Pathways Community HUB Workgroup

PathwaysCommunityHUBWorkgroup

March28,2018Meeting

Care Coordination / Pathways HUB

Transitional Care from acute settings

Whole Person Care

Chronic DiseasePrevention &

Control

Physical & Behavioral Health

Integration

Diversion Interventions

to avoid acute care

Preventing / Addressing Opioid Use

Social Determinants of

Health

Performance (P4P) Metrics

2A: Integ

ratio

n

2B: P

athw

ays

2C: Transition

al

2D: D

iversion

3A: O

pioid

3D: C

hron

ic

Total

Outpatient Emergency Department Visits per 1000 Member Months 1 1 1 1 1 1 6Inpatient Hospital Utilization 1 1 1 1 1 5Follow‐up After Discharge from ED for Mental Health 1 1 1 3Follow‐up After Discharge from ED for Alcohol or Other Drug Dependence 1 1 1 3Follow‐up After Hospitalization for Mental Illness 1 1 1 3Percent Homeless (Narrow Definition) 1 1 1 3Plan All‐Cause Readmission Rate (30 Days) 1 1 1 3Substance Use Disorder Treatment Penetration 1 1 2Mental Health Treatment Penetration (Broad Version) 1 1 2Child and Adolescents' Access to Primary Care Practitioners 1 1 2Comprehensive Diabetes Care: Eye Exam (Retinal) Performed 1 1 2Comprehensive Diabetes Care: Hemoglobin A1c Testing 1 1 2Comprehensive Diabetes Care: Medical Attention for Nephropathy 1 1 2Medication Management for People with Asthma (5‐64 years) 1 1 2Substance Use Disorder Treatment Penetration (Opioid) 1 1Antidepressant Medication Management 1 1Patients on high‐dose chronic opioid therapy by varying thresholds 1 1Patients with concurrent sedatives prescriptions 1 1Percent Arrested 1 1Statin Therapy for Patients with Cardiovascular Disease (Prescribed) 1 1

Opportunitiestosynchronizeourtargetpopulations

ChronicConditions

Behavioral Health

Conditions

High ED UtilizationIncarceration

Homelessness

General DataFood for Thought

RegionalHealthNeeds38

25

25

16

15

14

11

5

2

2

1

0

0

0

0

0

0 10 20 30 40

Mental Health Care Access

Access to care

Education

Obesity

Affordable Housing

Drug and Alcohol Abuse

Access to Healthy Food

Diabetes

Homelessness

Pre‐Conceptual and Perinatal Health

Transportation

Suicide

Accidents/Homicide

Sexually Transmitted Infections

Cancer

Lung Diseases

Source: Community Health Needs Assessment

MedicaidPopulationDemographicsNCACH Region (N=94,451)

Source: Healthier Washington Dashboard (Measurement period = 4/1/2016 – 3/31/2017)https://fortress.wa.gov/hca/tableau/t/51/views/HealthierWashingtonDashboard/FrontPage?:embed=y&:showShareOptions=true&:display_count=no&:showVizHome=no

CHELAN DOUGLAS GRANT OKANOGAN34% of population on Medicaid

N=26,10433% of population on Medicaid



N=17,123

Source: Healthier Washington Dashboard (Measurement period = 4/1/2016 – 3/31/2017)https://fortress.wa.gov/hca/tableau/t/51/views/HealthierWashingtonDashboard/FrontPage?:embed=y&:showShareOptions=true&:display_count=no&:showVizHome=no

Acute Care DataHospital and ED Utilization

TopTenMostCommonCausesofAcuteHospitalizationsAmongMedicaidRecipientsRank Cause of Acute Hospitalization Count % State Rank

1 Injury and Poisoning 266 12.1 2 (9.4%)

2 Mental and Behavioral Disorders 171 7.8 1 (18.2%)

3 Diseases of Heart 135 6.1 4 (5.7%)

4 Respiratory Infections 132 6.0 9 (3.6%)

5 Diseases of the Musculoskeletal System and Connective Tissue

115 5.2 5 (4.5%)

6 Substance Use Disorder 105 4.8 6 (4.6%)

7 Septicemia 105 4.8 3 (7.4%)

8 Cancer/Malignancies 102 4.6 8 (3.6%)

9 Diabetes 94 4.3

10 Diseases of Liver, Biliary Tract, and Pancreas 84 3.8 7 (3.7%)

Data for North Central ACH, Excluding Pregnancy and Child Delivery Related Hospitalizations (Jan 1, 2015 ‐ Oct 31,2015)Source: Health Care Authority Starter Kit, determined by primary diagnosis field in HCA ProviderOne Medicaid Data System

