Healthcare Payment Systems

CHSRA provides systems development, modeling, and analytical services to support Wisconsin Medicaid LTC programs. This includes:

  • Modeling nursing home utilization and costs for use in rate setting and managing the Medicaid nursing home payment system
  • Maintaining a database of nursing home cost reports and rate schedules (Orbs)
  • Maintaining a database of nursing home resident case mix information (RUGs) based on resident assessment data (MDS)
  • Analyzing managed LTC service encounter data, including both institutional and residential care services
  • Developing and evaluating pay for performance models
  • Other analytic support, as needed

-+ Orbs

The Orbs website was designed by CHSRA to support the Wisconsin Division of Long Term Care (DLTC) Medicaid rate setting process for institutional providers. Medicaid Cost Reports are an essential component for calculating Medicaid Long Term Care payments to skilled nursing facilities and intermediate care facilities for individuals with intellectual disabilities.

Project Duration: 2004 - present

Primary Personnel

Principal Investigator: Jim Robinson
Contact: Orbs helpdesk

Sponsoring Agency

Wisconsin Department of Health Services, Division of Long Term Care

Links

Orbs website
Wisconsin Department of Health Services, Division of Long Term Care

-+ Medicaid Interagency Services Agreement

CHSRA provides and assists Medicaid in: research, analyses, policy development, quality initiatives, project management, and medical & behavioral health consulting. Broadly this includes:

  • Modeling health care utilization and costs for use in rate setting and managing the various health care programs operated by DHS
  • Providing ongoing professional medical, pharmaceutical and project management consultation services
  • Serving as a liaison and providing access to University of Wisconsin resources, as needed
  • Other analytic support and requested research

Examples of recent evidence based Medicaid consultation, analysis and policy support research:

  • Ambulatory Sensitive Conditions
  • Anti-psychotic prescribing
  • C- Section & adverse outcome births (LBW)
  • Episode Treatment Groups
  • Evaluate single-specialty Health Homes
  • Excessive use of CAT, PET imaging
  • Gender bias in AIDS/HIV care
  • HEDIS measures
  • High Impact Procedures & Pharm. prescribing patterns
  • Hospital Readmits within 2-30 days by DX and DRG
  • Medicare - Medicaid price rationalization
  • Medicare “never events”
  • Multiple billings within 24 Hrs. for single ER visits
  • Multiple ER visits (e.g. Mental health, pain patients)
  • Prioritizing health services (e.g. Oregon state)

Project Duration: 7/1/2008 - present

Primary Personnel

Principal Investigator: Robert Stone Newsom
Contact Person: Robert Stone Newsom

Sponsoring Agency

DHS, Division of Medicaid Services, Formerly DHCAA – Division of Health Care Access and Accountability.

Links

Centers for Medicare and Medicaid Services (CMS)
DHS, Division of Medicaid Services

Presentations/Publications

Research & Publications, State of Wisconsin Bureau of Benefits Management, Division of Health Care Access & Accountability (DHCAA) Medicaid Division

  • Newsom, RS. “Wisconsin Medicaid AIDS/HIV Health Home SPA Two Years Post-Implementation: Effects of Beneficiaries Gender, Age, County, and Persistent FFS / HMO Membership on Costs, Utilization and Chronic Disease.” Center for Health Systems Research & Analysis, V1.0, UW-Madison, under contract with the Bureau of Benefits Management, DHCAA, State of Wisconsin, 4/1/16
  • Newsom RS, “Exploration of Evaluative Analyses & Methods: Claims-Based Options for the AIDS/HIV-Medicaid Health Home SPA, Exploring FFS Medicaid External Control Groups, Study II, 11/2014. Also the Urban Institute, Feb. 2015 and the National Academy for State Health Policy, Aug. 2015
  • Newsom, RS “Exploration of Evaluative Analyses & Methods: Claims-Based Options for the AIDS/HIV-Medicaid Health Home SPA, CDPS revision, Study 1, 7/25/14. Also the Urban Institute, Feb. 2015.
  • Newsom, RS "WI Medicaid Super-Utilizer Populations: Report I History, Methods, Data strategies". Research report, prepared for Director, WI Bureau of Benefits Management, DHCAA. Jan., 2014.
  • Newsom, Kilburn. "Finding Value & Cost savings by Reducing Payment Variation" A White Paper". Prepared for WI Bureau of Benefits Management, DHCAA Sept, 2013.

