The document summarizes information from the University of Missouri's 11th Annual Health Policy Summit. It discusses finding a model that aligns provider and patient interests, preventing chronic conditions and hospitalizations to reduce costs. It also shows data on Missouri's national health ranking decline since 1990, life expectancy and uninsured rates by county. It outlines Missouri's population management strategy and analyzes emergency department utilization trends by payer. Finally, it identifies high Medicaid emergency department utilization and cost "hot spots" by zip code and profiles high utilizing and costly Medicaid beneficiaries.

1. University of Missouri’s
Center for Health Policy
11th Annual Health Policy Summit
October 25, 2013

2. Holy Grail of Health Policymaking
Find a model that aligns the interests of health care providers
and patients.
Healthy Consumer
Continued Health
Preventable Condition
No Hospitalization
Efficient and Successful
Outcome
Acute Care Episode
High Cost and
Successful Outcome
Complications,
Infections,
Readmissions

3. Missouri’s National Health Ranking
Since 1990
Source: United Health Foundation, 2012 America’s Health Rankings

5. Life Expectancy and the Percent of the
Population Who Are Uninsured and
<138% FPL for Missouri Counties
Source: MO Dept. of Health and Senior Services and the U.S. Census Bureau

6. MO HealthNet Population Management
Strategy
L
o
w
Stratification
Well & Worried
Well
(80%)
Functionally
Chronically Ill
(15%)
Frail Ill & High Utilizers
(5%)
I
n
t
e
r
m
e
d
i
a
t
e
H
i
g
h
Well & Worried Well
330,639 Patients
80% of all Patients
19.2% of Charges
No Chronic
Conditions
Functionally
Chronically Ill
61,995 Patients
15% of all Patients
28.5% of all Charges
1 to 2 Chronic
Conditions
Frail Ill & High Utilizers
20,665 Patients
5% of all Patients
52.3% of Charges
3 or more Chronic
Conditions

7. Emergency Department Utilization
Percent Change Since 2004 by Payer

8. Missouri Psychiatric and Substance
Abuse ED Visits Percent Change
Since 2004 by Payer

9. Zip Code 63106: St. Louis
Place Neighborhood
•
•
•
•
Hot Spot Rank: 1st
Medicaid ED Visits: 5,879
Rate per 1,000: 537.2
Price: $3,938,385
Zip Code 64106: Forgotten
Homes Neighborhood Kansas
City, MO
•
•
•
•
Hot Spot Rank: 2nd
Medicaid ED Visits: 3,473
Rate per 1,000: 526.1
Price: $2,661,331
Zip Code 63857: Kennett, MO
*Ranked by 2011 Medicaid
ED Visits per 1000 in MO Zips
with over 500 Residents
•
•
•
•
Hot Spot Rank: 3rd
2011 Medicaid ED Visits: 5,708
Rate per 1,000: 461.7
Price: $2,706,106

10. Final Tally for 2011 (avg per beneficiary)
51 Individuals

3,662 ED Visits (71.8)
– $2,974,074 ($58,315)

366 IP Stays (8.3)
2011 Medicaid ED Frequent
Fliers Encounters and Costs
by Place of Service
$370,925
557
366
$1,932,536
– $1,932,536 ($43,921)

557 OP Visits (10.9)
– $370,925 ($7,728)
3,662
Total

$2,974,074
4,585 Encounters (90)
– $5,277,535 ($103,481)
Encounters
Costs
ED
IP
OP

11. Thank You
Questions?