Older Adult Population Served by California’s Medi-Cal Specialty
Mental Health Services
Presented by BHC-CalEQRO
at California Mental Health Planning Council Quarterly Meeting,
San Jose, Ca
April 20, 2017
Saumitra SenGupta, Ph.D., Executive Director
Rachel Phillips, MS, Reporting Manager
Behavioral Health
Concepts, Inc.
Older Adult Data Analysis
• Population Analyzed
• Methodology
• Age Groupings
• Overall Results CY15
• Demographic Results CY15
• Gender Results CY15
• Service Category Results CY15
• ACA Results CY15
Behavioral Health
Concepts, Inc.
POPULATION
ANALYZED
Define SDMC, Age breakouts, Medi-Medi, ACA
Behavioral Health
Concepts, Inc.
Older Adult Age Groupings
• 55-59
• 60-64
• 65-69
• 70-74
• 75-79
• 80-84
• 85+
Behavioral Health
Concepts, Inc.
METHODOLOGY
Data comes from the 2015 SDMC and IPC approved claims.
Overall population totals are unduplicated by client index number.
Results by Service Type are unduplicated by services; such that one
person with multiple services are included. Results by Region and Size
follow the same method as Service Type to account for beneficiaries
receiving services in multiple regions or those who move throughout the
year.
Behavioral Health
Concepts, Inc.
CY15 Medi-Medi Population
• Total
unduplicated
count age 55
and over is
69,087.
• Medi-Medi in
the CY15 total
is 30,956.
• Medi-Cal in the
CY15 total is
38,131.
Behavioral Health
Concepts, Inc.
CY15 Medi-Medi Younger than 65
• Medi-Medi under age
65 is 15,347.
• Medi-Cal under the
age 65 is 35,172.
Behavioral Health
Concepts, Inc.
CY15 Medi-Medi Age 65 and Over
• Medi-Medi age 65 and
over is 15,609.
• Medi-Cal age 65 over is
2,959.
Behavioral Health
Concepts, Inc.
OVERALL ANALYSIS
Number of beneficiaries served aged 55 and older.
Average approved SDMC dollars for 55 and older.
Results at the Statewide, Region, and Size levels.
Behavioral Health
Concepts, Inc.
CY15 Older Adult Age Groups Served
Age Group
30,000
55-59
28,854
60-64
65-69
70-74
25,000
75-79
80-84
21,660
85 +
Beneficiaries Served
20,000
• Age group 55-59 had
the largest number of
individuals who
received services.
15,000
10,429
10,000
5,000
4,315
2,167
996
664
0
55-59
60-64
Behavioral Health
Concepts, Inc.
65-69
• Ages 55-69 account for
the majority of older
adults who received
mental health services
funded by SDMC in
2015.
70-74
75-79
80-84
85 +
• Ages 80 and beyond
had the fewest services
compared to the other
older adult age groups
CY15 Average Approved Claims by Older Adult Group
$10,000
Age Group
55-59
60-64
65-69
70-74
75-79
80-84
Average Approved Claims
85 +
• Age group 55-59 had the
highest average approved
claims amount.
$5,000
$4,574
$4,481
$4,524
$4,110
$4,170
$3,786
$3,188
$0
55-59
60-64
Behavioral Health
Concepts, Inc.
65-69
• The average approved
claim amount between
the age groups ranges
from $3,188 to $4,574.
70-74
75-79
80-84
85 +
• Age group 85+ had the
lowest average approved
claims amount.
CY15 Older Adult Served by Region
Region
25,000
•
The unduplicated
number of older
adults served in CY15
totals 69,087.
•
The number of older
adults served across
California’s regions is
greatest in LA.
•
The Southern and Bay
Area regions have
comparable numbers
of beneficiaries
served.
•
Superior has the
fewest number of
older adults served.
Los Angeles
23,606
Southern
Bay Area
Central
Superior
20,000
16,861
Beneficiaries Served
15,923
15,000
10,000
9,508
5,000
2,889
0
Los Angeles
Behavioral Health
Concepts, Inc.
