Uses of NH’s Claims Database: Comprehensive Health Care Information System (CHIS)

1. Uses of NH’s Claims Database: Comprehensive Health Care Information System (CHIS) Christine Shannon Office of Medicaid Business & Policy, NH DHHS July 31, 2009

2. NH CHIS Uses • Medicaid program analysis, program and policy development and decision making; • NHID efforts to increase information available on cost to consumers and purchasers; and • Other groups focused on getting information to consumers, purchasers and communities.

3. Program Analysis, Policy Development and Decision Making • Primary Care • Depression • Children in Out-of-Home Placement • ED Use • Chronic Respiratory Disease • CV Diseases and Circulatory Disorders • Q-CHIP

4. Cont. • Prevalence/Utilization Mental Health Disorders in Children’s Health Insurance Programs • Diabetes • Health Plan Performance Summary • Adult Preventive • Payment Rate Benchmarking

5. Q-CHIP… once is not enough • What is going on with adolescents? • What is driving mental health utilization? • Are findings consistent across geographic areas? • How does clinical status affect utilization and cost?

6. “So What Factor” • Plan a statewide effort to improve adolescent use of preventive care. • Shape an Enhanced Care Coordination Program. • Perform a Primary Care Study. • Target efforts to decrease ED utilization by Medicaid beneficiaries. • Decide whether to pursue risk-based managed care contract. • Pilot Medical Home.

7. Cont. • Incorporate age standardization, CRG and statistical significant testing into future studies. • Report to legislative committee – and make public – Medicaid payment rates relative to commercial. • Dispel some myths.

8. Primary Care Study • 25% of NH Medicaid beneficiaries go to 2 types of provider groups (FQHCs and Dartmouth-Hitchcock Clinic). • FQHCs see a higher proportion of adults; DHC sees more children. • FQHCs had higher ED utilization. • Evaluation of Medical Home Pilot.

9. Payment Rate Benchmarking

10. NHID Cost Information NH Acute Care Hospital Comparison: A Commercial Insurance Relative Cost Comparison www.nh.gov/insurance/consumers/documents/nh_ac_hosp_comp.pdf • Analyzed 26 NH hospitals on inpatient and outpatient basis using NH CHIS and Hospital Discharge Data Set. • Created relative cost index.

11. Cont.

12. Cont. NH Health Cost www.nhhealthcost.org/

14. NH Health Cost

15. Information to Consumers, Purchasers and Communities NH Hospital Scorecard www.nhpghscorecard.org • Patient experience • Patient safety • Clinical quality • Cost

17. Information to Consumers, Purchasers and Communities CDC Community Health Assessment Initiative: Health Care Claims Module • Claims module will add information on disease prevalence and health care access for <65 insured (Medicaid and commercial). • Town/zip level code user defined geographic areas to support community health assessment. • 1st efforts directed to cardiovascular, mental health and ED and primary care use.

18. Conclusion • Be patient. • Involve Medicaid program and clinical staff in report development/review. • Budget/allocate funds for analysis. • Publicize who is using data. • NH is in good shape for health care reform.

19. Contact Information www.nhchis.org http://www.dhhs.state.nh.us/DHHS/OMBP/LIBRARY/Financial+Report/rate_benchmarks.htm Cshannon@dhhs.state.nh.us 603-271-4964 Achalsma@dhhs.state.nh.us 603-271-4514