Older Adult Population Served by Californias Medi-Cal Specialty - - PowerPoint PPT Presentation

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Older Adult Population Served by Californias Medi-Cal Specialty - - PowerPoint PPT Presentation

Mar 17, 2023 95 likes •490 views

Older Adult Population Served by Californias Medi-Cal Specialty Mental Health Services Presented by BHC-CalEQRO at California Mental Health Planning Council Quarterly Meeting, San Jose, Ca April 20, 2017 Saumitra SenGupta, Ph.D., Executive

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Behavioral Health Concepts, Inc.

Older Adult Population Served by California’s Medi-Cal Specialty Mental Health Services Presented by BHC-CalEQRO at California Mental Health Planning Council Quarterly Meeting, San Jose, Ca

April 20, 2017

Saumitra SenGupta, Ph.D., Executive Director Rachel Phillips, MS, Reporting Manager

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Behavioral Health Concepts, Inc.

Older Adult Data Analysis

  • Population Analyzed
  • Methodology
  • Age Groupings
  • Overall Results CY15
  • Demographic Results CY15
  • Gender Results CY15
  • Service Category Results CY15
  • ACA Results CY15
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Behavioral Health Concepts, Inc.

POPULATION ANALYZED

Define SDMC, Age breakouts, Medi-Medi, ACA

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Behavioral Health Concepts, Inc.

Older Adult Age Groupings

  • 55-59
  • 60-64
  • 65-69
  • 70-74
  • 75-79
  • 80-84
  • 85+
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Behavioral Health Concepts, Inc.

METHODOLOGY

Data comes from the 2015 SDMC and IPC approved claims. Overall population totals are unduplicated by client index number. Results by Service Type are unduplicated by services; such that one person with multiple services are included. Results by Region and Size follow the same method as Service Type to account for beneficiaries receiving services in multiple regions or those who move throughout the year.

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Behavioral Health Concepts, Inc.

CY15 Medi-Medi Population

  • Total

unduplicated count age 55 and over is 69,087.

  • Medi-Medi in

the CY15 total is 30,956.

  • Medi-Cal in the

CY15 total is 38,131.

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Behavioral Health Concepts, Inc.

CY15 Medi-Medi Younger than 65

  • Medi-Medi under age

65 is 15,347.

  • Medi-Cal under the

age 65 is 35,172.

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Behavioral Health Concepts, Inc.

CY15 Medi-Medi Age 65 and Over

  • Medi-Medi age 65 and
  • ver is 15,609.
  • Medi-Cal age 65 over is

2,959.

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Behavioral Health Concepts, Inc.

OVERALL ANALYSIS

Number of beneficiaries served aged 55 and older. Average approved SDMC dollars for 55 and older. Results at the Statewide, Region, and Size levels.

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Behavioral Health Concepts, Inc.

5,000 10,000 15,000 20,000 25,000 30,000

Beneficiaries Served

10,429 21,660 28,854 4,315 2,167 996 664

CY15 Older Adult Age Groups Served

Age Group

55-59 60-64 65-69 70-74 75-79 80-84 85 + 55-59 60-64 65-69 70-74 75-79 80-84 85 +

  • Ages 55-69 account for

the majority of older adults who received mental health services funded by SDMC in 2015.

  • Age group 55-59 had

the largest number of individuals who received services.

  • Ages 80 and beyond

had the fewest services compared to the other

  • lder adult age groups
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Behavioral Health Concepts, Inc.

$5,000 $10,000

Average Approved Claims

$3,786 $3,188 $4,110 $4,170 $4,574 $4,524 $4,481

CY15 Average Approved Claims by Older Adult Group

$0 55-59 60-64 65-69 70-74 75-79 80-84 85 +

  • The average approved

claim amount between the age groups ranges from $3,188 to $4,574.

  • Age group 55-59 had the

highest average approved claims amount.

  • Age group 85+ had the

lowest average approved claims amount.

Age Group

55-59 60-64 65-69 70-74 75-79 80-84 85 +

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Behavioral Health Concepts, Inc.