Southern
Bay Area
Central
Superior
CY15 Older Adult Average Approved Claims by Region
Region
Bay Area
$6,131
Superior
$6,000
Los Angeles
Southern
• The CY15 Statewide average
approved claim amount is
$4,023.
Central
$5,000
Average Approved Claims
$4,021
$4,000
$3,562
$3,207
$3,012
$3,000
• The Bay Area has the
greatest amount of average
approved claims for older
adults, with the value of
$6,131.
• The Central region has the
lowest amount of average
approved claims for older
adults, with the value of
$3,012.
$2,000
$1,000
$0
Bay Area
Superior
Behavioral Health
Concepts, Inc.
Los Angeles
Southern
Central
CY15 Older Adult Served by Size
35,000
MHP Size
Large
Very-Large
31,147
Medium
30,000
Small
Small-Rural
25,000
• Very-Large MHP (LA) served
the second highest number
of beneficiaries.
23,606
20,000
• Small-Rural has the fewest
number of older adults
served.
15,000
9,767
10,000
5,000
3,297
968
Large
Very-Large
Behavioral Health
Concepts, Inc.
• The number of older adults
served is greatest in the
Large Sized MHP’s.
Medium
Small
Small-Rural
CY15 Older Adult Average Approved Claims by Size
MHP Size
$5,500
Medium
$5,423
Large
Very Large
$5,000
Small
Small-Rural
$4,500
$4,242
• The average approved
claims amounts
($5,423) for older adults
is greatest in the in the
Medium Sized MHP’s.
$4,000
Average Approved Claims
$3,562
$3,427
$3,500
$3,000
$2,890
$2,500
• Large MHP has the
second greatest amount
of approved claims
dollars ($4,242).
$2,000
• Small-Rural has the
lowest average
approved claim amount
($2,890) for older adults
served.
$1,500
$1,000
$500
$0
Medium
Large
Behavioral Health
Concepts, Inc.
Very Large
Small
Small-Rural
RACE/ETHNICITY
ANALYSIS
Total Served Age 55+ by Race Group
Average Approved Claims Age 55+ by Race Group
Total Served in each Older Age Group by Race Group
Average Approved Claims in each Older Age Group by Race Group
Age groups 75-79, 80-84, and 85+ have been removed from this
section’s analysis to due HIPAA regulations.
Behavioral Health
Concepts, Inc.
CY15 Older Adults Served by Race/Ethnicity
30,000
Racegrp
White
26,713
•
Other
African-American
25,000
Hispanic
The number of White
older adults served in
CY15 was 26,713.
Asian-Pacific Islander
Native American
•
The number of
African American
older adults served in
CY15 was 11,092.
•
The number of
Hispanic older adults
served in CY15 was
10,709.
•
The number of Asian
Pacific Islander older
adults served in CY15
was 7,669.
•
The number of Native
American older adults
served in CY15 was
429.
Beneficiaries Served
20,000
15,000
12,473
11,092
10,709
10,000
7,669
5,000
429
0
White
Other
Behavioral Health
Concepts, Inc.
African-Amer..
Hispanic
Asian-Pacific
Islander
Native
American
CY15 Older Adult Average Approved Claims by Race/Ethnicity
Racegrp
$5,000
$4,749
$4,623
White
$4,447
$4,500
•
African-American
$4,701
Other
Native American
Asian-Pacific Islander
$4,000
Hispanic
$3,500
$3,220
•
Native American’s had an average
approved claim amount
comparable to African-Americans
and Whites at a value of $4,623.
•
Asian Pacific Islander’s had an
average approved claim amount
of $3,220.
•
Hispanic’s had the lowest average
approved claim amount at a value
of $3,108.
•
Others’ had an average approved
claim amount of $4,447.
Average Approved Claims Amount
$3,108
$3,000
$2,500
$2,000
$1,500
$1,000
$500
$0
African-Am..
White
Behavioral Health
Concepts, Inc.
Other
Native
American
AsianPacific..
Hispanic
African American and White
Race/Ethnicity groups have the
highest and similar average
approved claim amounts; $4,749
and $4,701.
