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Monitoring Access to

Care in New Hampshires


Medicaid Program
Review of Key Indicators June 2012

AReportPreparedbytheOfficeofMedicaidBusinessandPolicy
NewHampshireDepartmentofHealthandHumanServices

NicholasA.Toumpas,Commissioner
NewHampshireDepartmentofHealthandHumanServices

KathleenA.Dunn,MPH
MedicaidDirector

MarileeNihan,M.B.A.
MedicaidFinanceDirector
June22,2012

TheDepartmentofHealthandHumanServicesMissionistojoincommunitiesandfamilies
inprovidingopportunitiesforcitizenstoachievehealthandindependence

Acknowledgements
ThisreportwaswrittenbytheOfficeofMedicaidBusinessandPolicy,NewHampshireDepartmentof
HealthandHumanServices.Contributorsincludethefollowing:

AndrewChalsma,Chief,BureauofHealthCareAnalyticsandDataSystems

FarzanaAlamgir,SeniorManagementAnalyst

AndreaStewart,BusinessSystemAnalyst

CarolynRichards,BusinessSystemAnalyst

BetsyHippensteel,Administrator,NewHampshireMedicaidClientServices

ValerieBrown,SeniorMedicaidBusinessSystemAnalyst

RobinCalley,ProgramAssistant

CrystalIngerson,BusinessAdministrator

ValerieReed,UniversityofNewHampshire

Withassistancefrom:

JeanSullivan,AssociateViceChancellor,UniversityofMassachusetts,CenterforHealthLawand
Economics

DeborahBachrach,Manatt,Phelps&Phillips

MelindaDutton,Manatt,Phelps&Phillips

MONITORINGACCESSTOCAREINNEWHAMPSHIRESMEDICAIDPROGRAM:REVIEWOFKEYINDICATORS,JUNE2012

NewHampshireDepartmentofHealthandHumanServices
OfficeofMedicaidBusinessandPolicy

Table of Contents
1. Introduction

2. Methodology

3. DataandAnalysis

NewHampshireMedicaidBeneficiaries

ProviderAvailability

15

UtilizationofServices

18

BeneficiaryAssistanceandSatisfaction

43

Conclusion

46

4. BeneficiaryEngagement

47

NewHampshireMedicaidClientServicesUnit

47

MedicalCareAdvisoryCommittee(MCAC)

49

StakeholderMeetings

49

5. PlanforMonitoringAccess

51

UpdatestoMonitoring

51

InvestigationofAccessIssuesandCorrectiveActions

51

AccessMonitoringunderMedicaidManagedCare

52

6. SummaryandConclusion

56

7. Appendices

58

AppendixA:NewHampshireMedicaidCommunityHealthCenterAccessandCapacity

59

AppendixB:TabularVersionofDatainTrendCharts

61

MONITORINGACCESSTOCAREINNEWHAMPSHIRESMEDICAIDPROGRAM:REVIEWOFKEYINDICATORS,JUNE2012

NewHampshireDepartmentofHealthandHumanServices
OfficeofMedicaidBusinessandPolicy

1. Introduction
ThisreportdescribestheNewHampshireMedicaidprogramsoverallsystemofhealthcareaccess
measuring,monitoring,andintervention.Thereportprovidesdatameasuringtheadequacyofthe
Medicaidprovidernetworkandlevelofprovideravailability,utilizationofhealthcarebyMedicaid
beneficiariesoverafiveyearperiod,aswellasconsumerperceptionsoftheirabilitytoaccesscare.
NewHampshireengagesMedicaidbeneficiariesthroughitsconsumerhotlineaswellasthroughits
MedicalCareAdvisoryCommitteeandstakeholdermeetings.Takentogether,thisdataandanalysis
showthatNewHampshireMedicaidbeneficiarieshaveaccesstohealthcarethatissimilartothatofthe
generalpopulationinNewHampshire.ThedataandanalysisalsodemonstratethatNewHampshire
Medicaidbeneficiarieshavemaintainedsimilarlevelsofaccesssincetheimplementationofthe2008
ratechangesandthe2011DisproportionateShareHospital(DSH)paymentchanges.
Thisreportfocusesonbeneficiariesaccesstohospital,physician,andclinicalcareservicesandnoton
thefullrangeofNewHampshireMedicaidcoveredhealthcareservices.Forexample,dataconcerning
NewHampshireMedicaidbeneficiariesaccesstobehavioralhealthandlongtermcareservicesarenot
addressedinthisreportandwillbethesubjectoffutureevaluations.
NewHampshireMedicaidprovidescoverageforlowincomechildren,pregnantwomen,parentswith
children,elders,andpeoplewithdisabilities.TheNewHampshireDepartmentofHealthandHuman
Services(DHHS)isthesingleStateagencythatadministerstheNewHampshireMedicaidprogram.New
HampshireMedicaidcoveredallorpartofthehealthcarecostsofmorethan171,000peopleduring
StateFiscalYear2011(July1,2010throughJune30,2011)foratotalexpenditureof$1.4Billion.
NewHampshiremeasuresandmonitorsindicatorsofhealthcareaccesstoensuresufficientMedicaid
beneficiaryaccesstocoveredservices.Pursuantto42U.S.C.1396a(a)(30)(A),NewHampshires
Medicaidprogrammustprovideformethodsandproceduresrelativetotheutilizationofandpayment
forcoveredcareandservicesasarenecessarytosafeguardagainstunnecessaryutilizationofcareand
servicesandassurethatpaymentsareconsistentwithefficiency,economy,andqualityofcare.New
Hampshiremustalsoensurethatpaymentsaresufficienttoenlistenoughproviderstoprovidecareand
servicestoMedicaidbeneficiariesatleasttotheextentthatsuchcareandservicesareavailabletothe
generalpopulationinthegeographicregion.NewHampshiretakestheseobligationsseriouslyandhas
developedseveralmechanismstoassessandmonitorbeneficiaryaccess.
NocommonstandardsexisttodemonstrateappropriatehealthcareaccessforMedicaidbeneficiaries.
TheMedicaidandChildrensHealthInsuranceProgramPaymentandAccessCommission(MACPAC)
doesprovideguidance,however,ontheissueofaccessinitsMarch2011ReporttotheCongress.
MACPACsuggestsaframeworkforexamininghealthcareaccessforMedicaidandCHIPbeneficiaries.
Thesuggestedframeworkhasthreemainelements:beneficiariesandtheiruniquecharacteristics,
provideravailabilityfortheMedicaidandCHIPpopulations,andutilizationofavailablehealthcare

MONITORINGACCESSTOCAREINNEWHAMPSHIRESMEDICAIDPROGRAM:REVIEWOFKEYINDICATORS,JUNE2012
NewHampshireDepartmentofHealthandHumanServices
OfficeofMedicaidBusinessandPolicy

services.NewHampshireMedicaid
dssystematicapproachtoomeasuringaandmonitoringhealthcaree
MACPACframework.
accessbuildsonthisM
NewHam
mpshirehashighratesofco
ommerciallyccoveredindivvidualsandlo
owratesofM
Medicaidcovered
anduninssuredindividu
uals.Whileth
henationalavveragefortheepercentageeofastatesp
population
enrolledinMedicaidiss16%,approxximately8%o
ofNewHamppshirespopullationisenrolledinMedicaid.
mately18%ofNewHampsh
hireschildren
narecovereddbyMedicaid
dwhile70%o
ofNewHamp
pshire
Approxim
childrenrreceivedtheirrcoveragethrroughEmployyerSponsoreedInsurance.From2009tthrough2010
0,10%
ofNewHaampshireresidentswereu
uninsuredand
d5%ofNew Hampshirechildrenhadn
nohealth
insurance
ecoverage(naationalaveraggeswere16%
%forallresideentsand10%
%forchildren).BasedonU
Urban
InstituteaandKaiserCo
ommissiononMedicaidan
ndtheUninsuuredestimatees,whicharebasedonthe
CensusBu
ureau'sMarch
h2010and20
011CurrentP
PopulationSuurvey(CPS:AnnualSocialaandEconomic
Suppleme
ents),amongthenonelde
erlypopulation,NewHamppshirehastheesmallestpercentofits
populatio
onreceivinghealthcoveraggethroughM
Medicaidwith arateof8%comparedto
othenational
averageo
of16%.NewHampshireallsohasthehighestpercenntofitspopulationcovered
dbyemployeer
sponsored
dcoveragew
witharateof7
72%compare
edtothenati onalaverageof56%.Theefiguresbelow
w
presentth
hisinformatio
onforchildrenandadultswithsimilarddifferences.
NewHamp
pshireHealth
hInsuranceC
CoverageCom
mparedtotheeUnitedStattes,Childrenand
Adults,20092010

Figure1.

Adults

Children
100%

100%

90%

90%

80%

80%

70%

70%
Uninsured

60%

OtherPublic
O

50%

Uninsured

60%

OtherPublicc

50%

40%

Individual

40%

Individual

30%

Employer

30%

Employer

20%

Medicaid

20%

Medicaid

10%

10%

0%

0%
New
Hampshire
H

United
U
States
S

New
Hampshire

United
States

NewHam
mpshireisasm
mallstate.Ithasatotalpo
opulationsizeeof1.3Millio
onpersons.Ittis190mileslong
and70mileswide.Wiithtwentysixxacutecareh
hospitalsand affiliatedpraactices,andastrongnetwo
orkof
HCs)andFede
erallyQualifie
edHealthClinnics(FQHCs)distributedth
hroughoutthe
RuralHeaalthClinics(RH
State,Me
edicaidbenefiiciarieshaveaawiderange ofoptionsfoorobtainingh
healthcare.Seeemapofthee

MONITORINGACCESSSTOCAREINNEWHAMPSHIRESMEDDICAIDPROGRAM:REVIEWOFKEYINDDICATORS,JUNE20012
NeewHampshireDep
partmentofHealth
handHumanServvices
OffficeofMedicaidB
BusinessandPolicyy

StateofNewHampshire,setforthbelow,foradepictionoftheState,andlocationofhospitals,FQHCs
andRHCs.

