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Understanding and Using the CMMI and Actuarial Cost & Utilization Reports

Understanding and Using the CMMI and Actuarial Cost & Utilization Reports. Katie Matthews, ASA, MAAA Ally Weaver, ASA, MAAA November 3, 2017. Objectives. Gain understanding of and learn how to monitor the CMMI cost and utilization metrics.

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Understanding and Using the CMMI and Actuarial Cost & Utilization Reports

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  1. Understanding and Using the CMMI and Actuarial Cost & Utilization Reports Katie Matthews, ASA, MAAA Ally Weaver, ASA, MAAA November 3, 2017

  2. Objectives • Gain understanding of and learn how to monitor the CMMI cost and utilization metrics. • Gain understanding of and learn how to monitor actuarial cost and utilization metrics. • Learn how to identify what is “Going Well” or “Not so Much” financially.

  3. Reports Overview

  4. Why are these reports important? • What is going on outside the practice? • How do costs and use of services change over time?

  5. What detail is included? Each report contains information split by the following level of detail: • Practice compared to SIM aggregate cohorts (Family, Pediatric, or Adult) • Baseline Year in total and by quarter • Program Years-to-date and by quarter • By Line of Business (Commercial, Medicaid, Medicare) and in total • No risk adjustment yet

  6. What detail is included? CMMI Cost & Utilization Reports

  7. What detail is included? Actuarial Cost & Utilization Reports

  8. Which patients are represented for each practice? Attribution CIVHC performs attribution. Patients are assigned to a single primary care provider where they had the most visits in recent years.

  9. CMMI Cost & Utilization Reports

  10. Overview of CMMI Reports: Nine Metrics Behavioral Physical Follow-up after Hospitalization for Mental Illness Total Cost of Care PMPM Emergency Dept. Rate Emergency Dept. Rate Out-of-pocket Expenditures for Consumers Admissions Admissions Readmissions Readmissions

  11. Questions on CMMI reports?

  12. Actuarial Cost & Utilization Reports

  13. Overview of Actuarial Reports: Three Metrics

  14. Overview of Actuarial Reports: Service Categories

  15. How to Use Actuarial Reports • Track performance over time • Review which types of services show increasing/decreasing costs • Compare individual practice results to SIM family / pediatric / adult practice results • No risk adjustment (yet) • Aggregate SIM report is also produced • Inform cost projections, cost savings, ROI

  16. Proposed Cost Savings & ROI

  17. Proposed ROI through 3-Year SIM Program Assumed Grant Amount: Actual Grant Amount:

  18. Cost Savings Assumptions • Projected Savings: $17.3M (yr. 1), $42.2M (yr. 2), $67.1M (yr. 3) • Savings translates to about $1.90 PMPM Utilization & Cost Reductions Utilization & Cost Increases • Inpatient Physical • Inpatient Behavioral • Emergency Services • Ambulance • Skilled Nursing Facility • Professional Physical • Professional Behavioral • Diagnostic Testing • Imaging / Labs • Prescription Drugs

  19. Thank you Katie Matthews, ASA, MAAA Katie.Matthews@milliman.com Ally Weaver, ASA, MAAA Ally.Weaver@milliman.com

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