ANNUAL PROGRAM EVALUATION. Addendum: Adult Annual Utilization
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1 2014 ANNUAL PROGRAM EVALUATION Addendum: Adult Annual Utilization
2 ValueOptions- CT Annual QM/UM Evaluation Page 2
3 Contents I. EVALUATION OF 2014 QM/UM PROJECT PLAN ADDENDUM... 4 Goal 11: Monitor for under or over-utilization of behavioral health services; identify barriers and opportunities... 4 Adult Membership:... 4 Adult Inpatient Psychiatric Hospitalization... 7 Inpatient Detox Hospital Inpatient Detox Freestanding Mental Health Group Home Partial Hospitalization Program Intensive Outpatient Services Home Health Ambulatory Detox (AMD) Methadone Maintenance (MET) Outpatient (OTP/TST) ValueOptions- CT Annual QM/UM Evaluation Page 3
4 I. EVALUATION OF 2014 QM/UM PROJECT PLAN ADDENDUM Goal 11: Monitor for under or over-utilization of behavioral health services; identify barriers and opportunities Description of activities and findings that include trending and analysis of the measures to assess performance over time: Adult Membership: Membership by Benefit Group Membership CY '12 CY '13 CY '14 HUSKY A (Family Single) 204, , ,994 HUSKY B 1,845 1,710 1,891 HUSKY C (ABD Single) 40,076 38,521 37,058 HUSKY C (LTC Single) 3,532 2,773 2,762 HUSKY D (MLIA) 136, , ,535 All Benefits Duals Removed (Adult) 380, , ,228 All Benefits With Duals (Adult) 458, , ,190 Total Membership (Inc Youth) 777, , ,651 Membership figures are based on the number of unique individuals in any membership group that were eligible during the reporting period. Total adult membership increased by 18.0% from 2013 to 2014 (473,754 to 559,190). This increase in membership is related to the implementation of the Affordable Care Act. The HUSKY A (Family Single) population increased by 22,665 members, a 10.9% increase since The HUKSY D (MLIA) population increased by 70,977 members, a 47.8% increase since ValueOptions- CT Annual QM/UM Evaluation Page 4
5 Data Refresh Refresh Percent Change by Quarters All Benefit Groups - Duals Removed Q1 '13 Q2 '13 Q3 '13 Q4 '13 Q1 '14 Q2 '14 Q3 '14 Q4 '14 Original 316, , , , , , , ,909 Refresh One Quarter Later 320, , , , , , , ,987 Pct Change 1.16% 1.83% 1.77% 1.88% 7.41% 2.59% 1.63% 2.36% Since the implementation of the Affordable Care Act (ACA) in Q1 14, the impact of the data refresh has returned to a more historical level, indicating that efforts to process new enrollees has mostly caught up with the bolus in enrollment that occurred in the early implementation of the ACA. It is anticipated that the magnitude of the data refresh will be greater during periods of open enrollment. This refresh rate will continue to be monitored in anticipation of future such enrollment periods. Composition of Membership The following graph and table are to be used in tandem to provide information about the profile of membership for the current reporting period. The graph titled Composition of Membership displays the volume of members by benefit group for the reporting period, which provides context to the tabulation of Admits/1,000 by benefit group and level of care. This table serves not only to compare utilization of one level of care by benefit group (vertical comparison), but also to compare the utilization of all levels of care for each benefit group (horizontal comparison). Admits/1,000 in 2014 IPF IPDH IPDF PHP IOP AMD MET OTP HUSKY A (Family Single) HUSKY B HUSKY C (ABD Single) HUSKY C (LTC Single) HUSKY D (MLIA) All Benefits Duals Removed ValueOptions- CT Annual QM/UM Evaluation Page 5