Number of Medicaid Enrollees


With Location of Hospitals
and Affiliated Practices,
FQHCs, and RHCs

FQHC/RHC
Hospitals/Hospital-Affiliated Primary Care

Medicaid Enrollees
863 - 999
1,000 - 4,999
5,000 - 9,999
10,000 - 25,844

Non-Metro Counties

20

40 Miles

Map provided by DHHS/DCBCS/BBH/jh03/15/2012


C:\MedicaidMapping\MedicaidSFY2011AnnualReport\PrimaryCare.mxd

MONITORINGACCESSTOCAREINNEWHAMPSHIRESMEDICAIDPROGRAM:REVIEWOFKEYINDICATORS,JUNE2012
NewHampshireDepartmentofHealthandHumanServices
OfficeofMedicaidBusinessandPolicy

Metro Counties


Inthisreport,NewHampshireMedicaidexaminesMedicaidbeneficiaryaccesstophysicianandclinic
healthcareservicesbydocumentingdataandtrendsinthreedistinctareas:1)providerandclinic
availability,and2)utilizationofhealthcareservicesbyMedicaidbeneficiaries,and3)beneficiaryneeds.
ThedataandanalysissetforthinChapterThreeofthisreportestablishthehistoricalandcurrentaccess
levelsforthesefocalareasthroughanalysisoftrendsfrom2007through2011andincludescontrol
chartsandstatisticaltests.NewHampshireMedicaidusesthisanalysistosystematicallyevaluateand
monitorNewHampshireMedicaidbeneficiariesaccesstohealthcare,aswellastoprovideforanearly
warningsystemforaccessdisruptions.Evidenceofongoingbeneficiaryengagementisincludedand
evaluatedaswell.Systematic,datadrivenaccessmonitoringplans,basedonkeyindicatorschosento
evaluateaccess,aswellasplannedproceduresforcorrectiveactionshouldaccessproblemsarise,form
thebasisofNewHampshireMedicaidsaccessmeasuringandmonitoringframework.

MONITORINGACCESSTOCAREINNEWHAMPSHIRESMEDICAIDPROGRAM:REVIEWOFKEYINDICATORS,JUNE2012
NewHampshireDepartmentofHealthandHumanServices
OfficeofMedicaidBusinessandPolicy

2. Methodology
InformationpublishedbyMACPACwasusedastheprimarysourceofmaterialfordevelopingNew
HampshireMedicaidsframeworkforevaluatinghealthcareaccess.NewHampshireMedicaidsanalysis
ofhealthcareaccessfollowsMACPACsrecommendedthreeprongedapproach:beneficiary
characteristics,providercapacity,andserviceutilizationrates.Inaddition,NewHampshireaddsaforth
prong:beneficiaryassistanceandsatisfaction.
First,NewHampshireMedicaidevaluatedtheuniquecharacteristicsofNewHampshireMedicaid
beneficiaries.Usingretrospectivedataanalysis,NewHampshireMedicaiddocumentedthesizeofthe
Medicaidpopulation,demographics,enrollmentdata,trendsinenrollment,andgeographicdispersion.
Thiswasperformedtoprovideaclearpictureofthepopulation,theirhealthcareneeds,andthecontext
forevaluatingNewHampshireMedicaidsnetworkofproviders.
ThesecondprongofNewHampshireMedicaidanalysisfocusesonevaluatingtheadequacyoftheNew
HampshireMedicaidprovidernetwork.Evaluatingprovidernetworkcapacityentailsdetermining
whetherthenumberofproviders,i.e.physicians,physiciangroups,clinics,andhospitalemergency
departmentsaffordsufficientcapacityfortheMedicaidpatientloadinNewHampshire.New
HampshireMedicaidusedproviderenrollmentandenrollmenttrendstoevaluatephysicianand
provideradequacyinNewHampshire.
ThethirdprongofNewHampshiresaccessevaluationframeworkisananalysisofhealthcareservice
utilizationdataandtrends.ServiceutilizationbyMedicaidbeneficiariesrepresentsrealizedaccess.
RealizedaccessreferstohowNewHampshireMedicaidbeneficiariesareactuallyusingavailable
healthcareservices.NewHampshirefocusesonutilizationstatisticsbyage,geography,andeligibility
group.NewHampshireMedicaidexamineshowpatternsofhealthcareserviceusediffersamong
eligibilitygroups,agegroups,andgeographicregions;howhealthcareservicevenuehaschanged;and
howhealthcareserviceusetrendshavechangedovertime,particularlyovertheperiodoftimebefore
andafterNewHampshirereducedreimbursementratespaidtononcriticalcarehospitalsandmade
otherchangestohospitalpaymentarrangements,includingDSH.NewHampshireMedicaidextracted
datafortheperiodof2007through2011.Dataonhealthcareserviceutilizationwasinterpreted
generallybycomparingNewHampshireMedicaidutilizationovertime.
NewHampshireMedicaidcompiledeligibilityandadministrativeclaimsdataforfiveyearsofFFSpaid
claimsreflectingservicesusedbyMedicaidbeneficiaries.NewHampshireMedicaidcompiledservice
utilizationstatisticsforphysicians,forAPRNs,forFQHCsandRHCs.Theseproviderutilizationrateswere
calculatedper1,000Medicaidbeneficiaries.

Data Sources
Membership,utilization,andactiveproviderreportsarebasedondataextractedfromtheNew
HampshiresMedicaidManagementInformationSystem(MMIS),thestatesMedicaidclaimsprocessing
MONITORINGACCESSTOCAREINNEWHAMPSHIRESMEDICAIDPROGRAM:REVIEWOFKEYINDICATORS,JUNE2012
NewHampshireDepartmentofHealthandHumanServices
OfficeofMedicaidBusinessandPolicy

system.Inherentinthisdataaredifferencesincodingpracticesacrossproviders,whichpotentially
affectresultsandcontributetoobserveddifferences.ClientServicesCallCenterdataisbasedondata
extractedfromtheCallCenterscalltrackingdatabase.

Population Included in Trend Data


Thepopulationsincludedinthememberandutilizationtrenddataarethosebeneficiariesforwhom
NewHampshireMedicaidprovidestheonlyknownsolesourceofgeneralhealthcarecoverage.
BeneficiarieswithMedicareorotherhealthcoverageareexcludedbecauseforthesegroupsNew
HampshireMedicaidonlyplaysasecondaryroleinprovidinggeneralhealthcoverageandasaresult
doesnothavecompleteclaimsdata.Reportsonanannualtimespan(orinthecaseofthewellbaby
visitmeasure,thefirstfifteenmonthsoflife)onlyincludethosebeneficiariescontinuouslyenrolled
duringtheperiod,withnomorethanaonemonthgaptoallowforconsistencywithnationalmeasure
specificationstandards.

Service Date Periods and Claims Run-out


Allutilizationreportsarebasedondateofservicefortimeperiods,eithercalendaryearsorcalendar
yearquarters.Inordertoprovideaconsistentbasisforcomparingreportsovertime,itwasnecessary
toalsoprovideconsistentclaimsrunoutforeachreportingperiod.Quarterlymeasuresarebasedon
threemonthsofclaimsrunout(e.g.,iftheserviceperiodbeingreportedcoversJanuarytoMarch2011,
thereportwillincludeallclaimspaidthroughJune30,2011).Whilesomeadditionalclaimswillbepaid
afterthatservicedate,bykeepingtherestrictionconsistentfromperiodtoperiodthetrendwillnotbe
impacted.Annualmeasuresarebasedonalongerrunoutperiodofsixmonthstomakethemmore
comparabletonationalbenchmarksthataregenerallybasedonthesameperiod(sixmonthsensures
greaterthan99%ofclaimshavebeenprocessed).

Geographic Grouping
Beneficiariesaresubdividedgeographicallybasedontheircountyofresidence.NewHampshireis
dividedintothosecountiesthatareMetropolitanandthosethatareNonMetropolitanbasedonUSDA
rural/urbancontinuumcodes.MetropolitancountiesareHillsborough,Rockingham,andStraffordand
theNonMetropolitancountiesareBelknap,Carroll,Cheshire,Coos,Grafton,Merrimack,andSullivan.
Thecountiesinbothgroupingsarecontiguous.Asof2011,theMetropolitanareaincludes57%of
beneficiariesthathaveaninstateaddress.Asmallnumberofbeneficiarieswithoutofstateaddress
areexcludedfromthegeographicgroupings,butincludedinallotherreporting.Outlinesofthetwo
areasareincludedinthemaponpage3.

Age and Eligibility Grouping


Beneficiariesaresubdividedbasedontheirageandaidcategoryofassistanceduringeachmonthofa
quarterorforannualdata,thelastdateofthereportingperiod.Dataformosttrendsisreportedusing
thefollowinggroupings(ageandaidcategoriesusedinparenthesis):

Children(agelessthan19):
- BlindandDisabled(AidtoNeedyBlindandHomeCareforChildrenwithSevereDisabilities),
- FamiliesandChildren(TANFandPovertyLevelChildren),and
- FosterCare(FosterCareandAdoptionSubsidy).

MONITORINGACCESSTOCAREINNEWHAMPSHIRESMEDICAIDPROGRAM:REVIEWOFKEYINDICATORS,JUNE2012
NewHampshireDepartmentofHealthandHumanServices
OfficeofMedicaidBusinessandPolicy

Adults(age19andolder):
- Aged(OldAgeAssistance),
- BlindandDisabled(AidtoNeedyBlind,AidtoPermanentlyandTotallyDisabled,Medicaid
forEmployedAdultswithDisabilities),and
- FamiliesandChildren(TANFandPovertyLevelPregnantWomen).

DataforwellchildvisitmeasuresusetheagegroupingsasspecifiedbytheNationalCommitteefor
QualityAssurance(NCQA).Dataforthemeasurethatexamineswhatpercentofchildrenduringthe
yearhadapreventiveorotherambulatoryhealthserviceisdesignedtolookathowthismeasurevaries
byrefinedagebreakdownsofchildren(lessthanage1,age1,age2,age3to4,age5to9,age10to14,
age15to17,andage18to20).

Control Limits
Controllimitsareemployedinquarterlytrendchartstoprovideaconsistentindicationofapotential
accessproblemaseachnewquarterofdataisavailable.Controllimitsaresetasthreestandard
deviations(followingconventionalpractice)fromthemeanbasedonQuarter12007toQuarter32011
data.Becauseitistheprincipaltimeperiodanalyzedinthisreport,thefinalQuarterof2011was
excludedfromthecalculationofthecontrollimits.Controllimitsweresetbeforeanalyzingthedata.
Futureupdatestothisreportwillmaintainthesamecontrollimitsuntilsuchtimethatarebasingis
neededinresponsetoshiftsinhealthcaredelivery,thehealthofthepopulation,orchangesinavailable
data.
Dependingonthemeasure,arateforatimeperiodbelowthelowercontrollimitorabovetheupper
limitisthetriggerindicatingapotentialaccessproblemrequiringfurtherinvestigation.Additionally,a
persistenttrendaboveorbelowthemeanlinewouldwarrantfurtherresearch.

