Milliman, Inc., an independent actuarial consulting firm, uses AHRQ's Prevention Quality Indicators (PQIs) and Medical Expenditure Panel Survey (MEPS) data for some of its client projects. The firm's clients include payers and providers of health care services such as health plans, employers, State Medicaid plans, hospitals, provider groups, and disease management vendors.
Milliman encourages health plan and disease management clients to use the AHRQ PQI Web site. The PQI logic identifies admissions considered to be ambulatory care-sensitive admissions (ACSAs)—admissions that typically involve acute exacerbation of chronic conditions, which could be prevented with good outpatient care. Many health plans analyze inpatient stays by diagnosis-related group (DRG). The PQI coding logic shows how DRGs can be combined with ACSAs to identify potential opportunities for better patient management and reduction in ACSAs.
According to Kathryn Fitch, RN, MEd, Principal and Healthcare Management Consultant for Milliman, "For many clients, it's a way to gauge how effective they are in decreasing ACSAs.
We have also used AHRQ PQI measures to identify and compare efficiencies among health plans." Many health plan and disease management clients had been requesting valid and credible metrics to measure the effectiveness of their medical management efforts for chronically ill populations.
Clients were able to compare their current experiences and set targets for performance. These clients focused attention on more effective chronic disease management strategies aimed at reducing ACSAs. Monitoring the trend of these rates gives clients an indication of the success of their efforts.
In addition to using the AHRQ PQIs, Milliman also used MEPS data for a Families USA analysis project that sought to quantify the "hidden health tax" or costs that individuals and companies with health insurance pay in their premiums to make up for the care costs of the uninsured. In developing the estimates, the company used the 2006 MEPS-Household Component data to measure annual charges and expenditures for medical care and prescription drugs obtained by the full-year uninsured, partial-year uninsured, and full-year insured.
Based on these data—and data from other federal and private sources—Milliman estimated the total national cost of uncompensated care provided to the uninsured. It quantified that amount spread across the privately covered, non-Medicare, and non-Medicaid population. The estimated 2008 cost of uncompensated care for the uninsured came to $1,107 per privately insured family and $368 per privately insured individual annually.
The ACSA benchmarks that used the AHRQ PQIs can be seen at: http://www.milliman.com/expertise/healthcare/publications/rr/pdfs/ambulatory-care-sensitive-admission-RR01-01-09.pdf.
Impact Case Study Identifier: Multi-Center-10-01
AHRQ Products: MEPS, Prevention Quality Indicators
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