TopTenMostCommonCausesofOutpatientEDUtilizationAmongMedicaidRecipientsRank Cause of ED Utilization Count %

1 Symptoms, signs & abnormal clinical and lab findings 8,007 24

2 Injury, poisoning, and certain other consequences of external causes

7,822 23

3 Diseases of the respiratory system 3,860 11

4 Diseases of the digestive system 2,169 6

5 Diseases of the musculoskeletal system and connective tissue 1,635 5

6 Mental and behavioral disorders 1,554 5

7 Diseases of the skin and subcutaneous tissue 1,423 4

8 Diseases of the genitourinary system 1,352 4

9 Pregnancy, childbirth and the puerperium 1,195 4

10 Infectious and parasitic diseases 1,104 3

Source: Health Care Authority (ED utilization by Facility data set)Data for North Central ACH (Oct 1, 2015 ‐ Sep 30, 2016)

EDUtilizationbyCountyandDiagnosisGroupingBehavioralHealthReasons(Counts)

HCUP CCS Diagnosis Groupings (ICD10) Chelan Douglas Grant Okanogan Grand Total

Anxiety disorders 159 79 182 95 515

Alcohol‐related disorders 197 84 86 114 481

Substance‐related disorders 98 53 116 73 340

Mood disorders 97 38 93 50 278

Suicide and intentional self‐inflicted injury 104 43 69 51 267

Schizophrenia and other psychotic disorders 50 SN 32 21 112

Source: Health Care Authority (ED Utilization Sensitive data set)Data for North Central ACH (Measurement Period = Calendar Year 2016)

SN: Small Number

EDUtilizationbyCountyandDiagnosisGroupingBehavioralHealthReasons(Rates– per1,000membermonths)

HCUP CCS Diagnosis Groupings (ICD10) Chelan Douglas Grant Okanogan

Anxiety disorders 0.60 0.58 0.48 0.54

Alcohol‐related disorders 0.75 0.61 0.22 0.65

Substance‐related disorders 0.37 0.39 0.30 0.41

Mood disorders 0.37 0.28 0.24 0.28

Schizophrenia and other psychotic disorders 0.19 0.07 0.08 0.12

Suicide and intentional self‐inflicted injury 0.39 0.31 0.18 0.29

Source: Health Care Authority (ED Utilization Sensitive data set)Data for North Central ACH (Measurement Period = Calendar Year 2016)

PRISM DataRisk Scores

PRISMRiskScoreDatabyRegion

<1.0 1.0‐1.49 >1.5Count Percent Count Percent Count Percent

NCACH 62,773 2,035 3,522

Chelan 16,693 27.21 606 29.78 826 23.45

Douglas 8,812 14.37 258 12.68 361 10.25

Grant 24,746 40.34 768 37.74 1,447 41.08

Okanogan 11,090 18.08 403 19.80 888 25.21

Source: Health Care Authority and DSHS‐RDA | Measurement period CY2016, updated February 2018Data Notes• Population includes all WA Medicaid full benefit federally‐qualified Title XIX and SCHIP populations. • Members with both Medicaid and Medicare coverage (duals) are excluded. • Those with full third payer liability (TLP) as of the December 31, 2016 are excluded.

PRISMRiskScoreDatabyAge<1.0 1.0‐1.49 >1.5

Count Percent Count Percent Count Percent

0‐10 24,017 39.15 178 8.75 771 21.89

11‐19 16,244 26.48 159 7.81 317 9.00

20‐29 7,702 12.56 261 12.83 430 12.21

30‐39 5,201 8.48 346 17.00 433 12.29

40‐49 3,459 5.64 355 17.44 467 13.26

50‐59 3,379 5.51 515 25.31 750 21.29

60‐69 1,327 2.16 219 10.76 349 9.91

70‐79 SUPPRESSED SUPPRESSED SUPPRESSED SUPPRESSED SUPPRESSED SUPPRESSED

80+ SUPPRESSED SUPPRESSED SUPPRESSED SUPPRESSED SUPPRESSED SUPPRESSED

Source: Health Care Authority and DSHS‐RDA | Measurement period CY2016, updated February 2018Data Notes• Population includes all WA Medicaid full benefit federally‐qualified Title XIX and SCHIP populations. • Members with both Medicaid and Medicare coverage (duals) are excluded. • Those with full third payer liability (TLP) as of the December 31, 2016 are excluded.