Confidence Intervals
Forchartsbasedonannualdata,controllimitsarenotpresented(annualdatadoesnotprovideenough
experienceformeaningfullimits).Instead,95%confidenceintervalsarepresented.Theconfidence
intervaltakesintoaccountrandomvariabilityinthedatatoallowforcomparisonofratesovertime.
The95%confidenceintervalistherangeofvaluesthat,with95%certaintyincludestheunderlyingrate
fortheentirepopulation.Asthenumberofbeneficiariesrepresentedintherateincrease,the
confidenceintervalsbecomenarrower.
The95%confidenceintervaliscomputedusingthefollowingformulas:

Lower limit = p [1.96 x (p*q/B)]


Upper limit = p + [1.96 x (p*q/B)]
Where b = denominator; p = percent divided by 100; and q = 1- p
Ifthecurrentperiodofdatadeviatestosuchadegreethatitsconfidenceintervaldoesnotoverlapwith
thepriorperiodsconfidenceintervalitwillindicateapotentialaccessproblemrequiringfurther
investigation.Additionally,ifaslowlydecliningtrendisobservedandthecurrentperiodsconfidence

MONITORINGACCESSTOCAREINNEWHAMPSHIRESMEDICAIDPROGRAM:REVIEWOFKEYINDICATORS,JUNE2012
NewHampshireDepartmentofHealthandHumanServices
OfficeofMedicaidBusinessandPolicy

intervaldoesnotoverlapwithanyofthepreviousthreeconfidenceintervalsitwillindicateapotential
accessproblemrequiringfurtherinvestigation.

Small Numbers
BecauseNewHampshireisasmallState,itisnecessarytotakeintoaccountthevolumeofdata
availableforreporting.Forsomecombinationsofageandeligibility,thevolumeofdataistoosmallto
allowformeaningfulreporting.Ratesbasedonsmallernumbersaremorevolatileduetorandom
variation.Toaccountforthisvolatility,controllimitsandconfidenceintervalsmustbewider,rendering
themlessmeaningful.

Major Reimbursement Changes


FourNewHampshireLegislativechangesinMedicaidpaymentlevelsinrecentyearsarerelevanttothis
reportsaccessmeasuresandtrendanalyses:inpatientandoutpatienthospitalservicesratereductions
andDisproportionateShareHospital(DSH)methodologyandpaymentrestructuring.InDecember2008,
DHHSreducedMedicaidreimbursementratespaidtoNewHampshires13noncriticalaccesshospitals
foroutpatientservicesbyapproximately33%.NewHampshirereducedMedicaidinpatient
reimbursementratesfornoncriticalaccesshospitalsby10%effectiveDecember1,2008.New
HampshireMedicaidDSHprogrammethodologywasrevisedinDecember2010topayhigherratesof
reimbursementfortheuncompensatedcarecostsofcriticalaccesshospitals,whilestillmakingaDSH
paymenttoallbutonepsychiatrichospitalintheState.InDecember2011,DSHqualifyingcriteriawere
restructuredtomakepaymentsavailablealmostexclusivelytocriticalaccessanddeemedDSH
hospitals,andthetotalamountoffundingforDSHpaymentsstatewidewasreduced.Thepotential
impactsofthesechangesareconsideredinthisreportfromthestandpointofhealthcareaccessand
accesstrendanalysisbyrepresentingthechangesonquarterlyutilizationtrendcharts.
DescriptionofChange
OutpatientRateReductionsfor13acute carenon
criticalaccesshospitals
InpatientRateReductionsfor13acutecarenon
criticalaccesshospitals
RevisionofDSHMethodology
ReductionintotalDSHFunding

ImplementationDate
December2008
December2008
December2010
December2011

MONITORINGACCESSTOCAREINNEWHAMPSHIRESMEDICAIDPROGRAM:REVIEWOFKEYINDICATORS,JUNE2012
NewHampshireDepartmentofHealthandHumanServices
OfficeofMedicaidBusinessandPolicy

3. Data and Analysis


ThesectionsinthischapterpresentNewHampshireMedicaidtrendinformationonareasrelatedto
accesstohealthcareservices.Thetrenddataisdividedintothefollowingsections:

NewHampshireMedicaidBeneficiaries,
AvailabilityofProviderNetwork,
UtilizationofServices,and
BeneficiaryAssistanceandSatisfaction.

Datathroughoutispresentedasfiveyeartrends.Dependingonthemeasure,informationispresented
quarterlyorannually.Annualmeasuresarerestrictedtothosewherethenationalstandarddefinitionis
annual,typicallytoaccountforservicesthatareexpectedtakeplaceacertainnumberoftimesoveran
annualperiod(e.g.,wellchildvisits).Tomaintaintheclarityofthecharts,asnewperiodsofdataare
available,theoldestperiodofhistorywillberolledoffthereports.
Accompanyingthedataareindicationsofthemajorpaymentchangesimpactingthehealthsystem
beinganalyzed.
Beyondpresentingthedatainavisualform,thechartsalsoincludeanalytictoolsthatprovideadefined
triggerindicatingapotentialaccessproblemrequiringfurtherresearch.Quarterlydataarepresented
alongwithcontrollimitsandannualdata(wherethedataisinsufficienttosupportcontrollimits)with
confidenceintervals.Correlationsbetweenthepaymentchangesandthetrenddatathatappearto
existwillhelpinformanyfurtherresearchneeded.
Thefocusofthedatapresentedisgeneralmedicalphysician/APRN/group/clinicandhospitalservices.

New Hampshire Medicaid Beneficiaries


Overview of New Hampshire Medicaid Beneficiaries
NewHampshireMedicaidprogramBeneficiariesaremadeupofthefollowingmandatoryandoptional
eligibilitycategorieslistedinbelow.

MONITORINGACCESSTOCAREINNEWHAMPSHIRESMEDICAIDPROGRAM:REVIEWOFKEYINDICATORS,JUNE2012
NewHampshireDepartmentofHealthandHumanServices
OfficeofMedicaidBusinessandPolicy

MandatoryEligibilityGroups*

LowincomeMedicarebeneficiaries

IndividualswhowouldqualifyforTemporaryAssistancetoNeedyFamilies(TANF)todayunderthe
states1996AFDCeligibilityrequirements

Children under age six and pregnant women with family income at or below 133% of federal
povertylevel(FPL)guidelines

ChildrenbornafterSeptember30,1983,whoareatleastagefiveandliveinfamilieswithincome
uptotheFPL

InfantsborntoMedicaidenrolledpregnantwomen

Children who receive adoption assistance or who live in foster care, under a federallysponsored
TitleIVEprogram

Lowincomeaged,blind,anddisabledreceivingStatesupplementalassistance
OptionalEligibilityGroups

Children and pregnant women up to 185% of the FPL, and infants up to 300% of the FPL (in the
processofbeingexpandedto300%oftheFPLforallchildrenbyconversionofNewHampshires
separateCHIPprogramtoaMedicaidexpansionprogram).

Individualsdeterminedtobemedicallyneedyduetolargemedicalexpenses

HomeCareforChildrenwithSevereDisabilities(HCCSD),commonlyknownasKatieBeckett;for
severelydisabledchildrenuptoage19whosemedicaldisabilityqualifiesthemforinstitutionalcare
butarecaredforathome

MedicaidforEmployedAdultswithDisabilities(MEAD)allowsMedicaideligibledisabledindividuals
betweentheagesof18and64whowanttosavemoneyorworktoincreasetheirearningswhile
maintainingMedicaidcoverage(upto450%FPL)

NewHampshireMedicaidbeneficiariestendtohaveahigherburdenofillnessthanprivatelyinsured
individuals.Theyaretwiceaslikelytohaveasthma,coronaryarterydisease,hypertension,depression,
andmentalhealthdisorders(particularlychildren);theyarethreetofourtimesmorelikelytosuffer
fromastrokeorChronicObstructivePulmonaryDiseaseortousehospitalemergencyrooms;andfive
timesaslikelytohavelungcancerorheartfailure(NewHampshireMedicaidAnnualReport,2011).
Thetwofiguresbelowshowthedistributionofbeneficiariesbyage,eligibilitygroup,andgenderasof
June2011.

*In1974,NewHampshire,likeoverthirtyotherstatesatthetime,electedforthe209(b)statusprovidedinthefederallawthatcreatedthe
SupplementalSecurityIncome(SSI)program(thefederalincomeassistanceprogramfordisabled,blind,oragedindividuals).Whencreatingthe
SSIprogram,CongresshopedthatSSIbeneficiarieswouldalsoreceiveMedicaid.However,Congresswasmindfuloftheincreasedexpensefor
statestoautomaticallycoverallSSI beneficiaries.Toprovidestatessomefinancialflexibility,the209(b)optionwas craftedwhichalloweda
statetobemorerestrictiveinitsMedicaideligibilitythantheSSIprogrameligibilityguidelines,solongasthosemethodologieswerenomore
restrictive than methodologies in place on January 1, 1972. Accordingly, New Hampshire does not automatically grant Medicaid to SSI
beneficiaries.SSIbeneficiarieswhodesireMedicaidmustqualifyforastatedefinedcategoryofassistance.
In1996,federalpolicymakersseveredthetiebetweenmedicalandcashassistancewhentheAFDCprogramwasreplaced.TheAFDCstandard
was retained in Title XIX to prevent the states from using the more restrictive eligibility requirements and time limits of AFDCs successor
TemporaryAssistanceforNeedyFamiliesorTANFwhenprovidingMedicaidcoveragetoneedychildrenandfamilies.
TheACAextendedARRAeligibilitymaintenanceofeffort(MOE)requirementsforadultsuntil2014andforchildrenuntil2019.
WhileMedicallyNeedyisanoptionalcategory,asa209(b)State,ifNewHampshiredoesnotelecttoprovidemedicallyneedycoverage,we
mustallowadultcategoryindividualswhoseincome exceedsthe categoricallyneedyincomelimittospenddowntothecategoricallyneedy
incomelimit.Additionally,onceaStateoptstoprovidemedicallyneedycoverage,therearecertaingroupsthatmustbecoveredasmedically
needy(e.g.,pregnantwomen).

