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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Best Practices for Managing High-Risk Clinical Populations
- 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
Notas del editor
- 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.