6 Outpatient Services are authorized more often (highest Admits/1,000 rate) than any other level of care for each benefit group and for All Benefits Duals Removed. The HUSKY A (Family Single) population is the largest benefit group in adult membership. In 2014, Outpatient authorization rates for HUSKY A members greatly exceeded admission rates at higher levels of care. The HUSKY C (ABD Single) population had the greatest utilization of the Inpatient Psychiatric level of care on an Admits/1,000 basis when compared to other benefit groups. The HUSKY C (LTC Single) population had the highest Outpatient Admits/1,000 rate. The HUSKY D (MLIA) population had the most diverse utilization of care of any benefit group. The HUSKY D (MLIA) population utilized each level of care at the highest Admits/1,000 rate with the exceptions of Inpatient Psychiatric and Outpatient levels of care. HUSKY D (MLIA) Admits/1,000 rate for Freestanding detox (IPDF) are more than double the rate of any other benefit group. ValueOptions- CT Annual QM/UM Evaluation Page 6
7 Adult Inpatient Psychiatric Hospitalization The core measures of utilization for inpatient psychiatric care have remained relatively unchanged from 2012 to The exception was the decrease in Admits/1,000 for the HUSKY D (MLIA) population in 2014, during the implementation of the Affordable Care Act. Admits/1,000 Admits/1,000 CY '12 CY '13 CY '14 HUSKY A (Family Single) HUSKY B HUSKY C (ABD Single) HUSKY C (LTC Single) HUSKY D (MLIA) All Benefits Duals Removed Number of Admits CY '12 CY '13 CY '14 HUSKY A (Family Single) 1,577 1,471 1,568 HUSKY B HUSKY C (ABD Single) 2,431 2,269 2,162 HUSKY C (LTC Single) HUSKY D (MLIA) 4,851 4,788 5,273 All Benefits Duals Removed 8,965 8,604 9,055 The Admits/1,000 for All Benefit Groups decreased by 0.40 from 2013 to 2014, a 17.2% decrease. This is a statistically significant decrease, driven by the increase in membership due to the Affordable Care Act, which primarily impacted the HUSKY D (MLIA) population. The Admits/1,000 for HUSKY D (MLIA) decreased by 32.8% from 2013 to This is a statistically significant change, related to the growth in HUSKY D (MLIA) membership. The actual number of HUSKY D (MLIA) admissions increased slightly from 2013 to 2014 (4,788 to 5,273). ValueOptions- CT Annual QM/UM Evaluation Page 7
8 The decreases in Admits/1,000 were primarily confined to Q1 14, and levelled off in subsequent quarters. (Please see quarterly graphs on page 10). Days/1,000 Days/1,000 CY '12 CY '13 CY '14 HUSKY A (Family Single) HUSKY B HUSKY C (ABD Single) HUSKY C (LTC Single) HUSKY D (MLIA) All Benefits Duals Removed Number of Cases CY '12 CY '13 CY '14 HUSKY A (Family Single) 1,611 1,492 1,589 HUSKY B HUSKY C (ABD Single) 2,476 2,327 2,225 HUSKY C (LTC Single) HUSKY D (MLIA) 4,947 4,881 5,379 All Benefits Duals Removed 9,146 8,778 9,245 The results of Days/1,000 data follow the same trends as the Admits/1,000 data from 2013 to ValueOptions- CT Annual QM/UM Evaluation Page 8