MONITORINGACCESSTOCAREINNEWHAMPSHIRESMEDICAIDPROGRAM:REVIEWOFKEYINDICATORS,JUNE2012
NewHampshireDepartmentofHealthandHumanServices
OfficeofMedicaidBusinessandPolicy

10

Children((members18yearsorless)makeup60
0%oftheNew
wHampshire Medicaidpop
pulation.As
shownbe
elow,beneficiariesage19tto64represe
ent31%ofbeeneficiariesan
ndtheremain
ning10%are
membersaged65pluss.
FemalesaaccountforovverhalfofMe
edicaidbenefficiaries.Gennderdifferenccesareobserrvedinall
eligibilitycategorieswithfemalespredominatingglowincomeeadults(84%,,duetopregn
nantwomen
dgreaterlikelihoodofhead
dingsinglepaarentlowincomehouseho
olds)andthe
eligibilitycategoryand
elderly(74
4%,duetolo
ongerlifespan
nandlikelihoo
odoffewerreesourcesthan
nmales).Asshownbelow
w,the
onlygroupsinwhichm
malesmakeupalargerpro
oportionofbeeneficiariesarethelowincomechildand
severelyd
disabledchild
dgroups.

62%

47%
53%
Adultsw/MentalIllness
Disabilities

SLMB/QMB

26%
Elderly

SeverelyDisabledChild

38%

48%
52%
34%
Adultsw/PhysicalDisabilities

66%

74%

84%

Female

16%
Total

Age018
59.8%

Malle

L I
Ad lt
LowIncomeAdult

Age196
64
30.7%

90%
80%
70%
60%
50%
40%
30%
20%
10%
0%

NHMed
dicaidBeneficciariesbyGender
andEliggibilityCatego
ory,June201
11

52%
48%

Age65+
9.5%

Figure33.

LowIncomeChild

NHMedica
aidBeneficiariesbyAge
Categoriess,June2011

44%
56%

Figure2.

Thefigure
esabovearebasedontheentireMediccaidbeneficiaarypopulation.However,thefollowingg
figureson
nenrollment,andlaterfigu
uresshowinggutilizationtrrends,excludeeMedicareduallyeligibless,and
thosemembersknown
ntohaveothe
ermedicalinsurance.Theebeneficiarieesareexcludeedbecauseth
he
focusofthisreportisp
physicianand
dhospitalcare
e,andcarefoorthoseservicesisnearlyalwayspaidfforby
thirdparties,notNewHampshireM
Medicaid,forthesebeneficciaries.Approximately100,000
beneficiarriesarethesu
ubjectofthefollowingrep
porting.

New Ha
ampshire
e Medicaid
d Beneficiary Enrolllment Tre
ends
Thissectio
onreviewstrendinaveraggemonthlyen
nrollmentby quarterofNewHampshirreMedicaid
beneficiarries.Thedataainthefigure
eswillbeupd
datedquarterrly.Utilizationtrendsarettrackedforth
hese
members.
DataispresentedforthetotalMed
dicaidpopulattion,brokenooutbyagean
ndeligibilityggroupings,and
d
brokenou
utformetrop
politanandno
onmetropolittanareasofttheState.
MONITORINGACCESSSTOCAREINNEWHAMPSHIRESMEDDICAIDPROGRAM:REVIEWOFKEYINDDICATORS,JUNE20012
NeewHampshireDep
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handHumanServvices
OffficeofMedicaidB
BusinessandPolicyy

11

Thefiguresshowaverygradualriseinenrollmentin2007and2008,followedbymorerapidincreasein
2009duetotherecession,withaslightrisethereafter.In2011,therewasalessthan1%increasein
totalenrollment.
Asthelargestgroupbyfar,enrollmentfortheFamiliesandChildreneligibilitygroupswassimilartothe
total.However,theadultsinthisgrouphaveseenadecreaseinenrollmentthroughout2011.
Figure4.

NHMedicaidEnrollment,CY20072011:TotalPopulation
Note:excludesMedicareduallyeligiblesandmemberswithothermedicalinsurance

120,000
100,675
100,000
82,880
80,000

60,000

40,000

20,000

0
2007 2007 2007 2007 2008 2008 2008 2008 2009 2009 2009 2009 2010 2010 2010 2010 2011 2011 2011 2011
QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4
AverageMembers

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NewHampshireDepartmentofHealthandHumanServices
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12

Figure5.

NHMedicaidEnrollment,CY20072011:Child,FamiliesandChildrenEligibilityGroup
Note:excludesMedicareduallyeligiblesandmemberswithothermedicalinsurance

80,000

73,447

70,000
60,041
60,000
50,000
40,000
30,000
20,000
10,000
0
2007 2007 2007 2007 2008 2008 2008 2008 2009 2009 2009 2009 2010 2010 2010 2010 2011 2011 2011 2011
QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4
FamiliesandChildren

Figure6.

NHMedicaidEnrollment,CY20072011:ChildFosterCareandBlindandDisabled
Population
Note:excludesMedicareduallyeligiblesandmemberswithothermedicalinsurance

2,500

2,000

1,935
1,668

1,500

1,000
606

522
500

0
2007 2007 2007 2007 2008 2008 2008 2008 2009 2009 2009 2009 2010 2010 2010 2010 2011 2011 2011 2011
QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4
BlindandDisabled

FosterCare

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NewHampshireDepartmentofHealthandHumanServices
OfficeofMedicaidBusinessandPolicy

13

Figure7.

NHMedicaidEnrollment,CY20072011:AdultPopulationbyEligibilityGroup
Note:excludesMedicareduallyeligiblesandmemberswithothermedicalinsurance

16,000
14,098
14,000

12,630

12,000
9,953
10,000
8,000

7,080

6,000
4,000
2,000

902

672

0
2007 2007 2007 2007 2008 2008 2008 2008 2009 2009 2009 2009 2010 2010 2010 2010 2011 2011 2011 2011
QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4
Aged

BlindandDisabled

FamiliesandChildren

Figure8.

NHMedicaidEnrollment,CY20072011:MetropolitanandNonMetropolitanCounties
Note:excludesMedicareduallyeligiblesandmemberswithothermedicalinsurance
56,778

60,000

50,000

45,220
42,687

40,000

35,115

30,000

20,000

10,000

0
2007 2007 2007 2007 2008 2008 2008 2008 2009 2009 2009 2009 2010 2010 2010 2010 2011 2011 2011 2011
QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4
MetroCounties

NonMetroCounties

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NewHampshireDepartmentofHealthandHumanServices
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Provid
der Availlability
TheprovideravailabilittysectionfoccusesonwhettherhealthcaareservicesaareaccessibletoMedicaid
beneficiarries.Measure
esareinclude
edonprovide
erparticipatiooninNewHaampshireMed
dicaidandrattios
ofbeneficciariestoactivveproviders.Thedatainthefiguresw
willbeupdate dquarterly.

Physiciian and Hospital


H
Pa
articipatio
on
AllofNew
wHampshires26acutecarehospitalsaaswellastwooofthreespeecialtyhospitaalsareenrolledin
NewHam
mpshireMediccaidandactivvelyprovidesservices.Incoontrasttomaanystates,NeewHampshirees
Medicaidbeneficiariesssharethesamehospitalaandhealthceenternetworkk(ordeliverysystem)asth
he
ndthedistribu
utionofMedicaidpatient utilizationofthesefacilitieesisalsosimilarto
generalpopulation,an
thegenerralpatientpopulation.The
erearenopu
ublicsafetynnethospitalssinNewHam
mpshire,andin
somecom
mmunities,thelocalcomm
munityhealthcenters(FQH
HCorRHC)serveasthepriimaryambulaatory
caresitefforcommerciallyinsuredp
patients,asw
wellasMedicaaidanduninsuredindividu
uals.
Withregaardtophysiciaans,Figure9providesinfo
ormationontthemostreceentlyavailableedataon
enrollmen
ntbylicensed
dactiveprovid
ders.Ascanbeseen,nea rlyall(94%)o
oflicensedprracticing
physicianssarealsoNew
wHampshireMedicaidpro
oviders(dataasource:NHBoardofMed
dicine).Becaause
ofthisbro
oadoverlap,rratiosofNew
wHampshireM
Medicaidbenneficiariestoaactiveprovidersareveryh
high,
whichalso
oexplainswh
hymostindiviidualpractitio
onerswilllikeelyhavesmallnumbersofMedicaidpatients
intheirpaanel(ascomp
paredtomore
epopulousorurbanstate s).Forexample,NewHam
mpshirehas1
1.3
millionpe
eople,andatotalof4,047licensedpraccticingphysicciansforarattioof321peo
opleperlicensed
physician,,whilethereare0.1millio
onMedicaidb
beneficiariesaandatotaloff3,793activee(billing)
physicianssforaratioo
of26peoplep
perphysicianfortheNew HampshireM
Medicaidpopu
ulationtime.
Figure9.

