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Medicaid Readmissions Judy Zerzan, MD, MPH Colorado Department of Health Care Policy and Financing

Medicaid Readmissions Judy Zerzan, MD, MPH Colorado Department of Health Care Policy and Financing. Overview. Medicaid Medical Directors Learning Network Readmission Project Colorado Readmissions Next Steps. Medicaid Medical Directors Learning Network.

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Medicaid Readmissions Judy Zerzan, MD, MPH Colorado Department of Health Care Policy and Financing

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  1. Medicaid Readmissions Judy Zerzan, MD, MPH Colorado Department of Health Care Policy and Financing Zerzan

  2. Overview Zerzan Medicaid Medical Directors Learning Network Readmission Project Colorado Readmissions Next Steps

  3. Medicaid Medical Directors Learning Network • Funded by AHRQ and supported by Academy Health • 45 States represented • Focused on use of evidence based medicine, measurement and improvement of healthcare quality, and healthcare system redesign • Projects • Atypical antipsychotics • Re-hospitalizations • Peri-natal Outcomes Zerzan

  4. MMDLN Readmission Project • Benchmarks for Medicaid readmissions • Excluded duals –Medicare/Medicaid • Compare differences in readmits • Demographics • Health plan type • Compare variation in readmits • Policy collections and development Zerzan

  5. Project Methods • Event-based rates (as opposed to person-based) • Age Range: • <1 • 1-12 • 13-20 • 21-44 • 44-64 • Obstetrics/ Non-Obstetrics • Gender • Race/Ethnicity • Physical Health/Behavioral Health • Fee-for-Service/Managed Care Zerzan

  6. Draft Results Range Adult Non-OB 7.5%-23% Zerzan

  7. 30 Day Readmission Age 45-64 • Draft • Fee-for-service = 18% • Primary care case management = 21% • Managed care organization 11% Zerzan

  8. Top 10 MDC for Readmissions Zerzan

  9. Colorado 2009 Data Zerzan

  10. Readmissions Over Time Zerzan

  11. Next Steps • Dive into data • Top 10 hospitals and nursing homes • Top 10 diagnoses for age group • Have 48 hr non-payment policy • Potentially preventable readmissions • Develop transition program? • Develop capacity of nursing home to treat early? Zerzan

  12. Thank You! Questions? Judy.Zerzan@state.co.us Zerzan

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