5,000 10,000 15,000 20,000 25,000 Beneficiaries Served 23,606 16,861 15,923 9,508 2,889

Region

Los Angeles Southern Bay Area Central Superior Los Angeles Southern Bay Area Central Superior

  • The unduplicated

number of older adults served in CY15 totals 69,087.

  • The number of older

adults served across California’s regions is greatest in LA.

  • The Southern and Bay

Area regions have comparable numbers

  • f beneficiaries

served.

  • Superior has the

fewest number of

  • lder adults served.

CY15 Older Adult Served by Region

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Behavioral Health Concepts, Inc.

$1,000 $2,000 $3,000 $4,000 $5,000 $6,000 $3,562 $3,207 $3,012 $6,131 $4,021

CY15 Older Adult Average Approved Claims by Region

Region

Bay Area Superior Los Angeles Southern Central $0 Bay Area Superior Los Angeles Southern Central Average Approved Claims

  • The CY15 Statewide average

approved claim amount is $4,023.

  • The Bay Area has the

greatest amount of average approved claims for older adults, with the value of $6,131.

  • The Central region has the

lowest amount of average approved claims for older adults, with the value of $3,012.

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Behavioral Health Concepts, Inc.

5,000 10,000 15,000 20,000 25,000 30,000 35,000 31,147 23,606 9,767 3,297 968

CY15 Older Adult Served by Size

  • The number of older adults

served is greatest in the Large Sized MHP’s.

  • Very-Large MHP (LA) served

the second highest number

  • f beneficiaries.
  • Small-Rural has the fewest

number of older adults served.

MHP Size

Large Very-Large Medium Small Small-Rural Large Very-Large Medium Small Small-Rural

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Behavioral Health Concepts, Inc.

$3,000 $3,500 $4,000 $4,500 $5,000 $5,500 $5,423 $3,427 $2,890 $4,242 $3,562

CY15 Older Adult Average Approved Claims by Size

MHP Size

Medium Large Very Large Small Small-Rural $2,500 $2,000 $1,500 $1,000 $500 $0 Medium Large Very Large Small Small-Rural

  • The average approved

claims amounts ($5,423) for older adults is greatest in the in the Medium Sized MHP’s.

  • Large MHP has the

second greatest amount

  • f approved claims

dollars ($4,242).

  • Small-Rural has the

lowest average approved claim amount ($2,890) for older adults served.

Average Approved Claims

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Behavioral Health Concepts, Inc.

RACE/ETHNICITY ANALYSIS

Total Served Age 55+ by Race Group Average Approved Claims Age 55+ by Race Group Total Served in each Older Age Group by Race Group Average Approved Claims in each Older Age Group by Race Group Age groups 75-79, 80-84, and 85+ have been removed from this section’s analysis to due HIPAA regulations.

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White Other African-Amer.. Hispanic Asian-Pacific Islander Native American 5,000 10,000 15,000 20,000 25,000 30,000 Beneficiaries Served 10,709 26,713 12,473 11,092 7,669 429

CY15 Older Adults Served by Race/Ethnicity

Racegrp

White Other African-American Hispanic Asian-Pacific Islander Native American

  • The number of White
  • lder adults served in

CY15 was 26,713.

  • The number of

African American

  • lder adults served in

CY15 was 11,092.

  • The number of

Hispanic older adults served in CY15 was 10,709.

  • The number of Asian

Pacific Islander older adults served in CY15 was 7,669.

  • The number of Native

American older adults served in CY15 was 429.

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Behavioral Health Concepts, Inc.

African-Am.. White Other Native American Asian- Pacific.. Hispanic $500 $0 $1,000 $1,500 $2,000 $2,500 $3,000 $3,500 $4,000 $4,500 $5,000 $4,749 $4,447 $4,623 $3,220 $3,108 $4,701

CY15 Older Adult Average Approved Claims by Race/Ethnicity

Racegrp

African-American White Other Native American Asian-Pacific Islander Hispanic

  • African American and White

Race/Ethnicity groups have the highest and similar average approved claim amounts; $4,749 and $4,701.