ActiveNHMedicaidInStatePhysicianProviderssComparedttoLicensedP
ProvidersWithNH
BillingAdd
dress,2012
ActiveNo
on
Medicaid
d
Providerrs
6%

Active
Medicaid
Providers
94%

Active Primary
P
Care
C
Proviiders, Ped
diatricianss, and
Obstetr
ricians/Gy
ynecologists
Thefollow
wingthreefigguresshowth
hetrendinthe
eratioofbenneficiariestoactiveprovid
ders(thosewiith
oneclaim
minthequarte
er).MajorNe
ewHampshireMedicaidppaymentchan
ngesareindiccatedandcon
ntrol
limitsatthethirdstand
darddeviatio
onofthehisto
oricaldataareeincludedto
oprovideatriggerindicatin
nga

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BusinessandPolicyy

15

potentialaccessproblemrequiringfurtherinvestigation.Fortheratiospresented,exceedingtheupper
controllimitwouldindicateapotentialproblem.
Theratesshowninallfiguresdonotcrosstheuppercontrollimit,andthereforedonotindicatea
potentialaccessproblematthistime,noristhereevidenceofanimpendingaccessproblembasedon
currentdata.Theprimarycaretrendhasshownconsistentimprovementsduringthepastseveral
quarters.Thetrendinratiosofbeneficiariestopediatriciansandobstetricians/gynecologistswhile
stablesince2008,arelargercomparedto2007.Thischangewasdueentirelytogrowthinenrollment.
Figure10. RatioofNHMedicaidBeneficiariestoActiveInStatePrimaryCareProviders(Internal
Medicine,FamilyPractice,GeneralPractice,Pediatricians),CY20072011
50
46

45
40

38
36

35
30
25
20
15
10
5

DSHRedesign

HospitalRateReductions

DSHReduction

0
2007 2007 2007 2007 2008 2008 2008 2008 2009 2009 2009 2009 2010 2010 2010 2010 2011 2011 2011 2011
QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4
BeneficiariesperProvider

MeanRate

ControlLimit

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Figure11. RatioofNHMedicaidChildBeneficiariestoActiveInStatePediatricians,CY20072011
350

300

294
268

250
235
200

150

100

50
DSHRedesign

HospitalRateReductions

DSHReduction

0
2007 2007 2007 2007 2008 2008 2008 2008 2009 2009 2009 2009 2010 2010 2010 2010 2011 2011 2011 2011
QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4
BeneficiariesperProvider

MeanRate

ControlLimit

Figure12. RatioofNHMedicaidAdultFemaleBeneficiariesAge18to64toActiveInState
Obstetricians/Gynecologists,CY20072011
400
377
350
329
300
270
250
200
150
100
50

DSHRedesign

HospitalRateReductions

DSHReduction

0
2007 2007 2007 2007 2008 2008 2008 2008 2009 2009 2009 2009 2010 2010 2010 2010 2011 2011 2011 2011
QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4
BeneficiariesperProvider

MeanRate

ControlLimit

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Availability of Capacity at Health Centers


Inadditiontoongoingassessmentofproviderparticipation,NewHampshireMedicaidhasbegunto
undertakeperiodicassessmentoftheavailablecapacityofproviderstoacceptnewpatientsontheir
panels.ThefirstoftheseassessmentswasperformedforFederallyQualifiedHealthCenters(FQHC),
FQHCLookaLikes,andNonFQHCCommunityHealthCenters.Themajorityofthecentersthat
respondedtoinquiriesreportedhavingavailablecapacitytotakeonhundredsofnewpatientseach.
ThecompleteresultofthisassessmentisprovidedintheAppendixA.

Utilization of Services
Appropriatehealthcareutilizationistheultimateoutcomeofachievingeffectivehealthcareaccess.
Studyinghealthcareutilizationpatternscanprovideasignalthataparticularsubgrouporregionofthe
Statemayhaveanaccessissue.
Quarterlykeyphysicianandhospitalutilizationtrendswithcontrollimitsandannualutilizationof
preventiveandoffice/clinichealthservicestrendsarepresented.Dataisbrokenoutbyageand
eligibilitygroupings,andbrokenoutformetropolitanandnonmetropolitanareasoftheState(totakea
speciallookatareaswithagreatersensitivitytoaccessproblems).Thedatainthefigureswillbe
updatedquarterlyorannuallyasappropriate.
Alltrendsarebasedonadministrativeeligibilityandclaimsdata.Inherentinthesedataaredifferences
incodingpracticesacrossproviders,whichpotentiallyaffectresultsandcontributetoobserved
differences.

Quarterly Beneficiary Utilization Analysis


FiguresinthissectionshowthetrendinquarterlyuseofkeyphysicianandhospitalservicesbyNew
HampshireMedicaidbeneficiariesasindicatedbyMedicaidclaimsdata*.Thedatainthefigureswillbe
updatedquarterly.
Ratesarethenumberofvisitsinthequarterdividedbythenumberofbeneficiarymonthsforthe
quartertimes1,000.
MajorNewHampshireMedicaidpaymentchangesareindicatedandcontrollimitsatthethirdstandard
deviationofthehistoricaldataareincludedtoprovideatriggerindicatingapotentialaccessproblem
requiringfurtherinvestigation.
Detailispresentedbelowon:

Physician/APRN/ClinicUtilization,
EmergencyDepartmentUtilizationforConditionsPotentiallyTreatableinPrimaryCare,
TotalEmergencyDepartmentUtilization,
InpatientHospitalUtilizationforAmbulatoryCareSensitiveConditions,and

ExcludingMedicareduallyeligibles,andthosemembersknowntohaveothermedicalinsuranceastheirphysiciancareisnearlyalwayspaid
forbythirdparties,notNHMedicaid.

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18

TotalInpatientHospitalUtilization.

Inallcases,nocontrolchartindicatesapotentialaccessissuerequiringfurtherresearch.However,as
notedineachsectionbelow,somechartsexhibitpersistenttrendsthatwillberesearchedandreported
oninthenextissueofthisreport.
Seasonally Adjusted Physician/APRN/Clinic Utilization
Figuresinthissectionshowthetrendinquarterlyuseofphysician,APRN,FQHC,andRHCservicesby
NewHampshireMedicaidbeneficiariesasindicatedbyMedicaidclaimsdata.
DataispresentedforthetotalMedicaidpopulation,brokenoutbyageandeligibilitygroupings,and
brokenoutformetropolitanandnonmetropolitanareasoftheState.
ThedatapresentedhasbeenadjustedtoremoveseasonalitythatinNewHampshirereliablyresultsin
higherthanaverageratesinthefirstcalendarquarterandlowerthanaverageratesinthethirdcalendar
quarter(duetoseasonalityofrespiratoryinfections).
Forthephysician,APRN,FQHC,andRHCutilizationmeasure,aratebelowthelowercontrollimitisthe
triggerindicatingapotentialaccessproblemrequiringfurtherinvestigation.
Theratesshowninallfiguresnevercrossthelowercontrollimit,andthereforedonotindicatea
potentialaccessproblem.
Figure13. SeasonallyAdjustedPhysician/APRN/ClinicUtilizationper1,000NHMedicaid
Beneficiaries,CY20072011:TotalPopulation
450
413

400

368

350

332
300
250
200
150
100
50

DSHRedesign

HospitalRateReductions

DSHReduction

0
2007 2007 2007 2007 2008 2008 2008 2008 2009 2009 2009 2009 2010 2010 2010 2010 2011 2011 2011 2011
QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4
AdjustedRateper1,000

MeanAdjustedRate

ControlLimit

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Figure14. SeasonallyAdjustedPhysician/APRN/ClinicUtilizationper1,000NHMedicaid
Beneficiaries,CY20072011:Children,BlindandDisabledAidCategories
600
530
500
476
400
336
300

200

100
DSHRedesign

HospitalRateReductions

DSHReduction

0
2007 2007 2007 2007 2008 2008 2008 2008 2009 2009 2009 2009 2010 2010 2010 2010 2011 2011 2011 2011
QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4
AdjustedRateper1,000

MeanAdjustedRate

ControlLimit

Figure15. SeasonallyAdjustedPhysician/APRN/ClinicUtilizationper1,000NHMedicaid
Beneficiaries,CY20072011:Children,ChildrenandFamiliesAidCategories
400
350

346
316

300

286

250
200
150
100
50

DSHRedesign

HospitalRateReductions

DSHReduction

0
2007 2007 2007 2007 2008 2008 2008 2008 2009 2009 2009 2009 2010 2010 2010 2010 2011 2011 2011 2011
QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4
AdjustedRateper1,000

MeanAdjustedRate

ControlLimit

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Figure16. SeasonallyAdjustedPhysician/APRN/ClinicUtilizationper1,000NHMedicaid
Beneficiaries,CY20072011:Children,FosterCareAidCategories
450
400
381
350
329
300
276
250
200
150
100
50

DSHRedesign

HospitalRateReductions

DSHReduction

0
2007 2007 2007 2007 2008 2008 2008 2008 2009 2009 2009 2009 2010 2010 2010 2010 2011 2011 2011 2011
QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4
AdjustedRateper1,000

MeanAdjustedRate

ControlLimit

Figure17. SeasonallyAdjustedPhysician/APRN/ClinicUtilizationper1,000NHMedicaid
Beneficiaries,CY20072011:Adults,AgedAidCategories
800
700

674

600

584

500
433
400
300
200
100

DSHRedesign

HospitalRateReductions

DSHReduction

0
2007 2007 2007 2007 2008 2008 2008 2008 2009 2009 2009 2009 2010 2010 2010 2010 2011 2011 2011 2011
QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4
AdjustedRateper1,000

MeanAdjustedRate

ControlLimit

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NewHampshireDepartmentofHealthandHumanServices
OfficeofMedicaidBusinessandPolicy

21

Figure18. SeasonallyAdjustedPhysician/APRN/ClinicUtilizationper1,000NHMedicaid
Beneficiaries,CY20072011:Adults,BlindandDisabledAidCategories
800
700

676

600
568
500

473

400
300
200
100

DSHRedesign

HospitalRateReductions

DSHReduction

0
2007 2007 2007 2007 2008 2008 2008 2008 2009 2009 2009 2009 2010 2010 2010 2010 2011 2011 2011 2011
QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4
AdjustedRateper1,000

MeanAdjustedRate

ControlLimit

Figure19. SeasonallyAdjustedPhysician/APRN/ClinicUtilizationper1,000NHMedicaid
Beneficiaries,CY20072011:Adults,FamiliesandChildren
700

600

576

500

478
449

400

300

200

100
DSHRedesign

HospitalRateReductions

DSHReduction

0
2007 2007 2007 2007 2008 2008 2008 2008 2009 2009 2009 2009 2010 2010 2010 2010 2011 2011 2011 2011
QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4
AdjustedRateper1,000

MeanAdjustedRate

ControlLimit

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Figure20. SeasonallyAdjustedPhysician/APRN/ClinicUtilizationper1,000NHMedicaid
Beneficiaries,CY20072011:MetropolitanAreas
500
450

443

400

391
354

350
300
250
200
150
100
50

DSHRedesign

HospitalRateReductions

DSHReduction

0
2007 2007 2007 2007 2008 2008 2008 2008 2009 2009 2009 2009 2010 2010 2010 2010 2011 2011 2011 2011
QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4
AdjustedRateper1,000

MeanAdjustedRate

ControlLimit

Figure21. SeasonallyAdjustedPhysician/APRN/ClinicUtilizationper1,000NHMedicaid
Beneficiaries,CY20072011:NonMetropolitanAreas
450
400

402

350

346
322

300
250
200
150
100
50

DSHRedesign

HospitalRateReductions

DSHReduction

0
2007 2007 2007 2007 2008 2008 2008 2008 2009 2009 2009 2009 2010 2010 2010 2010 2011 2011 2011 2011
QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4
AdjustedRateper1,000

