Total medical payments in Study Group 2 rose in 1993
by 8.8 percent,
from $3.8 million to $4.1 million.
This is in comparison to the
14.5%
rise
in the expected value, from $5.1 million to $5.9 million.
If current trends continue, total payments in 1994
will be $2.1 million below the expected value.
Actual and expected values for total medical payments:
As indicated by the key findings below, the intervention area requiring most attention for Study Group 2 is that of utilization management.
Key Findings
Utilization Management:
-
Average length of stay in
All Inpatient Admissions
rose
45.7 percent,
from 4.3 days to 6.2 days.
Around $934,000 could have been saved if
average length of stay had been equal to
the expected value of 4.8 days.
If current conditions continue into the next period,
this trend will result in
$2.3 million
of additional expenses.
Recommendation:
Review the utilization concurrent review program for length of stay. Because there are care management programs that are condition specific, e.g. mental health, catastrophic, you should check to see if KeFiR key findings surface by benefit area or by MDC.
This will help to target an intervention.
Projected savings:
$699,000 (based on an expected payoff of
30%).
-
Average length of stay in
Mental Health Admissions
rose
657.9 percent,
from 9.5 days to 72.0 days.
Around $311,000 could have been saved if
average length of stay had been equal to
the expected value of 11.2 days.
If current conditions continue into the next period,
this trend will result in
$632,000
of additional expenses.
Recommendation:
Utilization review, particularly in the area of concurrent review, needs attention.
Projected savings:
$505,000 (based on an expected payoff of
80%).
-
Average length of stay in
High-cost Admissions
rose
93.6 percent,
from 16.8 days to 32.5 days.
If current conditions continue into the next period,
this trend will result in
$956,000
of additional expenses.
Recommendation:
Concurrent review of high-cost cases for length of stay.
Projected savings:
$383,000 (based on an expected payoff of
40%).
-
Admission rate (per 1000) in
High-cost Admissions
rose
34.3 percent,
from 5.5 to 7.4.
If current conditions continue into the next period,
this trend will result in
$505,000
of additional expenses.
Recommendation:
Most high cost cases require intensive services, including hospitalization. The best way to reduce utilization is to prevent it through early intervention programs and primary prevention. Even high cost cases that may be due to a car accident could be pre
ented with good driver safety information on the use of seatbelts..
Projected savings:
$253,000 (based on an expected payoff of
50%).
Case Management:
-
Payments per capita in
High-cost Behavioral Admissions (MDC 19,20)
rose
1248.9 percent,
from $4 to $58.
If current conditions continue into the next period,
this trend will result in
$282,000
of additional expenses.
Recommendation:
Behavioral case management should be implemented.
Projected savings:
$169,000 (based on an expected payoff of
60%).
KEFIR Report Copyright © 1995 GTE Laboratories Incorporated
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