Health Indicator System
For Rhode Islanders
On Medicaid
Presented by:
Jane Griffin, MPH
Project Director, RI Medicaid Research and Evaluation project
RI Department of Human Services
Presented to:
Academy Health – State Health, Research and Policy Interest Group
June 25, 2005
Purpose of RI Health Indicator System
To assess, design, monitor and evaluate health services and program interventions for Rhode Islanders on Medicaid using existing public health data sets, statewide surveys, and Medicaid program data.
Design of Health Indicators
Review policy studies, performance measure projects and research literature for recommended health outcome measures for an age-specific program population. Program staff selects priority measures.
TABLE 1: RECOMMENDED HEALTH INDICATORS FOR CHILDREN WITH DISABILITIES
Accreditation groups/
Consensus panels
Policy/Government groups
Published in Journals
FACCT/
NCQA
NACHRI TitleV-MCHB
Johns
Hopkins
Kuhlthau Newa-check
Powe Pantel
Utilization X
Preventive visit (well child)
X X X X X
Acute visits X X
Dental X X
Emergency * X X
Mental health * X X
Pharmacy/RX X X
Hospital Readmits *
X
* Program staff priority
Identify Health Indicator Data Sets
• Data set that collects health outcome/measures on an ongoing annual basis
• Includes health coverage so analysis can be made comparing privately insured with Medicaid
• Data sets collected on Medicaid recipients including MMIS and surveys
Data Sets in RI Medicaid Data Archive
• Vital Statistics Birth/Death File 1993-2003
• Behavioral Risk Factor Surveillance System (BRFSS) 1996-2003
• RI Health Interview Survey 1996, 2001
• Hospital Discharge Data Set 1992-2003
Public Health Data Sets:
Data Sets in RI Medicaid Data Archive
• Children with Disabilities
• Adults with Disabilities
• Children with Insurance Gaps
• Foster Children
Program Data:
• Medicaid Management Information System (MMIS)
Surveys on RI Medicaid Population:
Examples of Health Indicators by Medicaid Population Group:
• Healthy Children and Families
• Children with Disabilities
• Adults with Disabilities
• Uninsured
Health Indicators for Healthy Children and Families:
• Short Interbirth Interval
• Infant Mortality
• Repeat Teen Births
Figure 1Health Indicator – Short Interbirth Interval
Percent of Women with Short Interbirth Interval (<18 months) by Insurance Status 1993-2001
27.8 27.5 28.7
40.838.2
30 28.6 29.8 30.728.9 29.7 30.3
2827.526.628.4
30.227.2
10
20
30
40
50
1993 1994 1995 1996 1997 1998 1999 2000 2001
Private Medicaid
Data Source: Medicaid Research & Evaluation Project, Health Indicator ProjectVital Statistics Birth File 1993-2001 – (n=111,865)
Figure 2 Health Indicator - Infant Mortality
Rhode Island Infant Mortality by Insurance Status 1990-1999
10.6%
7.2% 7.1% 6.8%
6.0%5.3% 4.7% 4.7%
5.4% 5.3%
8.5%
10.7%9.9%
7.2% 7.2% 7.0%
6.4%6.4%5.4%4.8%
0%
5%
10%
15%
90 91 92 93 94 95 96 97 98 99
Public (n=325) Private (n=470)
Data Source: Medicaid Research & Evaluation Project, Health Indicator ProjectLinked Birth Death File 1990-99, Division of Family Health, Department of Health (n=905)Deaths per 1000 births to Infants 0-364 days – 3 year moving average
Figure 3 Health Indicator – Teen Repeat Births
Percent of Teen Mothers with Previous Live Births by Insurance Status 1993-2001
7.8%
11.7%14.7%
23.3%25.8%
24.2% 24.9%22.0%
12.4%
7.7%
12.8%15.4%
12.6%15.2%
26.0%26.8%24.1%23.0%
0%
5%
10%
15%
20%
25%
30%
35%
1993 1994 1995 1996 1997 1998 1999 2000 2001
Private Medicaid
Data Source: Medicaid Research & Evaluation ProjectVital Statistics birth File 1993-2001 (n=11,748)
Health Indicators for Children with Special Health Care Needs:
• Leading Cause of Hospitalizations
• Repeat Hospitalizations
Figure 4Health Indicator – Mental Health
Leading Causes of Hospitalizations by Principal Diagnosis by CSHCN Group
54.3
103.4 4.2
52.6
12.8
03.8
75.6
4.9 5.1 3.2
86.6
1.15.7
1.5
0
20
40
60
80
100
% o
f T
otal
Hos
pita
liza
tion
s
SSI KB AS TP
Respiratory V-Code Factors InjuryMental
Data Source: Medicaid Data ArchiveMMIS CY 2000, Children <21 on FFS Medicaid
Figure 5Health Indicator - Percent of Children and Adolescents with Repeat
Hospitalizations by Diagnoses 1: Physical vs. Mental Fee-For-Service Medicaid Recipients 2, Ages 21 and Under