MeanAdjustedRate

ControlLimit

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Seasonally Adjusted Emergency Department Utilization for Conditions


Potentially Treatable in Primary Care
Figuresinthissectionshowthetrendinquarterlyuseofhospitalemergencydepartmentsforconditions
thatmighthavebeenmoreappropriatelytreatedinprimarycare(e.g.,upperrespiratoryinfections)as
indicatedbyMedicaidclaimsdata.
DataispresentedforthetotalMedicaidpopulation,brokenoutbyageandeligibilitygroupings,and
brokenoutformetropolitanandnonmetropolitanareasoftheStatewheresupportedsufficientdata
neededforreliableresults.
ThedatapresentedhasbeenadjustedtoremoveseasonalitythatinNewHampshirereliablyresultsin
higherthanaverageratesinthefirstcalendarquarterandlowerthanaverageratesinthethirdcalendar
quarter(duetoseasonalityofrespiratoryinfections).
Forthismeasure,arateabovethecontrollimitsisthetriggerindicatingapotentialaccessproblem
requiringfurtherinvestigation.Higherrates,inconjunctionwithloweruseofprimarycarecould
indicateanaccessproblem.
Theratesshowninallfiguresnevercrossthecontrollimits,andthereforedonotindicateapotential
accessproblem.
Figure22. SeasonallyAdjustedEmergencyDepartmentUtilizationforConditionsPotentially
TreatableinPrimaryCareper1,000NHMedicaidBeneficiaries,CY20072011:Total
Population
25
22
20
19

15

15

10

5
DSHRedesign

HospitalRateReductions

DSHReduction

0
2007 2007 2007 2007 2008 2008 2008 2008 2009 2009 2009 2009 2010 2010 2010 2010 2011 2011 2011 2011
QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4
AdjustedRateper1,000

MeanAdjustedRate

ControlLimit

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Figure23. SeasonallyAdjustedEmergencyDepartmentUtilizationforConditionsPotentially
TreatableinPrimaryCareper1,000NHMedicaidBeneficiaries,CY20072011:Children,
ChildrenandFamiliesAidCategories
25

21

20

17
15
12
10

5
DSHRedesign

HospitalRateReductions

DSHReduction

0
2007 2007 2007 2007 2008 2008 2008 2008 2009 2009 2009 2009 2010 2010 2010 2010 2011 2011 2011 2011
QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4
AdjustedRateper1,000

MeanAdjustedRate

ControlLimit

Figure24. SeasonallyAdjustedEmergencyDepartmentUtilizationforConditionsPotentially
TreatableinPrimaryCareper1,000NHMedicaidBeneficiaries,CY20072011:Adults,
BlindandDisabledAidCategories
35
32
30

25

25

20

20

15

10

5
DSHRedesign

HospitalRateReductions

DSHReduction

0
2007 2007 2007 2007 2008 2008 2008 2008 2009 2009 2009 2009 2010 2010 2010 2010 2011 2011 2011 2011
QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4
AdjustedRateper1,000

MeanAdjustedRate

ControlLimit

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Figure25. SeasonallyAdjustedEmergencyDepartmentUtilizationforConditionsPotentially
TreatableinPrimaryCareper1,000NHMedicaidBeneficiaries,CY20072011:Adults,
ChildrenandFamiliesAidCategories
35
31

30

26

25

22
20

15

10

5
DSHRedesign

HospitalRateReductions

DSHReduction

0
2007 2007 2007 2007 2008 2008 2008 2008 2009 2009 2009 2009 2010 2010 2010 2010 2011 2011 2011 2011
QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4
AdjustedRateper1,000

MeanAdjustedRate

ControlLimit

Figure26. SeasonallyAdjustedEmergencyDepartmentUtilizationforConditionsPotentially
TreatableinPrimaryCareper1,000NHMedicaidBeneficiaries,CY20072011:
MetropolitanAreas
25
22
20

19

15
13
10

5
DSHRedesign

HospitalRateReductions

DSHReduction

0
2007 2007 2007 2007 2008 2008 2008 2008 2009 2009 2009 2009 2010 2010 2010 2010 2011 2011 2011 2011
QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4
AdjustedRateper1,000

MeanAdjustedRate

ControlLimit

MONITORINGACCESSTOCAREINNEWHAMPSHIRESMEDICAIDPROGRAM:REVIEWOFKEYINDICATORS,JUNE2012
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OfficeofMedicaidBusinessandPolicy

26

Figure27. SeasonallyAdjustedEmergencyDepartmentUtilizationforConditionsPotentially
TreatableinPrimaryCareper1,000NHMedicaidBeneficiaries,CY20072011:Non
MetropolitanAreas
30.00

26

25.00

20.00
18.15
16

15.00

10.00

5.00
DSHRedesign

HospitalRateReductions

DSHReduction

0.00
2007 2007 2007 2007 2008 2008 2008 2008 2009 2009 2009 2009 2010 2010 2010 2010 2011 2011 2011 2011
QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4
AdjustedRateper1,000

MeanAdjustedRate

ControlLimit

Seasonally Adjusted Total Emergency Department Utilization


FiguresinthissectionshowthetrendinquarterlyuseofhospitalemergencydepartmentsbyNew
HampshireMedicaidbeneficiariesasindicatedbyMedicaidclaimsdata.
DataispresentedforthetotalMedicaidpopulation,brokenoutbyageandeligibilitygroupings,and
brokenoutformetropolitanandnonmetropolitanareasoftheState.
ThedatapresentedhasbeenadjustedtoremoveseasonalitythatinNewHampshirereliablyresultsin
higherthanaverageratesinthefirstcalendarquarterandlowerthanaverageratesinthethirdcalendar
quarter(duetoseasonalityofrespiratoryinfections).
Forthetotalemergencydepartmentutilizationmeasure,arateeitheraboveorbelowthecontrollimits
isthetriggerindicatingapotentialaccessproblemrequiringfurtherinvestigation.Higherrates,in
conjunctionwithloweruseofprimarycarecouldindicateanaccessproblem.Ratesbelowthecontrol
limitcouldindicatemoreappropriateuseofcare(agoaloftheprogram),butwouldstillbeinvestigated
ifproviderenrollmentdataindicatesthepotentialforreducedemergencydepartmentaccess.
Asshownbelow,thedataindicatesthatemergencyutilizationhasnotcrossedthecontrollimitsand
supportstheconclusionthatMedicaidbeneficiariesinNewHampshiredonothaveaproblemaccessing
healthcareservices.

MONITORINGACCESSTOCAREINNEWHAMPSHIRESMEDICAIDPROGRAM:REVIEWOFKEYINDICATORS,JUNE2012
NewHampshireDepartmentofHealthandHumanServices
OfficeofMedicaidBusinessandPolicy

27

Figure28. SeasonallyAdjustedTotalEmergencyDepartmentUtilizationper1,000NHMedicaid
Beneficiaries,CY20072011:TotalPopulation
90
80

81

70

70

60

61

50
40
30
20
10

DSHRedesign

HospitalRateReductions

DSHReduction

0
2007 2007 2007 2007 2008 2008 2008 2008 2009 2009 2009 2009 2010 2010 2010 2010 2011 2011 2011 2011
QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4
Rateper1,000

MeanRate

ControlLimit

Figure29. SeasonallyAdjustedTotalEmergencyDepartmentUtilizationper1,000NHMedicaid
Beneficiaries,CY20072011:Children,BlindandDisabledAidCategories
90
80

77

70
60
53

50
40

39

30
20
10

DSHRedesign

HospitalRateReductions

DSHReduction

0
2007 2007 2007 2007 2008 2008 2008 2008 2009 2009 2009 2009 2010 2010 2010 2010 2011 2011 2011 2011
QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4
AdjustedRateper1,000

MeanAdjustedRate

ControlLimit

MONITORINGACCESSTOCAREINNEWHAMPSHIRESMEDICAIDPROGRAM:REVIEWOFKEYINDICATORS,JUNE2012
NewHampshireDepartmentofHealthandHumanServices
OfficeofMedicaidBusinessandPolicy

28

Figure30. SeasonallyAdjustedTotalEmergencyDepartmentUtilizationper1,000NHMedicaid
Beneficiaries,CY20072011:Children,ChildrenandFamiliesAidCategories
70
62

60

53

50

42

40

30

20

10
DSHRedesign

HospitalRateReductions

DSHReduction

0
2007 2007 2007 2007 2008 2008 2008 2008 2009 2009 2009 2009 2010 2010 2010 2010 2011 2011 2011 2011
QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4
AdjustedRateper1,000

MeanAdjustedRate

ControlLimit

Figure31. SeasonallyAdjustedTotalEmergencyDepartmentUtilizationper1,000NHMedicaid
Beneficiaries,CY20072011:Children,FosterCareAidCategories
70

60

60

50
43
40

40

30

20

10
DSHRedesign

HospitalRateReductions

DSHReduction

0
2007 2007 2007 2007 2008 2008 2008 2008 2009 2009 2009 2009 2010 2010 2010 2010 2011 2011 2011 2011
QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4
AdjustedRateper1,000

MeanAdjustedRate

ControlLimit

MONITORINGACCESSTOCAREINNEWHAMPSHIRESMEDICAIDPROGRAM:REVIEWOFKEYINDICATORS,JUNE2012
NewHampshireDepartmentofHealthandHumanServices
OfficeofMedicaidBusinessandPolicy

29

Figure32. SeasonallyAdjustedTotalEmergencyDepartmentUtilizationper1,000NHMedicaid
Beneficiaries,CY20072011:Adult,AgedAidCategories
70
66
60
57
50

40
35
30

20

10
DSHRedesign

HospitalRateReductions

DSHReduction

0
2007 2007 2007 2007 2008 2008 2008 2008 2009 2009 2009 2009 2010 2010 2010 2010 2011 2011 2011 2011
QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4
AdjustedRateper1,000

MeanAdjustedRate

ControlLimit

Figure33. SeasonallyAdjustedTotalEmergencyDepartmentUtilizationper1,000NHMedicaid
Beneficiaries,CY20072011:Adult,BlindandDisabledAidCategories
180
161

