Missouri Health Rankings and Affordable Care Act

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Herb Kuhn: President and CEO, Missouri Hospital Association …

Herb Kuhn: President and CEO, Missouri Hospital Association
Missouri Health Policy Summit 2013

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  • 1. University of Missouri’s Center for Health Policy 11th Annual Health Policy Summit October 25, 2013
  • 2. Holy Grail of Health Policymaking Find a model that aligns the interests of health care providers and patients. Healthy Consumer Continued Health Preventable Condition No Hospitalization Efficient and Successful Outcome Acute Care Episode High Cost and Successful Outcome Complications, Infections, Readmissions
  • 3. Missouri’s National Health Ranking Since 1990 Source: United Health Foundation, 2012 America’s Health Rankings
  • 4. Life Expectancy and the Percent of the Population Who Are Uninsured and <138% FPL for Missouri Counties Source: MO Dept. of Health and Senior Services and the U.S. Census Bureau
  • 5. MO HealthNet Population Management Strategy L o w Stratification Well & Worried Well (80%) Functionally Chronically Ill (15%) Frail Ill & High Utilizers (5%) I n t e r m e d i a t e H i g h Well & Worried Well 330,639 Patients 80% of all Patients 19.2% of Charges No Chronic Conditions Functionally Chronically Ill 61,995 Patients 15% of all Patients 28.5% of all Charges 1 to 2 Chronic Conditions Frail Ill & High Utilizers 20,665 Patients 5% of all Patients 52.3% of Charges 3 or more Chronic Conditions
  • 6. Emergency Department Utilization Percent Change Since 2004 by Payer
  • 7. Missouri Psychiatric and Substance Abuse ED Visits Percent Change Since 2004 by Payer
  • 8. Zip Code 63106: St. Louis Place Neighborhood • • • • Hot Spot Rank: 1st Medicaid ED Visits: 5,879 Rate per 1,000: 537.2 Price: $3,938,385 Zip Code 64106: Forgotten Homes Neighborhood Kansas City, MO • • • • Hot Spot Rank: 2nd Medicaid ED Visits: 3,473 Rate per 1,000: 526.1 Price: $2,661,331 Zip Code 63857: Kennett, MO *Ranked by 2011 Medicaid ED Visits per 1000 in MO Zips with over 500 Residents • • • • Hot Spot Rank: 3rd 2011 Medicaid ED Visits: 5,708 Rate per 1,000: 461.7 Price: $2,706,106
  • 9. Final Tally for 2011 (avg per beneficiary) 51 Individuals  3,662 ED Visits (71.8) – $2,974,074 ($58,315)  366 IP Stays (8.3) 2011 Medicaid ED Frequent Fliers Encounters and Costs by Place of Service $370,925 557 366 $1,932,536 – $1,932,536 ($43,921)  557 OP Visits (10.9) – $370,925 ($7,728) 3,662 Total  $2,974,074 4,585 Encounters (90) – $5,277,535 ($103,481) Encounters Costs ED IP OP
  • 10. Thank You Questions?