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DUAL ELIGIBLES IN MASSACHUSETTS: A PROFILE OF HEALTH CARE SERVICES AND SPENDING FOR NON-ELDERLY ADULTS ENROLLED IN BOTH MEDICARE AND MEDICAID. ELLEN BRESLIN DAVIDSON AND TONY DREYFUS, BD GROUP. TODAY’S PRESENTATION. DUAL ELIGIBLE POPULATION IN MASSACHUSETTS IN 2008 PRESENTATION FORMAT

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Dual eligibles in massachusetts

DUAL ELIGIBLES IN MASSACHUSETTS:

A PROFILE OF HEALTH CARE SERVICES AND SPENDING FOR NON-ELDERLY ADULTS ENROLLED IN BOTH MEDICARE AND MEDICAID

ELLEN BRESLIN DAVIDSON AND TONY DREYFUS, BD GROUP


Today s presentation

TODAY’S PRESENTATION

  • DUAL ELIGIBLE POPULATION IN MASSACHUSETTS IN 2008

  • PRESENTATION FORMAT

    • EXPLAIN KEY POINTS ABOUT THE DATA

    • COVER MAJOR TAKEAWAYS

    • PRESENT SLIDES, WITH TIME FOR REVIEW & QUESTIONS


Key points about the data

KEY POINTS ABOUT THE DATA

  • MEDICAID AND MEDICARE COMBINED DATA SET

    • EOHHS AND MMPI OBTAINED DATA VIA DATA USE AGREEMENT

    • JEN ASSOCIATES CONSTRUCTED THE DATA SET

    • MERCER PROVIDED DATA BASES

    • BD GROUP ANALYZED THE DATA

  • DATA SET INCLUDES

    • CALENDAR YEAR 2008, ONLY ONE YEAR OF DATA

    • DUALS AGES 21-64 YEARS OF AGE

    • CONTAINS ONLY DUALS WHO ARE NOT IN MANAGED CARE

    • EXCLUDES PACE AND MEDICARE ADVANTAGE ENROLLEES (n=10,000)

    • CONTAINS PAID FEE-FOR-SERVICE CLAIMS

    • EXCLUDES MEDICARE DEDUCTIBLES AND COPAYMENTS


Executive summary

EXECUTIVE SUMMARY

  • DIVERSE POPULATION

    • BEHAVIORAL HEALTH, PHYSICAL DIAGNOSES, AND DEVELOPMENTAL DISABILITIES

    • ONLY 3 PERCENT RESIDED IN INSTITUTIONS

    • 97 PERCENT OF DUALS LIVED IN THE COMMUNITY

    • 19 PERCENT USED HIGH LEVEL OF LONG-TERM SUPPORT SERVICES

    • HIGH INPATIENT USE

  • SMALL PROPORTION (6 PERCENT) HAD ANNUAL PER CAPITA COSTS OVER $100,000

  • BEHAVIORAL HEALTH DIAGNOSES

    • 65 PERCENT HAD A BEHAVIORAL HEALTH DIAGNOSIS

    • HALF WITH DEPRESSION OR MODERATE MENTAL ILLNESS

    • SUBGROUPS WITH MORE COMPLEX BEHAVIORAL HEALTH NEEDS


Together medicaid and medicare spent 2 5 billion for duals in 2008

TOGETHER MEDICAID AND MEDICARE SPENT $2.5 BILLION FOR DUALS IN 2008

COMBINED MEDICAID AND MEDICARE SPENDING FOR DUALS, 2008

$2.5 Billion / 105,000 Duals = $23,700 average annual per capita

MEDICARE SPENDING

$1.2 BILLION

($11,500 PER PERSON)

49%

51%

MEDICAID SPENDING

$1.3 BILLION

($12,200 PER PERSON)


More than three out of five duals were ages 45 64

MORE THAN THREE OUT OF FIVE DUALS WERE AGES 45–64

NUMBER AND PERCENT OF DUALS 21–64 BY AGE, 2008

33%

30%

22%

15%

21–34

35–44

45–54

55–64

AGE


A small proportion of duals accounted for a large proportion of total spending

A SMALL PROPORTION OF DUALS ACCOUNTED FOR A LARGE PROPORTION OF TOTAL SPENDING

PROPORTIONS OF DUALS AGES 21–64 AND EXPENDITURES, 2008

$0 – $20K

$20 – $50K

$50 – $100K

> $100K

RANGE OF ANNUAL PER CAPITA SPENDING LEVELS

SHARE OF ENROLLEES

SHARE OF SPENDING


Nearly nine out of ten health care dollars were spent on duals living in the community