Selected white papers, original research & analyses: State of Wisconsin Medicaid Program (Proprietary to WI Division of Health Care Access & Accountability)

  • Newsom, “Healthcare Cost Variation Effect on Value Measurement” , DHCAA Management Team, 2013
  • Newsom, Kilburn “Identification and Amelioration of High Impact Procedure Codes” , DHCAA Management Team, 2013
  • Newsom, Kilburn “Multiple ER Visits (e.g. Mental health, pain patients)”, , DHCAA Management Team, 2010, 2012
  • Newsom, Collins “WI Anti-psychotic Drug Prescribing”, , DHCAA Management Team, 2012
  • Newsom, “ER use for Dental Related Services”, DHCAA Management Team, 2011
  • Newsom, “Trends in the Overall Performance of Wisconsin’s Family Care and Waiver Medicaid populations” DHCAA Management Team, 2011
  • Newsom, “Episode Treatment Groups” , DHCAA Management Team, 2010
  • Newsom, “HEDIS Measures”, DHCAA Management Team, 2010
  • Newsom, Kilburn “Ambulatory Sensitive Conditions”, DHCAA Management Team, 2010
  • Newsom, Kilburn “Multiple Billings within 24 Hours for Single ER visits” , DHCAA Management Team, 2010
  • Newsom, Kilburn “Reverse engineering, adaptation and simulation on past WI Medicaid data of the State of Oregon Health Services Commission: Prioritization of Health Services plan software application” WI DHHS, 2010
  • Newsom, Kilburn, Beutel “C- Section & Adverse Outcome Births (LBW)” , DHCAA Management Team, 2010
  • Newsom, “Medicare - Medicaid Price Rationalization”, , DHCAA Management Team, 2009
  • Newsom, “Uses of the Oregon Priority List ” , DHCAA Management Team, 2009
  • Newsom, “Medicare Never Events” , DHCAA Management Team, 2009
  • Newsom, Kilburn, Collins “High Impact Procedures & Pharmacy Prescribing Patterns” , DHCAA Management Team, 2009
  • Newsom, Kilburn “Excessive Use of CAT, PET imaging” , DHCAA Management Team, 2009
  • Newsom, Kilburn “Hospital Readmits within 2-30 days by DX and DRG” , DHCAA Management Team, 2009

Consultant Publications as Robert Stone Newsom, PhD

-+ National Association of Health Data Organizations (NAHDO)

CHSRA provides scientific expertise to the National Association of Health Data Organizations (NAHDO). NAHDO is a non-profit member organization of state health data agencies, hospital associations, and other non-profit groups that collect and analyze health data for state reporting. CHSRA projects for NAHDO include providing state technical assistance via toolkits and translational white papers, statistical consulting, data collection design, data linkage with surveillance data, research on Medicaid information systems.

Project Duration: 10/1/2004 – present

Primary Personnel

Principal Investigator: Barbara A. Rudolph, Ph.D., MSSW
Contact: Barbara A. Rudolph

Sponsoring Agency

National Association of Health Data Organizations (NAHDO)

Funding Source

Centers for Disease Control, the Agency for Healthcare Research and Quality (AHRQ), State Departments of Health in Mississippi and Washington, and The Robert Wood Johnson Foundation

Links

National Association of Health Data Organizations (NAHDO)
Centers for Disease Control
Agency for Healthcare Research and Quality (AHRQ)
State Department of Health in Mississippi
State Department of Health in Washington
Robert Wood Johnson Foundation

Presentations/Publications

  • Welch, W.P., Harmon, R.G., Shah, M., Love, D., Rudolph, B.A., Blewett, L.A., Johnson, K., and Parente, S.T. (2005). Management Tools for Medicaid and State Children's Health Insurance Program (SCHIP): An Assessment Focusing on the Use of Administrative Data on Ambulatory Care. Contract No. 290-00-0012, Task#10, Agency for Health Care Research and Quality.
  • Rudolph, B.A., Shah, G., and Love, D. (2006). Small Numbers, Disclosure Risk, Security and Reliability Issues in Web-based Data Query Systems. J. Public Health Management Practice, 12(2), 175-182.
  • Welch, W.P., Rudolph, B.A., Blewett, L.A., Parente, S.T., Brach, C., and Love, D. (2006). Management Tools for Medicaid and State Children's Health Insurance Program (SCHIP). The Journal of Ambulatory Care Management, October-December, Vol. 29, Number 4, 272-282.
  • Rudolph, B.A., Presentation: Quality and Safety Transparency: The Public Reporting Landscape. Colorado Health Institute Summit, Denver, CO. March 2006.
  • Rudolph, B.A. Implementing Cost-to-Charge Ratios. Conference Call Presentation for HCUP Partners, HCUP Technical Support Task Order, AHRQ, July 26, 2006.

-+ Long Term Care Waiver Rate Setting Corrective Action Planning

Project Duration: 2016-2018