CY15 Beneficiaries Served by Age Group and Race/Ethnicity
Age Group
55-59
Racegrp
Racegrp
White
Other
Hispanic
4,269
Asian-Pacific Isla..
Asian-Pacific Islander
2,613
Native American
Native American
181
White
8,410
Other
4,035
African-American
3,436
Hispanic
3,005
Asian-Pacific Isla..
2,607
Native American
167
White
4,347
Other
1,855
African-American
1,333
Hispanic
1,639
Asian-Pacific Isla..
Native American
70-74
African-American
5,595
Hispanic
65-69
Other
5,447
African-American
60-64
1,201
54
White
1,789
Other
671
African-American
449
Hispanic
835
Asian-Pacific Isla..
Native American
White
10,749
559
12
0
2,000
4,000
6,000
8,000
10,000
12,000
14,000
Beneficiaries Served
• In all age groups, White beneficiaries received the highest number of services.
• In the age groups between 55-64, African-American beneficiaries received
more services than Hispanic, and in age groups 65-74 Hispanics received more
services than African-Americans.
• Native-Americans received the fewest number of services in all age groups.
• Asian Pacific Islander beneficiaries received the second to last number of
services across all age groups.
Behavioral Health
Concepts, Inc.
CY15 Beneficiaries Served by Age Group and Race/Ethnicity
Age Group
Racegrp
55-59
White
Age Group
Native American
65-69
$4,601
Other
$3,833
Asian-Pacific Islander
$3,088
$4,949
White
Native American
$5,222
African-American
$4,584
Other
$4,863
$3,973
Hispanic
Asian-Pacific Islander
$2,782
$5,372
White
Native American
$4,700
African-American
$4,642
Other
$4,693
$2,926
Hispanic
Asian-Pacific Islander
70-74
70-74
$4,896
Hispanic
65-69
60-64
$4,915
African-American
60-64
55-59
$5,046
$3,235
$4,671
White
Native American
$4,555
African-American
$4,883
Other
$4,202
$2,966
Hispanic
Asian-Pacific Islander
$3,286
$0
$500
$1,000
$1,500
$2,000
$2,500
$3,000
$3,500
$4,000
$4,500
$5,000
$5,500
Average Approved Claims
• In age group 55-59 Whites accounted for the highest average approved claim
amount at $4,915.
• Age group 60-64 Native Americans accounted for the highest average
approved claim amount at $5,222.
• Age group 65-69 Whites accounted for the highest average approved claim
amount at $5,372.
• Age group 70-74 African Americans accounted for the highest average
approved claim amount at $4,883.
Behavioral Health
Concepts, Inc.
GENDER ANALYSIS
Total Served Age 55+ by Gender
Average Approved Claims Age 55+ by Gender
Total Served in each Older Age Group by Gender
Average Approved Claims in each Older Age Group by Gender
Behavioral Health
Concepts, Inc.
CY15 Older Adult Beneficiaries Served by Gender
50,000
Gender
Female
Male
45,000
40,807
• The number of Female older
adults served in CY15 was
40,807.
40,000
Beneficiaries Served
35,000
30,000
28,278
• The number of Male older
adults served in CY15 was
28,278.
25,000
20,000
15,000
10,000
5,000
0
Female
Behavioral Health
Concepts, Inc.
Male
CY15 Adult Average Approved Claims by Gender
Gender
$4,500
$4,331
Female
Male
$4,000
$3,968
• The average approved claim
amounts for Female older
adults served in CY15 was
$3,968.
$3,500
Average Approved Claims
$3,000
• The average approved claim
amounts for Male older adults
served in CY15 was $4,331.
$2,500
$2,000
$1,500
• Male beneficiaries had a
greater average approved claim
amount than Females.
$1,000
$500
$0
Female
Behavioral Health
Concepts, Inc.
Male
CY15 Older Adults Served by Age Group and Gender
Female
Gender
Male
Female
Male
16,181
16,000
14,000
12,673
12,671
Beneficiaries Served
12,000
10,000
8,989
8,000
6,470
6,000
3,959
4,000
2,832
2,000
1,483
1,483
679
684
491
317
173
80-84
85 +
0
55-59
60-64
65-69
70-74
75-79
80-84
85 +
55-59
60-64
65-69
70-74
75-79
• Females in most age groups received more services than males.