  • Native American’s had an average

approved claim amount comparable to African-Americans and Whites at a value of $4,623.

  • Asian Pacific Islander’s had an

average approved claim amount

  • f $3,220.
  • Hispanic’s had the lowest average

approved claim amount at a value

  • f $3,108.
  • Others’ had an average approved

claim amount of $4,447.

Average Approved Claims Amount

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Behavioral Health Concepts, Inc.

Age Group Racegrp 2,000 4,000 6,000 10,000 12,000 14,000 8,000 Beneficiaries Served 55-59 White Other African-American Hispanic Asian-Pacific Isla.. Native American 60-64 White Other African-American Hispanic Asian-Pacific Isla.. Native American 65-69 70-74 10,749 5,595 4,269 5,447 2,613 181 4,035 3,005 2,607 3,436 8,410 167 1,855 1,639 4,347 1,333 1,201 White Other African-American Hispanic Asian-Pacific Isla.. Native American 54 1,789 835 449 559 671 White Other African-American Hispanic Asian-Pacific Isla.. Native American 12

CY15 Beneficiaries Served by Age Group and Race/Ethnicity

Racegrp White Other African-American Hispanic Asian-Pacific Islander Native American
  • In all age groups, White beneficiaries received the highest number of services.
  • In the age groups between 55-64, African-American beneficiaries received

more services than Hispanic, and in age groups 65-74 Hispanics received more services than African-Americans.

  • Native-Americans received the fewest number of services in all age groups.
  • Asian Pacific Islander beneficiaries received the second to last number of

services across all age groups.

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Age Group Racegrp $0 $500 $1,000 $1,500 $2,000 $3,500 $4,000 $4,500 $5,000 $5,500 $2,500 $3,000 Average Approved Claims 55-59 White Native American African-American Other Hispanic Asian-Pacific Islander 60-64 White Native American African-American Other Hispanic Asian-Pacific Islander 65-69 White Native American African-American Other Hispanic Asian-Pacific Islander 70-74 White Native American African-American Other Hispanic Asian-Pacific Islander $4,915 $3,088 $3,833 $5,046 $4,896 $4,601 $4,949 $4,863 $3,973 $4,584 $5,222 $2,782 $3,235 $4,693 $2,926 $4,700 $5,372 $4,642 $4,555 $4,883 $2,966 $3,286 $4,202 $4,671

CY15 Beneficiaries Served by Age Group and Race/Ethnicity

Age Group 55-59 60-64 65-69 70-74
  • In age group 55-59 Whites accounted for the highest average approved claim

amount at $4,915.

  • Age group 60-64 Native Americans accounted for the highest average

approved claim amount at $5,222.

  • Age group 65-69 Whites accounted for the highest average approved claim

amount at $5,372.

  • Age group 70-74 African Americans accounted for the highest average

approved claim amount at $4,883.

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Behavioral Health Concepts, Inc.

GENDER ANALYSIS

Total Served Age 55+ by Gender Average Approved Claims Age 55+ by Gender Total Served in each Older Age Group by Gender Average Approved Claims in each Older Age Group by Gender

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Behavioral Health Concepts, Inc.

10,000 15,000 20,000 25,000 30,000 35,000 45,000 50,000 Beneficiaries Served 28,278 40,807 40,000

Gender

Female Male 5,000 Female Male

  • The number of Female older

adults served in CY15 was 40,807.

  • The number of Male older

adults served in CY15 was 28,278.

CY15 Older Adult Beneficiaries Served by Gender

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Behavioral Health Concepts, Inc.

$500 $1,000 $1,500 $2,000 $2,500 $3,000 $3,500 $4,000 $4,500 $3,968 $4,331

CY15 Adult Average Approved Claims by Gender

Gender

Female Male $0 Female Male Average Approved Claims

  • The average approved claim

amounts for Female older adults served in CY15 was $3,968.

  • The average approved claim

amounts for Male older adults served in CY15 was $4,331.