9 Average Length of Stay ALOS CY '12 CY '13 CY '14 HUSKY A (Family Single) HUSKY B HUSKY C (ABD Single) HUSKY C (LTC Single) HUSKY D (MLIA) All Benefits Duals Removed Number of Discharges CY '12 CY '13 CY '14 HUSKY A (Family Single) 1,590 1,471 1,557 HUSKY B HUSKY C (ABD Single) 2,419 2,264 2,183 HUSKY C (LTC Single) HUSKY D (MLIA) 4,855 4,781 5,269 All Benefits Duals Removed 8,974 8,593 9,060 The average length of stay (ALOS) for each benefit group remained relatively unchanged from 2013 to HUSKY A (Family Single) members consistently have the shortest annual ALOS (of graphed benefit groups), ranging from 6.91 days to 7.30 days. HUSKY C (ABD Single) members consistently have the longest annual ALOS (of graphed benefit groups), ranging from 9.28 days to 9.81 days. ValueOptions- CT Annual QM/UM Evaluation Page 9
10 Admits/1,000 & Days/1,000: Quarterly These graphs are provided to illustrate the impact of the Affordable Care Act on the Admits/1,000 and Days/1,000 measures throughout this analysis. The per 1,000 calculations for HUSKY D (MLIA) decreased dramatically during Q1 14, when the Affordable Care Act was implemented, but in subsequent quarters, these measures have remained relatively steady from quarter to quarter. ValueOptions- CT Annual QM/UM Evaluation Page 10
11 Inpatient Detox (IPD) Inpatient Detox Hospital The utilization of hospital-based detoxification in each benefit group population appears to have reached levels that would be expected in future quarters. The average length of stay had been increasing steadily over the last few quarters, but levelled off in Q4 14. Admits/1,000 Admits/1,000 CY '12 CY '13 CY '14 HUSKY A (Family Single) HUSKY B HUSKY C (ABD Single) HUSKY C (LTC Single) HUSKY D (MLIA) All Benefits Duals Removed Number of Admits CY '12 CY '13 CY '14 HUSKY A (Family Single) HUSKY B HUSKY C (ABD Single) HUSKY C (LTC Single) HUSKY D (MLIA) ,790 All Benefits Duals Removed ,307 A change in authorization procedures led to an increase in admissions for hospital-based detoxification, beginning in March of There was a statistically significant increase in Admits/1,000 for each graphed benefit group from 2013 to Quarterly data is included below in order to better review the utilization for this level of care. ValueOptions- CT Annual QM/UM Evaluation Page 11
12 Admits/1,000: Quarterly Admits/1,000 Q4 '12 Q1 '13 Q2 '13 Q3 '13 Q4 '13 Q1 '14 Q2 '14 Q3 '14 Q4 '14 Q1 '15 HUSKY A (Family Single) HUSKY B HUSKY C (ABD Single) HUSKY C (LTC Single) HUSKY D (MLIA) All Benefits Duals Removed Number of Admits Q4 '12 Q1 '13 Q2 '13 Q3 '13 Q4 '13 Q1 '14 Q2 '14 Q3 '14 Q4 '14 Q1 '15 HUSKY A (Family Single) HUSKY B HUSKY C (ABD Single) HUSKY C (LTC Single) HUSKY D (MLIA) All Benefits Duals Removed The Admits/1,000 for each benefit group have decreased slightly from Q3 14 to Q4 14. ValueOptions- CT Annual QM/UM Evaluation Page 12
13 Days/1,000 Days/1,000 CY '12 CY '13 CY '14 HUSKY A (Family Single) HUSKY B HUSKY C (ABD Single) HUSKY C (LTC Single) HUSKY D (MLIA) All Benefits Duals Removed Number of Cases CY '12 CY '13 CY '14 HUSKY A (Family Single) HUSKY B HUSKY C (ABD Single) HUSKY C (LTC Single) HUSKY D (MLIA) ,792 All Benefits Duals Removed ,310 A change in authorization procedures led to an increase in Admits/1,000, and therefore Days/1,000, for hospital-based detoxification. This began in March of Quarterly data is included below in order to better review the utilization for this level of care. ValueOptions- CT Annual QM/UM Evaluation Page 13