PRISMRiskScoreDatabyGenderandMinorityStatus

<1.0 1.0‐1.49 >1.5Count Percent Count Percent Count Percent

Female 31,816 51.87 1,247 61.28 2,056 58.38

Male 29,525 48.13 788 38.72 1,466 41.62

Any Minority 32,941 53.70 738 36.27 1,461 41.48

Non‐ Hispanic White

23,221 37.86 1,218 59.85 1,850 52.53

Unknown/Other 5,179 8.44 79 3.88 211 5.99

Source: Health Care Authority and DSHS‐RDA | Measurement period CY2016, updated February 2018Data Notes• Population includes all WA Medicaid full benefit federally‐qualified Title XIX and SCHIP populations. • Members with both Medicaid and Medicare coverage (duals) are excluded. • Those with full third payer liability (TLP) as of the December 31, 2016 are excluded. • Race/ethnicity data based on population self‐identifying by various standard race/ethnicity reporting categories

Source: Health Care Authority and DSHS‐RDA, PRISM data setMeasurement period CY2016

Source: HCA and DSHS‐RDA

PRISM data set

Measurement period CY2016

Criminal Justice Data

ArrestData(2016)Measure Chelan Douglas Grant Okanogan WA State

Alcohol violation ‐ Adolescents 2.3 1.5 3.1 5.5 1.5

Drug law violation ‐ Adolescents 5.1 7.2 2.9 3.5 2.3

Violent crime ‐ Adolescents 2.0 0.9 1.2 0.3 1.5

Alcohol‐related ‐ Adults 5.1 5.2 3.3 4.4 4.9

Drug law violation ‐ Adults 4.1 2.8 3.2 1.5 2.4

Violent crime ‐ Adults 1.2 0.7 1.7 0.9 1.5

Prisoners ‐ Adults 1861.4 56.7 939.9 1200.3 662.0

Source: DSHS Risk and Protection Profiles for

Substance Abuse Prevention Planning

https://www.dshs.wa.gov/sesa/research‐and‐data‐

analysis/county‐and‐state

Measure definitions• Arrests of adolescents ages 10‐17 for alcohol violations, per 1,000 adolescents• Arrests of adolescents ages 10‐17 for drug law violations, per 1,000 adolescents• Arrests of adolescents ages 10‐17 for violent crime, per 1,000 adolescents• Alcohol‐related arrests for adults age 18+, per 1,000 adults• Violent crime arrests for adults age 18+, per 1,000 adults• Prisoners age 18+ in state correctional system, per 100,000 based on county of conviction

Percentreportingcurrent(past30‐day)substanceuse‐ Grade10

5%

6%

3%

5%

10%

6%

6%

6%

4%

3%

6%

4%

4%

8%

6%

0% 4% 8% 12%

Rx painkillers to get high

Rx drugs, not prescribed

All other illegal drugs

22%

25%

19%

23%

24%

29%

16%

20%

17%

20%

0% 10% 20% 30%

Marijuana

Alcohol

State

Grant

Chelan

Douglas

Okanogan

Source: 2016 Healthy Youth Survey http://www.askhys.net/FactSheets

YouthDetentionRates

Source: Washington State Center for Court Research (Juvenile Detention 2016 Annual Report)

Arrest/IncarcerationData

Source: Washington State Statistical Analysis Center County Profiles

The share of superior court filings for drug

crimes are 3+ times greater than the

share of arrests for drug violations.

Percentages show the share of drug violations/crimes compared to the total, across reported crimes, arrests and superior court filings.

Behavioral Health Data

BehavioralHealthConditions• Nearly 25% of the Medicaid members in the NCACH region have been diagnosed with a mental health condition.

• Anxiety disorders and depression are the most prevalent conditions.

• More than 5,000 Medicaid members have co‐occurring mental illness and substance use disorder diagnoses.

• Mental and behavioral disorders are the second leading cause of acute hospitalizations.

• Mental and behavioral health disorders are the sixth leading cause of Outpatient ED utilization among Medicaid recipients.

BehavioralHealthConditionshealthcareandsocialoutcomes

Source: DSHS Research and Data Analysis, “Measure Decomposition Data” file released October 27, 2017.

Chronic Conditions Data

ChronicConditions• Diabetes was one of the top ten most common causes of acute hospitalizations in our region, even though diabetes did not make it on the top ten list for Washington State.

• Nearly 10% of adults in the region reported having diabetes, the highest rate compared to other ACHs

• Respiratory infections were the fourth most common cause of acute hospitalizations for Medicaid recipients in our region (compared to 9th statewide)

• Diseases of the respiratory system third leading cause of Outpatient ED utilization among Medicaid recipients.