NEARLY NINE OUT OF TEN HEALTH CARE DOLLARS WERE SPENT ON DUALS LIVING IN THE COMMUNITY

SHARE OF ENROLLEES AND EXPENDITURES FOR DUALS IN THE COMMUNITY AND IN INSTITUTIONS, 2008

DUALS RECEIVING NO OR LOW LEVEL OF SUPPORT SERVICES IN THE COMMUNITY

DUALS RECEIVING HIGH LEVEL OF SUPPORT SERVICES IN THE COMMUNITY

ALL DUALS RESIDING IN THE COMMUNITY

DUALS RESIDING IN INSTITUTIONS

SHARE OF ENROLLEES

SHARE OF SPENDING


Dual eligibles in massachusetts

PER CAPITA SPENDING FOR DUALS RESIDING IN INSTITUTIONS WAS ALMOST DOUBLE THAT FOR DUALS RECEIVING A HIGH LEVEL OF SUPPORT SERVICES IN THE COMMUNITY

AVERAGE ANNUAL PER CAPITA COMBINED MEDICAID AND MEDICARE SPENDING

FOR DUALS IN THE COMMUNITY AND IN INSTITUTIONS, 2008

DUALS RECEIVING NO OR LOW LEVEL OF SUPPORT SERVICES IN THE COMMUNITY

DUALS RECEIVING HIGH LEVEL OF SUPPORT SERVICES IN THE COMMUNITY

ALL DUALS IN THE COMMUNITY

ALL DUALS

DUALS RESIDING IN INSTITUTIONS

AVERAGE ANNUAL

PER CAPITA SPENDING

NUMBER OF ENROLLEES


Dual eligibles in massachusetts

NEARLY FOUR OUT OF FIVE DUALS HAD A PHYSICAL ILLNESS OR DISABILITY AND TWO OUT OF THREE HAD A BEHAVIORAL DIAGNOSIS

PERCENTAGES OF DUAL ELIGIBLES WITH DIAGNOSES IN THREE MAJOR DIAGNOSTIC CATEGORIES, 2008

PHYSICAL ILLNESSOR DISABILITY

(n=82,400)

BEHAVIORAL DIAGNOSIS

(n=67,600)

DEVELOPMENTAL DISABILITY

(n=14,300)


What have we learned so far

WHAT HAVE WE LEARNED SO FAR

  • POPULATION

    • 60 PERCENT 45-64 YEARS OF AGE

    • ONLY 3 PERCENT RESIDED IN INSTITUTIONS

    • 19 PERCENT USED HIGH LEVEL OF LONG-TERM SUPPORT SERVICES

    • 65 PERCENT HAD A BH DIAGNOSIS

  • SPENDING

    • $2.5 BILLION IN COMBINED MEDICAID AND MEDICARE SPENDING

    • SMALL PROPORTION (6 PERCENT) HAD ANNUAL PER CAPITA COSTS OVER $100,000

    • 90 PERCENT OF SPENDING WAS FOR DUALS LIVING IN THE COMMUNITY


Dual eligibles in massachusetts

DUALS WITH DIAGNOSES IN TWO OR MORE MAJOR DIAGNOSTIC AREAS ACCOUNTED FOR MORE THAN 80 PERCENT OF SPENDING

PROPORTIONS OF DUAL ELIGIBLES WHO HAD DIAGNOSES RECORDED IN ZERO, ONE, TWO, OR THREE MAJOR DIAGNOSTIC CATEGORIES AND THEIR SPENDING, 2008

ZERO

ONE

TWO

THREE

SHARE OF ENROLLEES

SHARE OF SPENDING


Dual eligibles in massachusetts

DEPRESSION WAS THE MOST COMMON BEHAVIORAL DIAGNOSIS; HIGHEST PER CAPITA SPENDING WAS FOR THOSE WITH SERIOUS MENTAL ILLNESS

NUMBER OF DUALS AND AVERAGE ANNUAL EXPENDITURES FOR THOSE WITH SELECTED BEHAVIORAL DIAGNOSES, 2008

DEPRESSION

SCHIZOPHRENIA

ALCOHOL OR SUBSTANCE ABUSE

OTHER SERIOUS MENTAL ILLNESS

NUMBER OF DUALS

AVERAGE ANNUAL

PER CAPITA SPENDING


Dual eligibles in massachusetts

DUALS WITH DEVELOPMENTAL DISABILITY ANDDIAGNOSES FROM OTHER MAJOR CATEGORIESHAD HIGH AVERAGE HEALTH CARE EXPENDITURES

AVERAGE ANNUAL PER CAPITA SPENDING FOR DUALS WITH DEVELOPMENTAL DISABILITY

AND DIAGNOSES FROM OTHER MAJOR DIAGNOSTIC CATEGORIES, 2008

DEVELOPMENTAL ONLY

(n=1,550)