14 Days/1,000: Quarterly Days/1,000 Q4 '12 Q1 '13 Q2 '13 Q3 '13 Q4 '13 Q1 '14 Q2 '14 Q3 '14 Q4 '14 Q1 '15 HUSKY A (Family Single) HUSKY B HUSKY C (ABD Single) HUSKY C (LTC Single) HUSKY D (MLIA) All Benefits Duals Removed Number of Cases Q4 '12 Q1 '13 Q2 '13 Q3 '13 Q4 '13 Q1 '14 Q2 '14 Q3 '14 Q4 '14 Q1 '15 HUSKY A (Family Single) HUSKY B HUSKY C (ABD Single) HUSKY C (LTC Single) HUSKY D (MLIA) All Benefits Duals Removed The Days/1,000 for each benefit group have decreased slightly from Q3 14 to Q4 14, with the exception of HUSKY A (Family Single), which increased slightly. ValueOptions- CT Annual QM/UM Evaluation Page 14
15 Average Length of Stay ALOS CY '12 CY '13 CY '14 HUSKY A (Family Single) HUSKY B HUSKY C (ABD Single) HUSKY C (LTC Single) HUSKY D (MLIA) All Benefits Duals Removed Number of Discharges CY '12 CY '13 CY '14 HUSKY A (Family Single) HUSKY B HUSKY C (ABD Single) HUSKY C (LTC Single) HUSKY D (MLIA) ,769 All Benefits Duals Removed ,275 The ALOS for each benefit group has increased from 2013 to Authorizations for this level of care were predominantly completed by CHN until March Therefore, the increase in ALOS was expected given the complexities/co-morbidities experienced by members admitted to hospitals for detox. The change in ALOS from 2013 to 2014 for the HUSKY D (MLIA) population (as well as All Benefit Groups) was calculated to be statistically significant. ValueOptions- CT Annual QM/UM Evaluation Page 15
16 Average Length of Stay: Quarterly ALOS Q4 '12 Q1 '13 Q2 '13 Q3 '13 Q4 '13 Q1 '14 Q2 '14 Q3 '14 Q4 '14 Q1 '15 HUSKY A (Family Single) HUSKY B HUSKY C (ABD Single) HUSKY C (LTC Single) HUSKY D (MLIA) All Benefits Duals Removed Number of Discharges Q4 '12 Q1 '13 Q2 '13 Q3 '13 Q4 '13 Q1 '14 Q2 '14 Q3 '14 Q4 '14 Q1 '15 HUSKY A (Family Single) HUSKY B HUSKY C (ABD Single) HUSKY C (LTC Single) HUSKY D (MLIA) All Benefits Duals Removed The ALOS for HUSKY A (Family Single) has increased steadily since Q1 14. ValueOptions- CT Annual QM/UM Evaluation Page 16
17 Inpatient Detox Freestanding The core measures of utilization for free-standing detoxification have remained relatively unchanged from 2013 to 2014, indicating that there is little change in the utilization of care in the population or daily impact on the behavioral healthcare system. Admits/1,000 Admits/1,000 CY '12 CY '13 CY '14 HUSKY A (Family Single) HUSKY B HUSKY C (ABD Single) HUSKY C (LTC Single) HUSKY D (MLIA) All Benefits Duals Removed Number of Admits CY '12 CY '13 CY '14 HUSKY A (Family Single) 986 1,029 1,079 HUSKY B HUSKY C (ABD Single) HUSKY C (LTC Single) HUSKY D (MLIA) 6,981 7,314 8,364 All Benefits Duals Removed 8,662 9,019 10,117 The Admits/1,000 for All Benefit Groups decreased only slightly from 2013 to 2014, but calculated as statistically significant because of the influx of new membership with the implementation of the Affordable Care Act, which primarily impacted the HUSKY D (MLIA) population. The Admits/1,000 for HUSKY D (MLIA) decreased from 2013 to 2014, due to the influx of new membership with the implementation of the Affordable Care Act. This is a statistically significant decrease. The total number of admissions for HUSKY D (MLIA) however, increased by 14.4% from 2013 to ValueOptions- CT Annual QM/UM Evaluation Page 17
