N Preliminary Findings from the

Minnesota Disability Health
Options Program (MnDHO)

Sue Palsbo,  PhD

Center for the Stu...
| Acknowledgements

 

I Funding
0 Center for Health Care Strategies  T
0 Robert Wood Johnson Foundation

U US Dept.  of E...
i Evaluation Design

I Prospectively designed

I Pre-test,  post-test design during first 3 years
of start-up

I Two data ...
i Patient Reported Indicators

I 150 working-age Medicaid adults with
physical disabilities (nearly half the MnDHO
enrolle...
Distribution of Global Quality Ratings

   

100% ‘
90%
80%
70%
60% in Excellent
50% 0 Very Good
"W" I:  Good
30% [3 Fair
...
i In general,  the Enrollees: 

- Increased health literacy,  especially the need
for preventive health care services. 

°...
i Changes in Consumer Ratings of Access: 

Health Care Coordination

Enrollment Better Same Worse Significance
anniversary...
| Changes in Consumer Ratings of Access: 

Patient-Directed Care
Enrollment Better Same Worse Sig. 
anniversary (%) (%) (%...
| Changes in Consumer Ratings of Access: 

Provider Interactions

Enrollment Better Same Worse Sig. 
anniversary (%) (%) (...
| Selection Bias? 

I People who voluntarily enrolled in MnDHO
I People who voluntarily enrolled in the study
I People who...
Conclusions from the Beneficiary-reported

Outcomes Measures: 

(1) MnDHO reduced disparities and improved
access to care f...
Boxplots of Total Costs,  by Duration

1 IOOCC 00

t 20002 00 —

1000CC .00 —

BOOCC .00 -

A¢lj‘| ’ot

GOOCC .00 -

10002...
l Analytical Approach rim

I Not actuarial (group averages). 
I Time-series analysis of single subjects. 

I Combine each ...
4U

. u
'3

Count 01' People
8

l0

Number of People by Number ofMontns ofPre-MnDHO Data

 

2 a no it 2:
Number of Month:...
40

hi
0

Count ofPeople
3

Number of People by Number of Months in MnDHO

 

Enrollment Duration

l’rclinun; u'j. ‘ tl. i...
l Number of Study Subjects

I 446 people for whom we had prior-MnDHO
enrollment data. 

U - 57 for whom we had less than 1...
l Number of Study Subjects

I Of these,  at time of
enrollment: 

D 46.5% male;  13.22
U 44.4% Medicare Part A
U 42.9% Med...
l Care Coordination Costs by MnDHO

Enrollment Month

Adjusted for price inflation
What We Expect

EAT
19027531

Actual

— Predicted
(Seasonal)

Predicted (Linea r)

1 8 152229 36435057 6471
18345981

Actual
—Predicted

1 7 13192S31374349SS6167
25000 00

20000.00

1 5000 .00

1 0000 00

Value Ad]Tot

5000 .00

1261093

2221‘
511

Duration
9616977

1933000

Tot

1CZJ0.00

Value Adj

E 30 .00

000

Duration
l Next Steps:  Practice Based Evidence

I Identify costs underlying each spike. 

U Determine if spike was discretionary (...
Preliminary Findings from the Minnesota Disability Health Options Program (MnDHO)
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Preliminary Findings from the Minnesota Disability Health Options Program (MnDHO)

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Presented at the National Academy for State Health Policy's 20th Annual State Health Policy Conference in Denver, Colorado. Author: Sue Palsbo, Ph.D

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Preliminary Findings from the Minnesota Disability Health Options Program (MnDHO)

