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

2. Introductions: Jim Leonard, MHA
Vice President, West and South Sound Markets
Group Health Cooperative

3. “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 Categories
GHC Medicare (Tacoma): 1/1/2011 - 12/31/2011
Member Months: 103,981
Benchmark (Bmk) GHC Total = unfavorable variance, p<= 0.05
Client days Admits/1000
Title Admits Days TAH Bmk
TAH vs
GH
XS
Admits
Ambulatory Sensitive Total 375 1,638 43.28 31.31 138% 104
Angina 6 25 0.69 0.39 177% 3
Asthma in Younger Adults - - - -
Bacterial Pneumonia 72 385 8.31 8.14 102% 1
Chronic Obstructive Pulmonary Disease
(COPD) or Asthma in Older Adults
57 243 6.58 4.04 163% 22
Congestive Heart Failure (CHF) 119 542 13.73 9.53 144% 36
Dehydration 13 34 1.50 1.92 78% (4)
Diabetes Long-Term Complications 15 46 1.73 0.73 236% 9
Diabetes Short-Term Complications - - - 0.24 0%
Hypertension 7 19 0.81 0.37 218% 4
Lower-Extremity Amputation 2 22 0.23 0.22 104% 0
Perforated Appendix 2 8 0.23 0.23 102% 0
Uncontrolled Diabetes - - - 0.04 0%
Urinary Tract Infections 82 314 9.46 5.45 174% 35

4. Managing high risk populations
•Tahoma population at-large
–26th
(of 39) WA counties in socio-demographic standing

5. Moderator: Marc Mora, MD
Medical Director, Consultative Specialty Services
Group Health Physicians

6. Source: Milliman USA Health Cost Guidelines – 2001 Claim Probability Guidelines
The Burden of Illness

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8. THANK YOU