Best Practices for Managing High-Risk Clinical Populations

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Introductions from Jim Leonard, MHA, Vice President, West and South Sound Markets for Group Health Cooperative and from Marc Mora, MD, Medical Director, Consultative Specialty Services for Group Health.
Introduction to the Tacoma/Pierce County CME

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  • Understanding functional status is important as it will give us an idea of who is going to cost the most in the future – having chronic conditions and multiple ones predicts increased costs, but functional status impairments are a greater predictor.
  • Best Practices for Managing High-Risk Clinical Populations

    1. 1. Introductions: Jim Leonard, MHAVice President, West and South Sound MarketsGroup Health Cooperative
    2. 2. “Tahoma” Medicare – Ambulatory Sensitive Admits• TAH’s ambulatory sensitive admits are significantly higher than the rest of Group Health• The 11.97 APT difference equated to 104 Tahoma hospital admissions in 2011.Inpatient Utilization Analysis: Selected Ratios and DRG CategoriesGHC Medicare (Tacoma): 1/1/2011 - 12/31/2011Member Months: 103,981Benchmark (Bmk) GHC Total = unfavorable variance, p<= 0.05Client days Admits/1000Title Admits Days TAH BmkTAH vsGHXSAdmitsAmbulatory Sensitive Total 375 1,638 43.28 31.31 138% 104Angina 6 25 0.69 0.39 177% 3Asthma in Younger Adults - - - -Bacterial Pneumonia 72 385 8.31 8.14 102% 1Chronic Obstructive Pulmonary Disease(COPD) or Asthma in Older Adults57 243 6.58 4.04 163% 22Congestive Heart Failure (CHF) 119 542 13.73 9.53 144% 36Dehydration 13 34 1.50 1.92 78% (4)Diabetes Long-Term Complications 15 46 1.73 0.73 236% 9Diabetes Short-Term Complications - - - 0.24 0%Hypertension 7 19 0.81 0.37 218% 4Lower-Extremity Amputation 2 22 0.23 0.22 104% 0Perforated Appendix 2 8 0.23 0.23 102% 0Uncontrolled Diabetes - - - 0.04 0%Urinary Tract Infections 82 314 9.46 5.45 174% 35
    3. 3. Managing high risk populations•Tahoma population at-large–26th(of 39) WA counties in socio-demographic standing
    4. 4. Moderator: Marc Mora, MDMedical Director, Consultative Specialty ServicesGroup Health Physicians
    5. 5. Source: Milliman USA Health Cost Guidelines – 2001 Claim Probability GuidelinesThe Burden of Illness
    6. 6. 7
    7. 7. THANK YOU

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