• The number of Males and Females receiving SDMC funded services decline
around age 65.
Behavioral Health
Concepts, Inc.
CY15 Average Approved Claims by Age Group and Gender
Female
Gender
Male
Female
$10,000
Male
$5,105
$5,000
$4,158
$4,142
$4,171
$4,033
$4,959
$5,101
$4,258
$4,156
$4,201
$3,948
$3,437
$3,165
$3,253
$0
55-59
60-64
65-69
70-74
75-79
80-84
85 +
55-59
60-64
65-69
70-74
75-79
80-84
85 +
The average approved claim amounts between age groups are slightly
higher in Male beneficiaries.
Behavioral Health
Concepts, Inc.
SERVICE TYPE ANALYSIS
Total Served Age 55+ by Service Type
Average Approved Claims Age 55+ by Service Type
Total Served in each Older Age Group by Service Type
Average Approved Claims in each Older Age Group by Service Type
Behavioral Health
Concepts, Inc.
CY15 Older Adults Served by Service Type
55,000
Service Group
Medication Support
50,000
49,884
Mental Health Services
47,812
Case Management
Crisis Intervention
45,000
Crisis Stablization
Inpatient Services
40,000
Residential Services
Day Treatment
Beneficiaires Served
35,000
29,881
30,000
25,000
20,000
15,000
10,000
6,270
4,576
5,000
4,134
816
0
Medication
Support
Mental Health
Services
Case
Management
Crisis
Intervention
Crisis
Stablization
Inpatient
Services
Residential
Services
163
Day Treatment
• The top three types of services in CY15 for older adults were Med
Support, Mental Health Services, and Case Management.
• Residential Services and Day Treatment had the lowest utilization.
Behavioral Health
Concepts, Inc.
CY15 Average Approved Claims by Service Type
Service Group
Inpatient Services
$12,259
•
Residential Services
$12,000
Day Treatment
Crisis Stablization
Mental Health Services
$10,000
Medication Support
Case Management
$8,761
Crisis Intervention
$7,861
$8,000
Inpatient Services
had the highest
average approved
claim amount in
older adults, with a
value of $12,259.
•
Residential Services
and Day Treatment
had were the second
highest cost, though
they were the least
utilized.
•
Mental Health
Services ($2,480),
Medication Support
($1,491) and Case
Management
($1,235) had lower
cost though higher
use.
$6,000
$4,000
$2,507
$2,480
$2,000
$1,491
$1,235
$1,106
$0
Inpatient Residential
Day
Crisis Stab
Services
Services Treatment
lization
Behavioral Health
Concepts, Inc.
Mental
Health ..
Medication Case Mana Crisis Inter
Support
gement
vention
CY15 Beneficiaries Served by Service Type and Age Group
Case Management
Medication Support
Age Group
Mental Health Services
55-59
25,000
60-64
65-69
21,787
70-74
75-79
19,766
20,000
80-84
85 +
16,169
Beneficiaries Served
15,054
15,000
12,024
10,000
9,026
7,292
7,036
5,065
5,000
3,002
2,747
2,050
431
0
55-59 60-64 65-69 70-74 75-79 80-84
•
•
•
1,541
1,282
1,017
268
545
85 + 55-59 60-64 65-69 70-74 75-79 80-84
318
706
451
85 + 55-59 60-64 65-69 70-74 75-79 80-84 85 +
The top three services were reported for this analysis in compliance
with HIPAA.
Medication Support had the highest amount of beneficiaries.
Case Management was the third highest.
Behavioral Health
Concepts, Inc.