160
140

136

120

114

100
80
60
40
20

DSHRedesign

HospitalRateReductions

DSHReduction

0
2007 2007 2007 2007 2008 2008 2008 2008 2009 2009 2009 2009 2010 2010 2010 2010 2011 2011 2011 2011
QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4
AdjustedRateper1,000

MeanAdjustedRate

ControlLimit

MONITORINGACCESSTOCAREINNEWHAMPSHIRESMEDICAIDPROGRAM:REVIEWOFKEYINDICATORS,JUNE2012
NewHampshireDepartmentofHealthandHumanServices
OfficeofMedicaidBusinessandPolicy

30

Figure34. SeasonallyAdjustedTotalEmergencyDepartmentUtilizationper1,000NHMedicaid
Beneficiaries,CY20072011:Adult,FamiliesandChildrenAidCategories
160
140

141

120

121
113

100
80
60
40
20

DSHRedesign

HospitalRateReductions

DSHReduction

0
2007 2007 2007 2007 2008 2008 2008 2008 2009 2009 2009 2009 2010 2010 2010 2010 2011 2011 2011 2011
QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4
AdjustedRateper1,000

MeanAdjustedRate

ControlLimit

Figure35. SeasonallyAdjustedTotalEmergencyDepartmentUtilizationper1,000NHMedicaid
Beneficiaries,CY20072011:MetropolitanCounties
90
85
80
73

70
60

57

50
40
30
20
10

DSHRedesign

HospitalRateReductions

DSHReduction

0
2007 2007 2007 2007 2008 2008 2008 2008 2009 2009 2009 2009 2010 2010 2010 2010 2011 2011 2011 2011
QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4
AdjustedRateper1,000

MeanAdjustedRate

ControlLimit

MONITORINGACCESSTOCAREINNEWHAMPSHIRESMEDICAIDPROGRAM:REVIEWOFKEYINDICATORS,JUNE2012
NewHampshireDepartmentofHealthandHumanServices
OfficeofMedicaidBusinessandPolicy

31

Figure36. SeasonallyAdjustedTotalEmergencyDepartmentUtilizationper1,000NHMedicaid
Beneficiaries,CY20072011:NonMetropolitanCounties
90
85
80
70

67
64

60
50
40
30
20
10

DSHRedesign

HospitalRateReductions

DSHReduction

0
2007 2007 2007 2007 2008 2008 2008 2008 2009 2009 2009 2009 2010 2010 2010 2010 2011 2011 2011 2011
QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4
AdjustedRateper1,000

MeanAdjustedRate

ControlLimit

Seasonally Adjusted Inpatient Hospital Utilization for Ambulatory Care


Sensitive Conditions
Figuresinthissectionshowthetrendinquarterlyuseofinpatienthospitalsforambulatorycare
sensitiveconditions(ACSC)byNewHampshireMedicaidbeneficiariesasindicatedbyMedicaidclaims
data.RatesofhospitalizationforanACSCareconsideredtobeameasureofappropriateprimary
healthcaredelivery.Whilenotalladmissionsfortheseconditionsareavoidable,appropriate
ambulatorycarecanhelpprevent,orcontrol,acuteepisodes,andimprovethemanagementofthese
illnessesorconditions.AdisproportionatelyhighrateofACSCadmissionsmayreflectunderutilization
ofappropriateprimarycare.Theambulatorycaresensitiveconditionsincludedinthismeasureare:
asthma,dehydration,bacterialpneumonia,urinarytractinfection,andgastroenteritis,whichare
commonlygroupedtogetherasACSCs.
DataisonlypresentedforthetotalMedicaidpopulationduetothesmallnumberofcasesthatoccur
eachquarter,brokenoutbyageandeligibilitygroupings,andbrokenoutformetropolitanandnon
metropolitanareasoftheState.
ThedatahasbeenadjustedtoremoveseasonalitythatinNewHampshirereliablyresultsinhigherthan
averageratesinthefirstcalendarquarterandlowerthanaverageratesinthethirdcalendarquarter
(duetoseasonalityofrespiratoryinfections).

MONITORINGACCESSTOCAREINNEWHAMPSHIRESMEDICAIDPROGRAM:REVIEWOFKEYINDICATORS,JUNE2012
NewHampshireDepartmentofHealthandHumanServices
OfficeofMedicaidBusinessandPolicy

32

Forthismeasure,arateabovethecontrollimitsisthetriggerindicatingapotentialaccessproblem
requiringfurtherinvestigation.Higherrates,especiallyinconjunctionwithloweruseofprimarycare,
couldindicateanaccessproblem.
However,theratesshowninthefiguredonotcrossthecontrollimits,andthereforedonotindicatea
potentialaccessproblem.
Figure37. SeasonallyAdjustedInpatientHospitalUtilizationforAmbulatoryCareSensitive
Conditionsper1,000NHMedicaidBeneficiaries,CY20072011:TotalPopulation
0.90
0.80

0.81

0.70

0.70

0.60
0.50
0.40

0.40

0.30
0.20
0.10

DSHRedesign

HospitalRateReductions

DSHReduction

0.00
2007 2007 2007 2007 2008 2008 2008 2008 2009 2009 2009 2009 2010 2010 2010 2010 2011 2011 2011 2011
QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4
AdjustedRateper1,000

MeanAdjustedRate

ControlLimit

Seasonally Adjusted Total Inpatient Hospital Utilization


FiguresinthissectionshowthetrendinquarterlyuseofgeneralinpatienthospitalsbyNewHampshire
MedicaidbeneficiariesasindicatedbyMedicaidclaimsdata.
DataispresentedforthetotalMedicaidpopulation,brokenoutbyageandeligibilitygroupings,and
brokenoutformetropolitanandnonmetropolitanareasoftheState.
ThedatapresentedhasbeenadjustedtoremoveseasonalitythatinNewHampshirereliablyresultsin
higherthanaverageratesinthefirstcalendarquarterandlowerthanaverageratesinthethirdcalendar
quarter(duetoseasonalityofrespiratoryinfections).
Forthetotalinpatienthospitalutilizationmeasure,arateeitheraboveorbelowthecontrollimitsisthe
triggerindicatingapotentialaccessproblemrequiringfurtherinvestigation.Higherrates,inconjunction
withloweruseofprimarycarecouldindicateanaccessproblem.Ratesbelowthecontrollimitcould
indicatemoreappropriateuseofcare(agoaloftheprogram),butwouldstillbeinvestigatedifprovider
enrollmentdataindicatesthepotentialforreducedinpatienthospitalaccess.
MONITORINGACCESSTOCAREINNEWHAMPSHIRESMEDICAIDPROGRAM:REVIEWOFKEYINDICATORS,JUNE2012
NewHampshireDepartmentofHealthandHumanServices
OfficeofMedicaidBusinessandPolicy

33

Theratesshowninallfiguresnevercrossthecontrollimits,andthereforedonotindicateapotential
accessproblem.

Figure38. SeasonallyAdjustedInpatientHospitalUtilizationper1,000NHMedicaidBeneficiaries,CY
20072011:TotalPopulation
14

12

12

10

10
9

2
DSHRedesign

HospitalRateReductions

DSHReduction

0
2007 2007 2007 2007 2008 2008 2008 2008 2009 2009 2009 2009 2010 2010 2010 2010 2011 2011 2011 2011
QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4
Rateper1,000

MeanRate

ControlLimit

Annual Utilization of Preventive and Office/Clinic Health Services


FiguresinthissectionshowthetrendinthepercentofcontinuouslyenrolledNewHampshireMedicaid
beneficiarieswhomadeuseofatleastoneexpectedserviceasindicatedbyMedicaidclaimsdata.
MeasuredefinitionsfollowthosespecifiedbytheNationalCommitteeonQualityAssurance(NCQA).
Thesemeasuresarecalculatedusingannualdatabecauseexpectedserviceuseisbasedonanannual(or
greater)period.Onlycontinuouslyenrolledbeneficiaries(withnomorethanaonemonthgapin
coverage)areincludedtoensureadequatetimefortheexpectedserviceusetooccur.Whereavailable,
nationalNCQAaveragesforMedicaidarereportedonthecharts.
Measurespresentedinclude:

SixorMoreWellChildVisitsintheFirst15MonthsofLife,
WellChildVisitsintheThirdThroughSixthYearsofLife,
AdolescentWellCareVisits,
ChildAccesstoPreventive/AmbulatoryHealthServicesbyAge,and
AdultAccesstoPreventive/AmbulatoryHealthServicesbyAge.

MONITORINGACCESSTOCAREINNEWHAMPSHIRESMEDICAIDPROGRAM:REVIEWOFKEYINDICATORS,JUNE2012
NewHampshireDepartmentofHealthandHumanServices
OfficeofMedicaidBusinessandPolicy

34

MeasuresarepresentedforthetotalMedicaidpopulation,brokenoutformetropolitanandnon
metropolitanareasoftheState,exceptfortheChildandAdultAccesstoPreventive/AmbulatoryHealth
ServicesbyAgemeasures.
Forchartsbasedonannualdata,controllimitsarenotpresented(annualdatadoesnotprovideenough
experienceformeaningfullimits).Instead,95%confidenceintervalsarepresented.Theconfidence
intervaltakesintoaccountrandomvariabilityinthedatatoallowforcomparisonofratesovertime.
The95%confidenceintervalistherangeofvaluesthat,with95%certaintyincludestheunderlyingrate
fortheentirepopulation.Asthenumberofbeneficiariesrepresentedintherateincrease,the
confidenceintervalsbecomenarrower.
Ifthecurrentperiodofdatadeviatestosuchadegreethatitsconfidenceintervaldoesnotoverlapwith
thepriorperiodsconfidenceintervalitwillindicateapotentialaccessproblemrequiringfurther
investigation.Additionally,ifaslowlychangingtrendisobservedandthecurrentperiodsconfidence
intervaldoesnotoverlapwithanyofthepreviousthreeconfidenceintervalsitwillindicateapotential
accessproblemrequiringfurtherinvestigation.
Analysisofthetrendsandconfidenceintervalsdonotindicateapotentialaccessproblem.
Figure39. PercentofContinuouslyEnrolledNHMedicaidBeneficiariesWithSixorMoreWellChild
VisitsintheFirst15MonthsofLife,CY20072011:TotalPopulation
100.0%
90.0%
80.0%
70.0%