  1. 1. N Preliminary Findings from the Minnesota Disability Health Options Program (MnDHO) Sue Palsbo, PhD Center for the Study of Chronic Illness and Disability / B1 GEORGE N 44 niversity Dr. MS 5B7 UNIVIRIIIV Fai . VA22030
  2. 2. | Acknowledgements I Funding 0 Center for Health Care Strategies T 0 Robert Wood Johnson Foundation U US Dept. of Education/ National Institute for Disability and Rehabilitation Research #H133A040016 0 Agency for Healthcare Research and Quality #R03 HS16537-01 I Collaborators D Patient-reported indicators: Pei—Shu Ho, PhD Time- series cost analysis: Jessica Lin, PhD Anna
  3. 3. i Evaluation Design I Prospectively designed I Pre-test, post-test design during first 3 years of start-up I Two data sources U Beneficiary-reported indicators U Medicare and Medicaid claims data I Longitudinal
  4. 4. i Patient Reported Indicators I 150 working-age Medicaid adults with physical disabilities (nearly half the MnDHO enrollees) who signed informed consents I Custom survey based on Medicaid CAHPS I Added additional questions to measure access to disability-specific services I Administered upon enrollment, 12 & 24 months post enrollment
  5. 5. Distribution of Global Quality Ratings 100% ‘ 90% 80% 70% 60% in Excellent 50% 0 Very Good "W" I: Good 30% [3 Fair 20% El Poor 10% 0% FFS1yr 2yr FFS1yr2yr FFS1yr 2yr Health Care Primary Care Doctor Personal Care Services Attendants
  6. 6. i In general, the Enrollees: - Increased health literacy, especially the need for preventive health care services. ° Were more likely to receive needed care and medical equipment. ° Reduced their need for rehabilitation therapies. l’; i.l~lu- at Hm, "(.1-mun1cr lax .1lu-. in<m or-.1 l)1s-. xlul1rj; (§. u'c Ci. » unlinntiun ( li'_, ;.i11i1-. m- »n', _I. HC. llll‘. L". ll‘C for I’; -1-: & l’
  7. 7. i Changes in Consumer Ratings of Access: Health Care Coordination Enrollment Better Same Worse Significance anniversary (%) (%) (%) I Someone helped manage health care services 1 year (n=123) 81.3 17.0 1.6 *** 2 year (n =62) 82.3 16.1 1.6 *** I Someone talked with you about needed care & treatment plan 1 year (n =122) 82.0 16.4 1.6 *** 2 year (n =62) 87.1 12.9 0.0 *** I Talked to someone about your health care questions & concerns 1 year (n =122) 74.6 24.6 0.8 *** 2 year (n =62) 69.4 30.6 0.0 *** I Someone was available to answer your questions on how to get needed care 1 year (n =122) 77.9 22.1 0.0 *** 2year (n =62) 71.0 29.0 0.0 *** l’; LLsl)u ck Hu_ "ti. -un. ~4un1cr l‘. ‘. LlU; lll(rl'l of-.1 l)1s; )lul1r_' ('L. u'c Cr-I -nliiutiun ( )l'_; ;.ll1l/ ;.‘1tlI : n'', _I. HC. llll‘. C‘. ll‘C fur Pm-r 45.: ll
  8. 8. | Changes in Consumer Ratings of Access: Patient-Directed Care Enrollment Better Same Worse Sig. anniversary (%) (%) (%) I Involved as much as you wanted in making a health care decision 1 year (n=121) 32.2 62.0 5.8 *** 2 year (n =63) 28.6 61.9 9.5 * I Providers offered choices 1 year (n =121) 32.2 64.5 3.3 *** 2 year (n =63 ) 31.8 61.9 6.3 *** P; l.L~l)1I 6.; Ho, "(Zn -nsunicr lax .1lu-. m<>n of-.1 l)1.s-.1tul1rj. ' ('L. u'c Ct‘-u unlinariun (lr'_, ;.111I/ ;at1-»n", _I. HC. llll‘. L“. ll‘C for 1’: mr ck l’
  9. 9. | Changes in Consumer Ratings of Access: Provider Interactions Enrollment Better Same Worse Sig. anniversary (%) (%) (%) I Providers took time to listen to you 1 year (n=122) 27.9 68.8 3.3 *“ 2 year (n =62 ) 24.2 72.6 3.2 "’ I Had hard time communicating with providers 1 year (n =119) 48.8 37.8 13.4 “' 2 year (n =61 ) 54.2 42.6 3.2 *** I Providers explained things well 1 year (n =119) 59.7 31.1 9.2 *" 2 year (n =60 ) 50.0 21.6 18.4 ""' I Providers treated you with respect & courtesy 1 year (n =119) 48.7 41.2 10.1 ‘“ 2 year (n =60 ) 50.0 41.7 8.3 ‘“ I Providers spent enough time with you 1year (n =119)53.8 31.1 15.1 '“ 2 year (n =60 ) 55.0 28.3 16.7 '“ I Providers made it easy for you to discuss your questions or concerns 1 year (n =120) 56.7 30.8 12.5 "' _ tit I’-.1Lsbn & Ho, "Cunsumcr l3.‘~.1lu-. mon of -.1 l)is;1lul1ry (’. '.1rc (“. m‘-rdination ( )i'g.1i1i/ .ntinn', _I. Hc;1l1l‘. c;u'c fur Pun: ES: [3