Calendar Year 2000
37.5%
21.2%
0%
10%
20%
30%
40%
50%
Percent
At least 1 diagnosis of Mental Disorder
1. Includes Principal, Secondary or Tertiary Diagnosis
2. Total Recipients =12,062
Physical Diagnosis Only(n=448)(n=415)
Health Indicators for Adults with Disabilities
• Leading Cause of Hospitalizations
• Repeat Hospitalizations
Figure 6Health Indicator – Mental Health Hospitalizations for Adults
Leading Causes of Hospitalization by Principal Diagnosis for Fee-For-Service Medicaid Recipients Ages 21-64
24.5
12.4 12.1
9.26.8
4.3
26.2
4.5
10.2
3.5
11.99.8
27.3
4.3
11.1
2.9
11.19.1
0
10
20
30
40
Mental Metabolic Heart Disease Infection Respiratory Digestive
% o
f T
otal
Hos
pita
lizat
ions
199819992000
Data Source: Health Indicator Project, Medicaid Data Archive, ICD-9 GroupingsMMIS Extract (1998 n = 6,423 hospitalizations; 2000 n = 7,397)
Figure 7 Health Indicator - Percent of Working-Age Adults with Repeat
Hospitalizations by Diagnoses 1: Physical vs. Mental Fee-For-Service Medicaid Recipients 2, Ages 21 to 64
Calendar Year 2000
41.1%
29.2%
0%
10%
20%
30%
40%
50%
Percent
At least 1 diagnosis of Mental Disorder
1. Includes Principal, Secondary or Tertiary Diagnosis
2. Total Recipients =25,485
Physical Diagnosis Only
(n=1,984)(n=2,377)
Health Indicators for Uninsured Rhode Islanders
• Changes in Type of Insurance Coverage
• Uninsured Rhode Islanders by Age Group
• Uninsured Rhode Islanders by Income
Figure 8Changes in Type of Insurance Coverage
For Rhode Islanders <65 Years Old1996-2003
12.2 11.7
72.8 70.2 72.8 75.9 77.7 73.969.3 70.4
12.316.5 15.8
8.112 11.5 6.9 9 11.3
13.98.5 10.7 119.9
0
20
40
60
80
1996 1997 1998 1999 2000 2001 2002 2003
% Uninsured % Employer Based % Medicaid
Data Source: Medicaid Research and Evaluation Project; RI Access Project US Bureau of the Census, Current Population Surveys 1996-2003 (September estimate, 2004)
Figure 9Percent Uninsured Rhode Islanders by Age Group
Ages 18-64 – 1996-2003
15.5
18.5
9.28.2 8.2 8.3 7.6
6.7
9.1
6.9
4.5 4.4
12.814.1 14.5 14.1
12.8
16.8
6.8
6
5.8 6.95
7.3
0
5
10
15
20
1996 1997 1998 1999 2000 2001 2002 2003
Ages 18-34 Ages 35-49 Ages 50-64
Data Source: Medicaid Research and Evaluation Project; RI Access Project Behavioral Risk Factor Surveillance System 1996-2003, RI Department of Health
Figure 10Percent Uninsured Rhode Islanders by Income Level
Ages 18-64 – 1996-2003
22.2 23.1
9.27.7 8.7 8.2
11.29.2 10
13.4
1.1 1.42.8 3.2
24.522.321.1
25.6
19.7
26.5
2.12.82.11.6
0
10
20
30
1996 1997 1998 1999 2000 2001 2002 2003
<$25,000 $25,000-$49,000 >$50,000
Data Source: Medicaid Research and Evaluation Project; RI Access ProjectBehavioral Risk Factor Surveillance System 1996-2003, RI Department of Health
Creating Health Indicators from the Medicaid Management
Information System (MMIS)
List of Health Indicators by Population Type Recommended from Expert Panels /Policy Literature* and can be designed from MMIS
Measures found in 3 or more policy studies
HealthyAdolescents
Children with DisabilitiesHealthyAdults
Adults withDisabilities
Physical exams, checkups Preventive visits CVD Screening Assisted Living Facilities
Dental visits Acute visits Breast Cancer Screening Specialists
Family Planning Visits Dental Visits Cervical Cancer Screening Nursing Home (stays & days)
Mental health visits/readmits Emergency Department Visits Colorectal Cancer Screening
Hospital (stays & days)
Immunization (HepB) Mental Health Diabetic Retinal Exams Emergency Department Visits
AIDS/HIV Pharmacy/RXInfluenza/pneumonia vaccination Rehab Services (PT, OT, ST)
Motor Vehicle Accident Hospital Readmits Dental visits Readmits (7,14,30 days)
Violence/Homicide Specialty care appointments ACS Hospitalizations
Depression/SuicideDurable medical equipment/assistive tech Primary Care Doctor Visits
AsthmaPhysical, speech, occupational therapy Unmet Need for Care
Diabetes Mental health counseling Average Costs
Respite care
Length of time with PCP
Total annual $ spent on child
Conclusion
Health Indicator System is an effective program evaluation
model that state Medicaid programs can use to identify
unmet needs and evaluate program initiatives
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