps • Service use outside of county of residence • Average driving distance to provider • Institutionalization • Self-reported access/availability data from the county survey • Discrepancies between authorized and used service amounts • Utilization levels and services not used • Examine determinants of utilization and critical access through multivariate analysis

  12. Defining Critical Access • Seeking Partners Panel input on how to define and operationalize this construct • Utilization rates and amounts • Discrepancy between authorized and used services • Combinations of local providers • Geographic accessibility of providers • Potential correlates or drivers of critical access • Demographics, including diagnosis • Location, e.g., county or Rural Urban Commuting Area (RUCA) category • Assessed need • Number and type of registered providers

  13. Defining Critical Access • Seeking Partners Panel input on potential areas or groups with suspected constrained critical access • Does your experience and feedback from constituents suggest particular pockets of concern: • Areas of the State • Disability subgroups • Users of specific HCBS services • Provider supply • Other factors, such as limited English proficiency, immigrant status or race/ethnicity

  14. Potential Analyses • Matched case cohort analysis • Construct cohorts or analytic groups matching on multiple variables, such as assessment data (e.g., number and type of ADLs, behaviors), diagnosis and demographics • Goal is to examine differences in utilization or other factors, such as institutionalization or use of certain provider types, between “similar” individuals • Variations by RUCA category or Census tract • Allows us to explore correlates of critical access

  15. Potential Analyses • Examine supply and demand for specific services and groups • Define key service and provider needs for specific subpopulations • Respite providers and children and adolescents with behavioral health needs • Compare to actual number of users and potential demand • Compare with other state and national ratios, as feasible

  16. Simple Caseload Example Average PCA Provider Caseload by RUCA, FY2012

  17. Potential Analyses: Geography • Actual distance analysis • Match recipient and provider addresses to individual claims, for select services • Can calculate actual driving distance by service type, using SAS and Google Maps • Examine variation by subpopulation, service and geography • Potential driving distance for all providers in a certain service category • For example, average distance between older adults with certain assessed needs and PDN agencies • Analyze substitute services used when no “close” providers are available • Examine “outcomes,” such as institutionalization, for those with constrained geographic access

  18. Potential Analyses: Geographic • Examine utilization and utilization trends by: • RUCA • Census tract • Service-specific, e.g., customized living • Subpopulation specific, e.g., individuals with dementia • Combination of location, service and population

  19. Simple Utilization Example Total and per person PCA utilization by RUCA Category, FY2012* *Not adjusted for number of eligibility days

  20. Potential Analyses: Frequent Flyer • Create a profile (in the form of a bundle of common characteristics) of a “frequent flyer”, or high utilizer of services (e.g., ED services, behavioral crisis intervention services, etc.) • Similar to “crisis user” analysis under MA Reform • Assess potentially missing or underutilized services, such as certain therapies or respite • Assess supply gaps for these services, by geographic location and subpopulation

  21. Potential Analyses: CFSS • Examine population not eligible for Community First Services and Supports (CFSS) (i.e., individuals with no ADLs or Level 1 Behaviors but who may have a mental health diagnosis). • What are they receiving now? • How does this match what they need? • This would be coordinated with other ongoing efforts to evaluate CFSS

  22. Potential Analyses: High Need • Create consensus definition of a “high need” population • Physical and mental health disabilities • Cognitive and mental health disabilities • Complex medical needs • Examine variations in utilization, supply and demand • What are they receiving now? • How does this match what they need? • How does this vary across the state and by subpopulation?

  23. Questions and Feedback • Suggested focus areas • Populations • Services • Providers • Suggested research questions

  24. Contacts Mary Olsen Baker, DHS mary.olsen.baker@state.mn.us Sara Galantowicz, Abt Associates sara_galantowicz@abtassoc.com

More Related