DEVELOPMENTAL AND BEHAVIORAL

(n=1,340)

DEVELOPMENTAL AND PHYSICAL

(n=4,200)

DEVELOPMENTAL, BEHAVIORAL AND PHYSICAL

(n=7,200)

NOTE: 14 PERCENT OF DUALS HAVE A DEVELOPMENTAL DISABILITY


Annual health care spending for duals with common diagnoses

ANNUAL HEALTH CARE SPENDING FOR DUALS WITH COMMON DIAGNOSES

AVERAGE ANNUAL PER CAPITA SPENDING FOR DUALS WITH COMMON DIAGNOSES, 2008

CATEGORIES CANNOT BE SUMMED. THESE ARE NOT MUTUALLY EXCLUSIVE CATEGORIES.

DIABETES

(n=23,200)

CHRONIC OBSTRUCTIVE PULMONARY DISEASE

(n=24,700)

CORONARY HEART DISEASE

(n=15,000)


What have we learned so far1

WHAT HAVE WE LEARNED SO FAR

  • DUALS WITH MULTIPLE DIAGNOSES ACCOUNTED FOR 80 PERCENT OF THE SPENDING

  • PREVALENCE OF BEHAVIORAL HEALTH CONDITIONS, WITH DEPRESSION BEING THE MOST COMMON

  • DUALS WITH A DEVELOPMENTAL DISABILITY AND OTHER CONDITIONS HAD HIGH COSTS

  • SOME OF THE MOST COMMON DIAGNOSES INCLUDE DIABETES, COPD, CHD


Dual eligibles in massachusetts

35 PERCENT OF COMBINED HEALTH CARE SPENDINGWAS FOR LONG-TERM SUPPORT SERVICES AND 22 PERCENT FOR INPATIENT SERVICES

DISTRIBUTION OF COMBINED MEDICAID AND MEDICARE SPENDING FOR DUAL ELIGIBLES BY SERVICE CATEGORIES, 2008

Pharmacy

All Other, including lab, radiology, DME

Outpatient

13%

8%

8%

Physicians/Practitioners

14%

35%

Long-term Support Services

22%

Inpatient


Distribution of long term support services ltss spending on duals

DISTRIBUTION OF LONG-TERM SUPPORT SERVICES (LTSS) SPENDING ON DUALS

TOTAL COMBINED MEDICAID AND MEDICARE SPENDING ON LTSS FOR DUALS, 2008

Institutional Services

$280M

HCBS Waiver Services$390M

33%

45%

22%

Non-Institutional

(Non-Waiver) Services

$190M


Dual eligibles in massachusetts

EIGHTEEN PERCENT OF DUALS SPENT AT LEAST ONE NIGHT IN THE HOSPITAL; FOUR PERCENT WERE HOSPITALIZED FOR MORE THAN FIFTEEN DAYS

PROPORTION OF DUALS AND THEIR USE OF INPATIENT CARE, 2008

0

1–15

16–30

>30

HOSPITAL DAYS


Thirty eight percent of duals received more than five prescriptions per month

THIRTY-EIGHT PERCENT OF DUALS RECEIVED MORE THAN FIVE PRESCRIPTIONS PER MONTH

PROPORTIONS OF DUAL ELIGIBLES WITH AVERAGE NUMBER OF PRESCRIPTIONS PER MONTH, 2008

None

<1

1–2

>2–5

>5–10

>10–15

>15

AVERAGE NUMBER OF PRESCRIPTIONS PER MONTH


What have we learned

WHAT HAVE WE LEARNED

  • DIVERSE POPULATION

    • BEHAVIORAL HEALTH, PHYSICAL DIAGNOSES, DEVELOPMENTAL DISABILITIES

    • ONLY 3 PERCENT RESIDED IN INSTITUTIONS

    • HIGH LONG-TERM SUPPORT SERVICES USE, HIGH INPATIENT USE

    • 19 PERCENT USED A HIGH LEVEL OF LONG-TERM SUPPORT SERVICES

  • HIGH COSTS

    • SMALL PROPORTION (6 PERCENT) HAD ANNUAL PER CAPITA COSTS OVER $100,000

    • MOST COMPLEX GROUP HAD 3 TIMES THE AVERAGE PER CAPITA COST

  • BEHAVIORAL HEALTH DIAGNOSES

    • 65 PERCENT HAD A BEHAVIORAL HEALTH DIAGNOSIS

    • HALF WITH DEPRESSION OR MODERATE MENTAL ILLNESS

    • SUBGROUPS WITH MORE COMPLEX BEHAVIORAL HEALTH NEEDS


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