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claims data collection & analyses

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  1. claims data collection & analyses Comparison of Draft CTC Rates for Contract Adjudication March 7, 2017

  2. Notes • Onpoint analysis included medical eligibility data for: • Blue Cross Blue Shield of Rhode Island (BCBSRI) • Neighborhood Health Plan of Rhode Island (NHPRI) • Tufts (not included in RTI analysis) • UnitedHealthcare • UnitedHealthcare (New England) (Medicaid managed care) • Data are not risk adjusted • Maternity and behavioral health excluded • Onpoint’s standard attribution method uses a 24-month look-back and CMS Evaluation and Management (E&M) codes

  3. Inpatient Admissions per 1,000 Member Months

  4. ED Visits per 1,000 Member Months

  5. CTC Cohort 1 & ComparisonInpatient Admissions per 1,000 Member Months

  6. CTC Cohort 1 & ComparisonED Visits per 1,000 Member Months

  7. CTC Cohort 2 & ComparisonInpatient Admissions per 1,000 Member Months

  8. CTC Cohort 2 & ComparisonED Visits per 1,000 Member Months

  9. CTC Cohort 3 & ComparisonInpatient Admissions per 1,000 Member Months

  10. CTC Cohort 3 & ComparisonED Visits per 1,000 Member Months

  11. Potential reasons for differences • Different data consolidation methods • Patients linked across carriers • Providers are mastered, NPI/Name errors eliminated • Rules around valid claims- (duplicate, orphan) • Inclusion of Tufts • Potentially different runout periods • Minor differences in attribution methodology • Others?