Meeting Summary: September 20, 2005

Chair: Paula Armbruster

Next meeting: Thursday October 20 (instead of 10-13) at 9 AM. Room TBA.

Presetn: P. Armbruster (Chair), Dr. A. Geertsma, Dr.D. Balaski (DSS), Dr. E.Kamens, E. Semeraro (HN), J.Piper (CHNCT), L. Casey & P. Kiniry(PONE), M.A.Lee (CTVoices),M.Mcourt (Staff).

Department of Social Services Update

Ø Lead Data Match with DPH & DSS

Dr. Donna Balaski (DSS) reviewed the 2004 lead data received from DPH June 30, cross-linked with the managed care organizations at the end of July and then distributed to the MCOs. The data identified MCO members that still require testing and the lead levels of those already tested. Summary of information presented:

Percent of children < 6 years who still require testing, by MCO:

• Anthem – 33%

• CHNCT –26%

• Health Net – 32%

• Preferred One (PONE) – 24%

• National average-45%

2004 lead levels for HUSKY A children up to age 10 years (unduplicated count at the highest recorded blood lead level):

• 10-19.99 mcg/dl – 1338 HUSKY A children

• 20-29.99 mcg/dl –313 HUSKY A children

• 30-39.99 mcg/dl –116 HUSKY A children

• 49-99 mcg/dl –48 HUSKY A children

• >50 mcg/dl –35 HUSKY A children

• > 100 mcg/dl –2 HUSKY A children

Dr. Balaski will meet with the MCOs October 6^th to discuss the LAMPP lead abatement program, communication process between MCO and provider about tests done and results and identify MCO” best practices” in improving the percentage of their members that have age-appropriate lead tests.

Discussion points:

ü It was noted that there are testing differences by provider sites and geographic areas (i.e. urban, suburban, rural).

ü MCOs should identify Medicaid providers that are not providing age-appropriate lead screens, as they are non-compliant with Medicaid rules for universal testing in Medicaid programs.

ü DPH may want to monitor the quality of lab reports sent to them.

ü The shared lead data provides an opportunity for process and outcome measurements.

Ø EPSDT forms update:

o The form content is complete; DSS staff external to HUSKY is working on the form format.

o Bulletin that EDS will send to Medicaid providers regarding the forms is being reviewed.

o The health plans in attendance each said they would put the forms on-line for practitioner use.

Ø 2003 Preventive report for adult services update:

o Hilary Silver is working with MCOs to ensure the reports capture all services, including behavioral health.

Discussion points:

ü Interested in learning who gets services for what, who doesn’t.

ü Useful to link parent/child utilization through head-of-household identifier, as 15% of continuously enrolled children do not have evidence (CTVoices data) of ambulatory services: 5% of these children receive some services and 10% have no encounter listed in a year period. Is there a relationship of families under-utilizing the HUSKY program versus children and/or the adult?

ü Children may be more connected to a primary care provider. Traditionally, older youth and adults seem to be less involved with a consistent primary care provider.

ü The three plans attending noted that they are increasing and/or revamping their ‘outreach’ activities, hiring dedicated staff to follow-up with members that haven’t had a PCP visit 5 months after enrollment. CHNCT and PONE have also developed disease management (DM) programs (Health Net & Anthem had DM programs).

Escalating Emergency Room Use in HUSKY A

Data presented by DSS at the September 2005 Council meeting showed that HUSKY A ED use:

• Is more than double that of HUSKY B children (59/1000MM versus 24/1000MM). This is puzzling since both programs share the same health plans, same provider network and both are reimbursed based on the Medicaid rates.

• CTVoices reports have found that ED use is greater for Hispanic children than White or African American (AA) children; however AA and Hispanic children with asthma are more likely to use the ED than asthmatic White children.

• In the beginning of the managed care program, ED rates averaged 29.8 to 33.3 visits/1000MM, well under the 1994 Fee-for-service rate of 72 visits/1000MM. Access to primary care was thought to decrease ED use.

o Late in 1998 the average ED visit rate climbed to 41.9 – 47 visits/1000MM.

o In 2000 the rates were steady at 49.5-49.7 visits/1000MM.

o In 2002 and 2003 the rates increased up to 56.5 visits/1000MM

o By the October 2004 to March 2005 time period ED visits were at close to 60 visits/1000MM. The latter translates into 720/1000 members used the ED during that 6-month period.

The Council requested the QA subcommittee review this further and report back to the Council.

Discussion led to the following information requests:

ü % Of providers in MCO plan by practice site that have evening or off-hour availability.

ü ED visit patterns by Age group (children and adults) and common adult diagnoses.

ü How does each MCO analyze their Ed utilization trends? Can they identify ‘frequent’ ED users? If so, what do they do.

ü How does DSS analyze the growing ED utilization trends?

ü Is there data from focus groups on this topic, if not, how could this be done to inform us about the member perspective.

The Subcommittee will meet on October 20 (changed from October 13). The agenda items will include:

Ø Further DSS discussion of 1) the results of the 10/6 MCO lead meeting, 2) who are the adults not using any health services in HUSKY A.

Ø Emergency Room utilization: MCO, DSS

Ø Women’s Health Forum Plans

Ø CTVoices Reports.