CY15 Average Approved Claims by Service Type and Age
Case Management
Medication Support
Service Group
Mental Health Services
Case Management
$3,000
Medication Support
$2,671
$2,487
$2,500
Mental Health Services
$2,658
$2,514
$2,392$2,387
$2,248
Average Approved Claims
$2,000
$1,574 $1,549 $1,541
$1,480$1,464$1,457
$1,500
$1,351$1,331
$1,276
$1,375
$1,336
$1,222
$1,107
$1,023
$1,000
$500
$0
70-74 75-79 8 0-84 60-64 55-59 65-69
85 + 70-74 75-79 80-84 60-64 55-59 65-69
85 + 70-74 75-79 80-84 60-64 55-59 65-69 85 +
The top three services were reported for this analysis in compliance with
HIPAA. Mental Health Services had the highest average approved claim per
beneficiary. Medication Support had the second highest average approved
claim per beneficiary across all age groups.
Behavioral Health
Concepts, Inc.
ACA POPULATION
Overall total ACA beneficiaries served, ACA Average Approved Claims ,
ACA population served by Service Type.
Behavioral Health
Concepts, Inc.
CY15 ACA Older Adults Served
Age Group
55-59
12,387
60-64
12,000
65-69
Beneficiaries Served
10,000
• CY15 ACA Older Adult
population had the largest
amount of beneficiaries who
received services in the age
range 55-59.
• The age group 60-64 had
6,609 beneficiaries receive
SDMC funded services.
8,000
6,609
6,000
• The age group 65-69 have 380
beneficiaries receive SDMC
funded services.
4,000
2,000
380
0
55-59
Behavioral Health
Concepts, Inc.
60-64
65-69
• Age groups 70 and beyond
were not reported in
compliance with HIPAA
regulations.
CY15 ACA Older Adult Average Approved Claims
Age Group
55-59
$3,601
$3,478
$3,500
60-64
65-69
$3,000
$2,518
Average Approved Claims
$2,500
$2,000
• CY15 ACA Older Adult population
had the highest average
approved claim amount of
$3,601 in the age range 55-59.
• The age group 60-64 had an
average approved claim amount
of $3,478.
• The age group 65-69 have an
average approved claim amount
of $2,518.
$1,500
$1,000
$500
$0
55-59
Behavioral Health
Concepts, Inc.
60-64
65-69
• Age groups 70 and beyond were
not reported in compliance with
HIPAA regulations
• Mental Health Services had the highest amount of beneficiaries from the
ACA population at 14,212.
• Medication Support and Case Management had the second and third
largest amount of beneficiaries served, 12,455 and 7,161.
Behavioral Health
Concepts, Inc.
Discussion based on
Questions from the
Planning Council
Behavioral Health
Concepts, Inc.
Questions
How do you define "older population"?
What data do you collect that directly relates to the older population?
Have you identified any counties that are providing exemplary programs
for the older population?
Have you identified any programs in the state that focus on providing
specifically older adults with mental health and/or substance use
disorders?
Based on your research, what do you identify as the significant (mental
health and substance use) issues for older adults?
Behavioral Health
Concepts, Inc.
Questions
If EQRO does not collect data specific to the older adult population, is
this an opportunity to introduce such data collection?
Does BHC do any amalgamation of the data they gather from each
county and analyze it for trends across the state?
If BHC does notice trends, do they issue an annual report, and if so, who
receives it? Is it available on line on their website?
Are there in fact any trends that the Planning Council might want to be
aware of?
Does BHC do mentoring or technical support to counties to assist them
in gathering date that is accurate and ultimately useful?
Behavioral Health
Concepts, Inc.
Questions
If in the development of the American Health Care Act, if Medicaid
is block granted to the
States, will the EQRO still be an activity that the State might promote?
Do you have targeted data information for specific age subgroups in the older adult
population; e.g., ages 60-64; 65-69; 70-74; 75- 79, etc.
Do you gather any information for single older males who may have a higher risk of suicide
ideation/attempts?
Is there any way to further break out data for Older Adults by age groupings 60- 65, 65-70, etc.?
For example, variation between Older Adults at any given age range. With Children's data, we
can break the data for 0-5, 5-11, etc. This is very helpful because there are more consistent
developmental stages associated with Children's age ranges. And that doesn't exist with Older
Adults.
Behavioral Health
Concepts, Inc.