18 Days/1,000 Days/1,000 CY '12 CY '13 CY '14 HUSKY A (Family Single) HUSKY B HUSKY C (ABD Single) HUSKY C (LTC Single) HUSKY D (MLIA) All Benefits Duals Removed Number of Cases CY '12 CY '13 CY '14 HUSKY A (Family Single) 994 1,039 1,094 HUSKY B HUSKY C (ABD Single) HUSKY C (LTC Single) HUSKY D (MLIA) 7,053 7,374 8,437 All Benefits Duals Removed 8,746 9,090 10,208 The results of Days/1,000 data follow the same trends as the Admits/1,000 data from 2013 to ValueOptions- CT Annual QM/UM Evaluation Page 18
19 Average Length of Stay ALOS CY '12 CY '13 CY '14 HUSKY A (Family Single) HUSKY B HUSKY C (ABD Single) HUSKY C (LTC Single) HUSKY D (MLIA) All Benefits Duals Removed Number of Discharges CY '12 CY '13 CY '14 HUSKY A (Family Single) 984 1,024 1,086 HUSKY B HUSKY C (ABD Single) HUSKY C (LTC Single) HUSKY D (MLIA) 6,993 7,302 8,352 All Benefits Duals Removed 8,675 8,999 10,112 The ALOS has remained flat across all time periods and benefit groups. Protocol driven detox regimens drive the length of stay at free-standing facilities. The change in ALOS from 2013 to 2014 for the HUSKY D (MLIA) population (as well as All Benefit Groups) was statistically significant. This result occurs because small deviations with a large population can indicate statistical significance, without clinical significance. ValueOptions- CT Annual QM/UM Evaluation Page 19
20 Mental Health Group Home Admits/1,000 Admits/1,000 CY '12 CY '13 CY '14 HUSKY A (Family Dual) HUSKY A (Family Single) HUSKY B HUSKY C (ABD Dual) HUSKY C (ABD Single) HUSKY C (LTC Dual) HUSKY C (LTC Single) HUSKY D (MLIA) All Benefits Duals Removed Number of Admits CY '12 CY '13 CY '14 HUSKY A (Family Dual) HUSKY A (Family Single) HUSKY B HUSKY C (ABD Dual) HUSKY C (ABD Single) HUSKY C (LTC Dual) HUSKY C (LTC Single) HUSKY D (MLIA) All Benefits Duals Removed There has been minimal change in the Admits/1,000 between CY 2013 and CY ValueOptions- CT Annual QM/UM Evaluation Page 20
21 Days/1,000 Days/1,000 CY '12 CY '13 CY '14 HUSKY A (Family Dual) HUSKY A (Family Single) HUSKY B HUSKY C (ABD Dual) HUSKY C (ABD Single) HUSKY C (LTC Dual) HUSKY C (LTC Single) HUSKY D (MLIA) All Benefits Duals Removed Number of Cases CY '12 CY '13 CY '14 HUSKY A (Family Dual) HUSKY A (Family Single) HUSKY B HUSKY C (ABD Dual) HUSKY C (ABD Single) HUSKY C (LTC Dual) HUSKY C (LTC Single) HUSKY D (MLIA) All Benefits Duals Removed There has been minimal change in the Days/1,000 between CY 2013 and CY ValueOptions- CT Annual QM/UM Evaluation Page 21
22 ALOS ALOS CY '12 CY '13 CY '14 HUSKY A (Family Dual) HUSKY A (Family Single) HUSKY B HUSKY C (ABD Dual) HUSKY C (ABD Single) HUSKY C (LTC Dual) HUSKY C (LTC Single) HUSKY D (MLIA) All Benefits Duals Removed Number of Discharges CY '12 CY '13 CY '14 HUSKY A (Family Dual) HUSKY A (Family Single) HUSKY B HUSKY C (ABD Dual) HUSKY C (ABD Single) HUSKY C (LTC Dual) HUSKY C (LTC Single) HUSKY D (MLIA) All Benefits Duals Removed The ALOS for MH Group Homes continues to increase. ValueOptions- CT Annual QM/UM Evaluation Page 22
23 E. Day Treatment Programs: Partial Hospital Programs (PHP) and Intensive Outpatient Programs (IOP) Partial Hospitalization Program Admits/1,000 CY '12 CY '13 CY '14 HUSKY A (Family Single) HUSKY B HUSKY C (ABD Single) HUSKY C (LTC Single) HUSKY D (MLIA) All Benefits Duals Removed Number of Admits CY '12 CY '13 CY '14 HUSKY A (Family Single) HUSKY B HUSKY C (ABD Single) HUSKY C (LTC Single) HUSKY D (MLIA) 2,772 2,658 2,956 All Benefits Duals Removed 4,099 3,774 3,988 As seen in the Inpatient Psychiatric Facility graphs, the 2014 decreases are limited to Q1 14 and primarily due to the increase in enrollment. ValueOptions- CT Annual QM/UM Evaluation Page 23