ChronicConditionshealthcareandsocialoutcomes

Source: DSHS Research and Data Analysis, “Measure Decomposition Data” file released October 27, 2017.

ChronicConditionsCo‐occurringwithMHorSUD

0

500

1000

1500

2000

2500

3000

3500

4000

4500

5000

Musculoskeletal Cardiovascular Gastrointestinal Pulmonary Diabetes

Coun

ts based

on Claims /

Encou

nters

Mental Health SUD

Source: Health Care Authority (Behavioral Health and Chronic Conditions data set)Data for North Central ACH | Measurement Period, June 2016

Project Performance Metrics

CommunityBasedCareCoordination– PerformanceMetricsP4P Measure NCACH Statewide

Follow‐up After Discharge from ED for Mental Health (30 day) 83.3% 68.5%

Follow‐up After Discharge from ED for Mental Health (7 day) 77.6% 56.8%Follow‐up After Discharge from ED for Alcohol or Other Drug Dependence (30 day) 32.2% 30.4%

Follow‐up After Discharge from ED for Alcohol or Other Drug Dependence (7 day) 25.9% 22.5%

Follow‐up After Hospitalization for Mental Illness (30 day)* 88.9% 79.8%

Follow‐up After Hospitalization for Mental Illness (7 day)* 76.7% 65.8%

Inpatient Hospital Utilization, per 1000 members 53 65Outpatient Emergency Department Visits, per 1000 member months (Broad measure) 38 52

Percent Homeless (Narrow Definition) 2.8% 5.3%

Plan All‐Cause Readmission Rate (30 Days) 12% 15%

Mental Health Treatment Penetration 18+ 44.7% 45.6%

Mental Health Treatment Penetration (6‐17) 58.2% 61.5%

Substance Use Disorder Treatment Penetration 21.0% 26.7%

Source: Health Care Authority and DSHS‐RDA | Measurement period CY2016 for most measures (CY2015 for those that are starred)

CommunityBasedCareCoordination– PerformanceMetricsP4P Measure NCACH Numerator Denominator

Follow‐up After Discharge from ED for Mental Health (30 day) 83.3% 145 174

Follow‐up After Discharge from ED for Mental Health (7 day) 77.6% 135 174Follow‐up After Discharge from ED for Alcohol or Other Drug Dependence (30 day) 32.2% 92 286

Follow‐up After Discharge from ED for Alcohol or Other Drug Dependence (7 day) 25.9% 74 286

Follow‐up After Hospitalization for Mental Illness (30 day)* 88.9% Not available Not available

Follow‐up After Hospitalization for Mental Illness (7 day)* 76.7% Not available Not available

Inpatient Hospital Utilization, per 1000 members 53 1,555 29,277Outpatient Emergency Department Visits, per 1000 member months (Broad measure) 38 37,213 984,614

Percent Homeless (Narrow Definition) 2.8% 684 24,225

Plan All‐Cause Readmission Rate (30 Days) 12% 186 1,491

Mental Health Treatment Penetration 18+ 44.7% 4,301 9,625

Mental Health Treatment Penetration (6‐17) 58.2% 2,475 4,250

Substance Use Disorder Treatment Penetration 21.0% 851 4,062

Source: Health Care Authority and DSHS‐RDA | Measurement period CY2016 for most measures (CY2015 for those that are starred)

All‐CauseEDVisits,per1000MMGeographicdetailOutpatient Emergency Department Visits per 1,000 member months

Rate Numerator Denominator

Chelan 37 9,978 268,365

Douglas 34 4,865 141,458

Grant 37 14,735 395,285

Okanogan 43 7,635 179,506

Source: Health Care Authority and DSHS‐RDA | Measurement period 1/1/2016‐12/31/2016Updated February 2018 *Data is preliminary ‐ encounter reporting completeness issues still affect many regions in CY 2016. Preliminary baselines will be updated as data matures.

InpatientHospitalUtilization,per1000MembersGeographicdetail

Inpatient Hospital Utilization, per 1000 Members


Chelan 49 410 8,419

Douglas 50 196 3,927

Grant 57 612 10,760

Okanogan 55 337 6,171


PlanAll‐CauseHospitalReadmissions– ages18to64Geographicdetail

Plan All‐Cause Hospital Readmissions – ages 18 to 64


Chelan 11% 49 429

Douglas 13% 24 188

Grant 16% 89 542

Okanogan 7% 24 332


Pathways Community HUB Workgroup

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