  • Male beneficiaries had a

greater average approved claim amount than Females.

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Behavioral Health Concepts, Inc.

Female Male 2,000 4,000 6,000 8,000 10,000 12,000 14,000 16,000 Beneficiaries Served 16,181 12,671 1,483 6,470 2,832 679 491 12,673 8,989 3,959 1,483 317 173 684

CY15 Older Adults Served by Age Group and Gender

Gender

Female Male 55-59 60-64 65-69 70-74 75-79 80-84 85 + 55-59 60-64 65-69 70-74 75-79 80-84 85 +

  • Females in most age groups received more services than males.
  • The number of Males and Females receiving SDMC funded services decline

around age 65.

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Behavioral Health Concepts, Inc.

Female Male $5,000 $10,000 $3,165 $4,158 $3,948 $4,033 $4,156 $4,142 $4,171 $5,105 $4,959 $4,258 $3,437 $3,253 $5,101 $4,201

CY15 Average Approved Claims by Age Group and Gender

Gender

Female Male $0 55-59 60-64 65-69 70-74 75-79 80-84 85 + 55-59 60-64 65-69 70-74 75-79 80-84 85 +

The average approved claim amounts between age groups are slightly higher in Male beneficiaries.

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Behavioral Health Concepts, Inc.

SERVICE TYPE ANALYSIS

Total Served Age 55+ by Service Type Average Approved Claims Age 55+ by Service Type Total Served in each Older Age Group by Service Type Average Approved Claims in each Older Age Group by Service Type

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Behavioral Health Concepts, Inc.

Medication Support Mental Health Services Case Management Crisis Intervention Crisis Stablization Inpatient Services Residential Services Day Treatment 5,000 25,000 20,000 15,000 10,000 30,000 35,000 40,000 45,000 50,000 55,000 Beneficiaires Served 49,884 47,812 29,881 4,576 6,270 4,134 163 816

CY15 Older Adults Served by Service Type

Service Group

Medication Support Mental Health Services Case Management Crisis Intervention Crisis Stablization Inpatient Services Residential Services Day Treatment

  • The top three types of services in CY15 for older adults were Med

Support, Mental Health Services, and Case Management.

  • Residential Services and Day Treatment had the lowest utilization.
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Behavioral Health Concepts, Inc.

Inpatient Residential Day Crisis Stab Services Services Treatment lization Mental Medication Case Mana Crisis Inter Health .. Support gement vention $0 $2,000 $4,000 $6,000 $8,000 $10,000 $12,000 $12,259 $1,235 $2,507 $1,106 $2,480 $8,761 $7,861 $1,491

CY15 Average Approved Claims by Service Type

Service Group

Inpatient Services Residential Services Day Treatment Crisis Stablization Mental Health Services Medication Support Case Management Crisis Intervention

  • Inpatient Services

had the highest average approved claim amount in

  • lder adults, with a

value of $12,259.

  • Residential Services

and Day Treatment had were the second highest cost, though they were the least utilized.

  • Mental Health

Services ($2,480), Medication Support ($1,491) and Case Management ($1,235) had lower cost though higher use.

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Behavioral Health Concepts, Inc.

Mental Health Services 5,000 15,000 20,000 25,000 Beneficiaries Served 12,024 5,065 1,017 10,000 9,026 2,050 431 16,169 21,787 2,747 7,036 1,282 545 268 318 19,766 15,054 7,292 3,002 1,541 706 451

CY15 Beneficiaries Served by Service Type and Age Group

Case Management Medication Support

Age Group

55-59 60-64 65-69 70-74 75-79 80-84 85 + 55-59 60-64 65-69 70-74 75-79 80-84 85 + 55-59 60-64 65-69 70-74 75-79 80-84 85 + 55-59 60-64 65-69 70-74 75-79 80-84 85 +

  • The top three services were reported for this analysis in compliance

with HIPAA.

  • Medication Support had the highest amount of beneficiaries.
  • Case Management was the third highest.
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Behavioral Health Concepts, Inc.