24 Intensive Outpatient Services Admits/1,000 CY '12 CY '13 CY '14 HUSKY A (Family Single) HUSKY B HUSKY C (ABD Single) HUSKY C (LTC Single) HUSKY D (MLIA) All Benefits Duals Removed Number of Admits CY '12 CY '13 CY '14 HUSKY A (Family Single) 2,737 2,752 2,836 HUSKY B HUSKY C (ABD Single) 1,554 1,382 1,423 HUSKY C (LTC Single) HUSKY D (MLIA) 9,104 9,925 11,728 All Benefits Duals Removed 13,453 14,102 15,993 As seen in the Inpatient Psychiatric Facility graphs, the 2014 decreases are limited to Q1 14 and primarily due to the increase in enrollment. ValueOptions- CT Annual QM/UM Evaluation Page 24
25 Home Health Admits/1,000 Admits/1,000 CY '12 CY '13 CY '14 HUSKY A (Family Dual) HUSKY A (Family Single) HUSKY B HUSKY C (ABD Dual) HUSKY C (ABD Single) HUSKY C (LTC Dual) HUSKY C (LTC Single) HUSKY D (MLIA) All Benefits Duals Removed Number of Admits CY '12 CY '13 CY '14 HUSKY A (Family Dual) HUSKY A (Family Single) HUSKY B HUSKY C (ABD Dual) HUSKY C (ABD Single) HUSKY C (LTC Dual) HUSKY C (LTC Single) HUSKY D (MLIA) All Benefits Duals Removed 2,384 2,497 2,536 The Admits/1,000 for most benefit groups have decreased minimally between CY 2013 and CY ValueOptions- CT Annual QM/UM Evaluation Page 25
26 Ambulatory Detox (AMD) Admits/1,000 CY '12 CY '13 CY '14 HUSKY A (Family Single) HUSKY B HUSKY C (ABD Single) HUSKY C (LTC Single) HUSKY D (MLIA) All Benefits Duals Removed Number of Admits CY '12 CY '13 CY '14 HUSKY A (Family Single) HUSKY B HUSKY C (ABD Single) HUSKY C (LTC Single) HUSKY D (MLIA) All Benefits Duals Removed Admits/1,000 for HUSKY D (MLIA) had been decreasing steadily from quarter to quarter since the beginning of 2013, but began to hold steady after Q1 14. As seen in the Inpatient Psychiatric Facility graphs, the 2014 decreases are limited to Q1 14 and primarily due to the increase in enrollment. ValueOptions- CT Annual QM/UM Evaluation Page 26
27 Methadone Maintenance (MET) Admits/1,000 CY '12 CY '13 CY '14 HUSKY A (Family Single) HUSKY B HUSKY C (ABD Single) HUSKY C (LTC Single) HUSKY D (MLIA) All Benefits Duals Removed Number of Admits CY '12 CY '13 CY '14 HUSKY A (Family Single) HUSKY B HUSKY C (ABD Single) HUSKY C (LTC Single) HUSKY D (MLIA) 2,991 3,227 4,287 All Benefits Duals Removed 3,980 4,479 5,510 The Admits/1,000 for the HUSKY D (MLIA) population decreased from 2013 to As seen in the Inpatient Psychiatric Facility graphs, this decrease is limited to the first quarter in 2014 and primarily due to the increase in enrollment. ValueOptions- CT Annual QM/UM Evaluation Page 27
28 Outpatient (OTP/TST) Admits/1,000 CY '12 CY '13 CY '14 HUSKY A (Family Single) HUSKY B HUSKY C (ABD Single) HUSKY C (LTC Single) HUSKY D (MLIA) All Benefits Duals Removed Number of Admits CY '12 CY '13 CY '14 HUSKY A (Family Single) 23,642 24,182 27,299 HUSKY B HUSKY C (ABD Single) 6,844 6,863 7,000 HUSKY C (LTC Single) HUSKY D (MLIA) 29,219 32,427 44,476 All Benefits Duals Removed 60,540 64,581 79,365 As seen in the Inpatient Psychiatric Facility graphs, the 2014 decreases are limited to Q1 14 and primarily due to the increase in enrollment. ValueOptions- CT Annual QM/UM Evaluation Page 28
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