  10. 10. | Selection Bias? I People who voluntarily enrolled in MnDHO I People who voluntarily enrolled in the study I People who disenrolled from the study
  11. 11. Conclusions from the Beneficiary-reported Outcomes Measures: (1) MnDHO reduced disparities and improved access to care for this vulnerable population. (2) People with significant physical disabilities may increase access to better care in a DCCO that has a limited-provider panel, even when it is prepaid, than in open-panel fee-for- service delivery systems. [ ll 3;: >- The $64,000 Question: How can organized health systems be persuaded to participate? p. Lll)tI 8.; H- »_ "(in -nsumcr lax . ilu. in<m at .1 l)1s. al)1l1tj. ' ('. ’.u'c Ct-n -rtliimtiun (li'_. ;.ii1i/ aria in", _I. HC. llll‘. L‘. ll‘C tlar P1-1:1’ «S; l’
  12. 12. Boxplots of Total Costs, by Duration 1 IOOCC 00 t 20002 00 — 1000CC .00 — BOOCC .00 - A¢lj‘| ’ot GOOCC .00 - 10002 00 - "lllll I llll — l'l'| l1— *24lUJ7C2 , .31-122161 j‘ °°’”°°° 1w3a"= ° stun/ i-i-oi -2. _ I" , 5'9“‘°7 . , . ~24-i-ma I I ; . l920’C77 TIZZSCOE ' ‘ 53591722 ' ' 52944-2o l2045545 A I , _., .,: .m:7s1a1 173 .99 642?; ‘$337,680 ,1 50975370 19zo. w77 , , 94425:-', i§, “W3”-.3 53-,9” ". acmiosa ls 30 1! "$81.3 -. 9 war. . . u urswfia . o4s2rr:3. mm? " E‘ 2 , Q . - I 11313523 c . ('5 W -' en‘ 0, 2 ’ . nniszaoorg, ‘ . ,, . 3,; 7; . ’ . .ie5o«oi§ . , ‘T4173 ; si . . 2:. ..’ , _‘ _ 'I"‘1a4omo - V , .v. , . _I). .-. ;-. : v. .‘“ , ["J‘: -1 ~ ' '~ ’ . . we . - ‘. II . ' - I ' ‘er’ , -'4: L g" ; i‘-' i ‘ ‘l i f I F ; , . -. illnliiiiilllilliilllllIIIllllilllll| |l| |l| ||lllfilllllllllllllllmm .13/‘J11 ll¢({1.'JJiJJ lllt(I'u6"t'nall4 1) ll. .. '.‘111iIa4A. ' I, |I. "lll'n. "lI)| “) os2u! d4z«. ‘lIo4..3o-. has-2030410 Duration . lctln: .n'c pnccs ; uc nor yet Jtllustfil
  13. 13. l Analytical Approach rim I Not actuarial (group averages). I Time-series analysis of single subjects. I Combine each person's Medicare and Medicaid expenses month by month U Adjust for Federal and state changes in fee schedules U Include the cost of care coordination I Tag each expense with the time before or alter enrollment. 0 Number of available months for analysis depends on when they become eligible for Medicaid and how long enrolled in MnDHO P'. l.L~l)tI fie Ho, "(In -nsunicr i‘. ‘. Llu; Ill(>l'l of -.1 l)1s-. )lul1rj. ' ('L. u'c Ct‘-n -rtliiutiun ( ll'_>; .ll1l/ ;.‘1tlI un", _I. HC. llll‘. C‘. ll‘C fur Pm-r «S; [V
  14. 14. 4U . u '3 Count 01' People 8 l0 Number of People by Number ofMontns ofPre-MnDHO Data 2 a no it 2: Number of Month: l’rclinun; u'j. ‘ d. it;1; not yer pact‘ to R“-Kftl Nr=1n= -391' Std Dr. ’ -‘l‘oI’7l-: l -41$
  15. 15. 40 hi 0 Count ofPeople 3 Number of People by Number of Months in MnDHO Enrollment Duration l’rclinun; u'j. ‘ tl. it;1; not yer pccr i'c R“-€(l NPTI =11 SI‘; Ltd Dev -110:0 rs = 149
  16. 16. l Number of Study Subjects I 446 people for whom we had prior-MnDHO enrollment data. U - 57 for whom we had less than 1 year of prior claims data (n= 389) U - 56 for whom we had less than 1/2-year experience in MnDHO (n=333)
  17. 17. l Number of Study Subjects I Of these, at time of enrollment: D 46.5% male; 13.22 U 44.4% Medicare Part A U 42.9% Medicare Part B
  18. 18. l Care Coordination Costs by MnDHO Enrollment Month Adjusted for price inflation
  19. 19. What We Expect EAT
  20. 20. 19027531 Actual — Predicted (Seasonal) Predicted (Linea r) 1 8 152229 36435057 6471
  21. 21. 18345981 Actual —Predicted 1 7 13192S31374349SS6167
  22. 22. 25000 00 20000.00 1 5000 .00 1 0000 00 Value Ad]Tot 5000 .00 1261093 2221‘ 511 Duration
  23. 23. 9616977 1933000 Tot 1CZJ0.00 Value Adj E 30 .00 000 Duration
  24. 24. l Next Steps: Practice Based Evidence I Identify costs underlying each spike. U Determine if spike was discretionary (e. g. power wheelchair) or non-discretionary (hospitalization) U Determine if non-discretionary episodes were preventable (e. g. heart-attack vs. UTI) I Compute total predicted expenditures I Subtract total actual from total predicted I See if there are common characteristics among those who Care Coordination helped versus those who Care Coordination did not

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