Mental Health Services $500 $1,000 $1,500 $2,000 $2,500 $3,000 Average Approved Claims $1,107 $1,023 $1,276 $1,336 $1,222 $1,351$1,331 $1,375 $1,480$1,464$1,457 $1,574$1,549$1,541 $2,658 $2,248 $2,487 $2,514 $2,392$2,387 $2,671

CY15 Average Approved Claims by Service Type and Age

Case Management Medication Support

Service Group

Case Management Medication Support Mental Health Services $0 70-74 75-79 8 0-84 60-64 55-59 65-69 85 + 70-74 75-79 80-84 60-64 55-59 65-69 85 + 70-74 75-79 80-84 60-64 55-59 65-69 85 +

The top three services were reported for this analysis in compliance with

  • HIPAA. Mental Health Services had the highest average approved claim per
  • beneficiary. Medication Support had the second highest average approved

claim per beneficiary across all age groups.

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Behavioral Health Concepts, Inc.

ACA POPULATION

Overall total ACA beneficiaries served, ACA Average Approved Claims , ACA population served by Service Type.

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Behavioral Health Concepts, Inc.

2,000 4,000 6,000 8,000 10,000 12,000 Beneficiaries Served 12,387 6,609 380

CY15 ACA Older Adults Served

Age Group

55-59 60-64 65-69 55-59 60-64 65-69

  • CY15 ACA Older Adult

population had the largest amount of beneficiaries who received services in the age range 55-59.

  • The age group 60-64 had

6,609 beneficiaries receive SDMC funded services.

  • The age group 65-69 have 380

beneficiaries receive SDMC funded services.

  • Age groups 70 and beyond

were not reported in compliance with HIPAA regulations.

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$500 $1,000 $1,500 $2,000 $2,500 $3,000 $3,500 Average Approved Claims $3,478 $2,518 $3,601

CY15 ACA Older Adult Average Approved Claims

Age Group

55-59 60-64 65-69 $0 55-59 60-64 65-69

  • CY15 ACA Older Adult population

had the highest average approved claim amount of $3,601 in the age range 55-59.

  • The age group 60-64 had an

average approved claim amount

  • f $3,478.
  • The age group 65-69 have an

average approved claim amount

  • f $2,518.
  • Age groups 70 and beyond were

not reported in compliance with HIPAA regulations

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Behavioral Health Concepts, Inc.

  • Mental Health Services had the highest amount of beneficiaries from the

ACA population at 14,212.

  • Medication Support and Case Management had the second and third

largest amount of beneficiaries served, 12,455 and 7,161.

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Discussion based on Questions from the Planning Council

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Questions

How do you define "older population"? What data do you collect that directly relates to the older population? Have you identified any counties that are providing exemplary programs for the older population? Have you identified any programs in the state that focus on providing specifically older adults with mental health and/or substance use disorders? Based on your research, what do you identify as the significant (mental health and substance use) issues for older adults?

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Questions

If EQRO does not collect data specific to the older adult population, is this an opportunity to introduce such data collection? Does BHC do any amalgamation of the data they gather from each county and analyze it for trends across the state? If BHC does notice trends, do they issue an annual report, and if so, who receives it? Is it available on line on their website? Are there in fact any trends that the Planning Council might want to be aware of? Does BHC do mentoring or technical support to counties to assist them in gathering date that is accurate and ultimately useful?

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Questions

If in the development of the American Health Care Act, if Medicaid is block granted to the States, will the EQRO still be an activity that the State might promote? Do you have targeted data information for specific age subgroups in the older adult population; e.g., ages 60-64; 65-69; 70-74; 75- 79, etc. Do you gather any information for single older males who may have a higher risk of suicide ideation/attempts? Is there any way to further break out data for Older Adults by age groupings 60- 65, 65-70, etc.? For example, variation between Older Adults at any given age range. With Children's data, we can break the data for 0-5, 5-11, etc. This is very helpful because there are more consistent developmental stages associated with Children's age ranges. And that doesn't exist with Older Adults.