77.7%

78.6%

78.9%

80.2%

79.9%
77.1%

71.9%

72.8%

73.4%

74.8%

74.4%

60.0%
50.0%
40.0%
30.0%
20.0%
2011National MedicaidNCQAHEDISAverage=60.2%

10.0%
0.0%
CY2007

CY2008

CY2009

CY2010

MONITORINGACCESSTOCAREINNEWHAMPSHIRESMEDICAIDPROGRAM:REVIEWOFKEYINDICATORS,JUNE2012
NewHampshireDepartmentofHealthandHumanServices
OfficeofMedicaidBusinessandPolicy

CY2011

35

Figure40. PercentofContinuouslyEnrolledNHMedicaidBeneficiariesWithSixorMoreWellChild
VisitsintheFirst15MonthsofLife,CY20072011:MetropolitanCounties
100.0%
90.0%
80.0%

76.6%

77.7%

78.3%

80.7%

80.3%
76.6%

70.0%
68.9%

70.1%

70.9%

CY2007

CY2008

CY2009

73.4%

73.0%

CY2010

CY2011

60.0%
50.0%
40.0%
30.0%
20.0%
10.0%
0.0%

Figure41. PercentofContinuouslyEnrolledNHMedicaidBeneficiariesWithSixorMoreWellChild
VisitsintheFirst15MonthsofLife,CY20072011:NonMetropolitanCounties
100.0%
90.0%

82.3%

82.5%

83.2%

83.1%

80.0%
70.0%

82.2%
78.0%

73.2%

73.3%

74.4%

74.6%

73.8%

CY2007

CY2008

CY2009

CY2010

CY2011

60.0%
50.0%
40.0%
30.0%
20.0%
10.0%
0.0%

MONITORINGACCESSTOCAREINNEWHAMPSHIRESMEDICAIDPROGRAM:REVIEWOFKEYINDICATORS,JUNE2012
NewHampshireDepartmentofHealthandHumanServices
OfficeofMedicaidBusinessandPolicy

36

Figure42. PercentofContinuouslyEnrolledNHMedicaidBeneficiariesintheThirdThroughSixth
YearsofLifeWithaWellChildVisit,CY20072011:TotalPopulation
100.0%
90.0%
80.0%

74.7%

74.9%

71.7%

71.9%

70.0%

78.1%

78.1%

78.3%
76.9%

75.2%

75.4%

75.6%

60.0%
50.0%
40.0%
30.0%
20.0%
2011National MedicaidNCQAHEDISAverage=71.9%

10.0%
0.0%
CY2007

CY2008

CY2009

CY2010

CY2011

Figure43. PercentofContinuouslyEnrolledNHMedicaidBeneficiariesintheThirdThroughSixth
YearsofLifeWithaWellChildVisit,CY20072011:MetropolitanCounties
100.0%
90.0%
80.5%
80.0%
70.0%

76.6%

76.8%

72.4%

72.8%

CY2007

CY2008

80.5%

80.4%
78.6%

76.6%

76.8%

76.8%

CY2009

CY2010

CY2011

60.0%
50.0%
40.0%
30.0%
20.0%
10.0%
0.0%

MONITORINGACCESSTOCAREINNEWHAMPSHIRESMEDICAIDPROGRAM:REVIEWOFKEYINDICATORS,JUNE2012
NewHampshireDepartmentofHealthandHumanServices
OfficeofMedicaidBusinessandPolicy

37

Figure44. PercentofContinuouslyEnrolledNHMedicaidBeneficiariesintheThirdThroughSixth
YearsofLifeWithaWellChildVisit,CY20072011:NonMetropolitanCounties
100.0%
90.0%
80.0%

73.8%

73.9%

76.9%

76.6%

77.0%
75.0%

70.0%
69.1%

69.3%

CY2007

CY2008

72.5%

72.4%

72.9%

CY2009

CY2010

CY2011

60.0%
50.0%
40.0%
30.0%
20.0%
10.0%
0.0%

Figure45. PercentofContinuouslyEnrolledAdolescentNHMedicaidBeneficiariesWithaWellCare
Visit,CY20072011:TotalPopulation
100.0%
90.0%
80.0%
70.0%
60.0%
50.0%
40.0%

47.9%

46.0%

52.2%

51.8%

51.7%

50.2%

49.9%

49.8%

48.6%

50.8%

46.6%

30.0%
20.0%
2011National MedicaidNCQAHEDISAverage=48.1%

10.0%
0.0%
CY2007

CY2008

CY2009

CY2010

MONITORINGACCESSTOCAREINNEWHAMPSHIRESMEDICAIDPROGRAM:REVIEWOFKEYINDICATORS,JUNE2012
NewHampshireDepartmentofHealthandHumanServices
OfficeofMedicaidBusinessandPolicy

CY2011

38

Figure46. PercentofContinuouslyEnrolledAdolescentNHMedicaidBeneficiariesWithaWellCare
Visit,CY20072011:MetropolitanCounties
100.0%
90.0%
80.0%
70.0%
60.0%
50.4%

54.8%

53.4%

52.8%

52.1%

50.8%

CY2009

CY2010

CY2011

52.1%

50.0%
40.0%

55.6%
51.0%

47.8%

48.2%

CY2007

CY2008

30.0%
20.0%
10.0%
0.0%

Figure47. PercentofContinuouslyEnrolledAdolescentNHMedicaidBeneficiariesWithaWellCare
Visit,CY20072011:NonMetropolitanCounties
100.0%
90.0%
80.0%
70.0%
60.0%
50.0%
40.0%

48.0%

48.8%

45.2%

45.8%

CY2007

CY2008

51.6%

50.9%

51.3%
49.9%

48.6%

48.0%

48.5%

CY2009

CY2010

CY2011

30.0%
20.0%
10.0%
0.0%

MONITORINGACCESSTOCAREINNEWHAMPSHIRESMEDICAIDPROGRAM:REVIEWOFKEYINDICATORS,JUNE2012
NewHampshireDepartmentofHealthandHumanServices
OfficeofMedicaidBusinessandPolicy

39

Figure48. PercentofContinuouslyEnrolledNHMedicaidChildBeneficiariesWithaPreventiveor
OtherAmbulatoryService,SFY20072011byAge:0to11Months
100.0%
90.0%

99.4%

99.2%

99.5%

98.9%

98.5%
97.4%

97.6%

97.2%

97.8%

96.9%

96.3%

SFY2007

SFY2008

SFY2009

SFY2010

SFY2011

80.0%
70.0%
60.0%
50.0%
40.0%
30.0%
20.0%
10.0%
0.0%

Figure49. PercentofContinuouslyEnrolledNHMedicaidChildBeneficiariesWithaPreventiveor
OtherAmbulatoryService,SFY20072011byAge:12to24Months
100.0%

98.1%

98.0%

98.4%

97.8%

97.1%

97.0%

97.5%

96.9%

97.2%
96.6%

90.0%

96.1%

80.0%
70.0%
60.0%
50.0%
40.0%
30.0%
20.0%
10.0%

2011National MedicaidNCQAHEDISAverage=96.1%

0.0%
SFY2007

SFY2008

SFY2009

SFY2010

MONITORINGACCESSTOCAREINNEWHAMPSHIRESMEDICAIDPROGRAM:REVIEWOFKEYINDICATORS,JUNE2012
NewHampshireDepartmentofHealthandHumanServices
OfficeofMedicaidBusinessandPolicy

SFY2011

40

Figure50. PercentofContinuouslyEnrolledNHMedicaidChildBeneficiariesWithaPreventiveor
OtherAmbulatoryService,SFY20072011byAge:25Monthsto6Years
100.0%
89.4%

89.4%

90.4%

91.2%

90.3%

88.4%

89.5%

90.3%

89.4%

90.0%
80.0%

89.8%
88.4%

70.0%
60.0%
50.0%
40.0%
30.0%
20.0%
10.0%

2011National MedicaidNCQAHEDISAverage=88.3%

0.0%
SFY2007

SFY2008

SFY2009

SFY2010

SFY2011

Figure51. PercentofContinuouslyEnrolledNHMedicaidChildBeneficiariesWithaPreventiveor
OtherAmbulatoryService,SFY20072011byAge:7to11Years
100.0%
90.0%
80.0%

87.2%

86.5%

87.8%

88.7%

88.1%

85.2%

86.6%

87.6%

87.0%

87.5%
86.0%

70.0%
60.0%
50.0%
40.0%
30.0%
20.0%
2011National MedicaidNCQAHEDISAverage=90.2%

10.0%
0.0%
SFY2007

SFY2008

SFY2009

SFY2010

MONITORINGACCESSTOCAREINNEWHAMPSHIRESMEDICAIDPROGRAM:REVIEWOFKEYINDICATORS,JUNE2012
NewHampshireDepartmentofHealthandHumanServices
OfficeofMedicaidBusinessandPolicy

SFY2011

41

Figure52. PercentofContinuouslyEnrolledNHMedicaidChildBeneficiariesWithaPreventiveor
OtherAmbulatoryService,SFY20072011byAge:12to18Years
100.0%
91.6%

91.4%

92.4%

93.6%

93.6%

91.5%

92.8%

92.8%

93.2%

90.0%
90.7%

90.4%

80.0%
70.0%
60.0%
50.0%
40.0%
30.0%
20.0%
2011National MedicaidNCQAHEDISAverage(1219years)=88.2%
10.0%
0.0%
SFY2007

SFY2008

SFY2009

SFY2010

SFY2011

Figure53. PercentofContinuouslyEnrolledNHMedicaidAdultBeneficiariesWithaPreventiveor
OtherAmbulatoryService,SFY20072011byAge:20to44Years
100%
91%

89%

89%

89%

87%

85%

86%

86%

90%

87%
86%

80%

84%

70%
60%
50%
40%
30%
20%
2011National MedicaidNCQAHEDISAverage=81.2%
10%
0%
CY2006

CY2007

CY2008

CY2009

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NewHampshireDepartmentofHealthandHumanServices
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CY2010

42

Figure54. PercentofContinuouslyEnrolledNHMedicaidAdultBeneficiariesWithaPreventiveor
OtherAmbulatoryService,SFY20072011byAge:45to64Years
100%

96%

96%

96%

95%

95%
93%

90%
89%

90%

90%

89%

90%

80%
70%
60%
50%
40%
30%
20%
2011National MedicaidNCQAHEDISAverage=86.1%
10%
0%
CY2006

CY2007

CY2008

CY2009

CY2010

Beneficiary Assistance and Satisfaction


Beneficiary Requests for Assistance Accessing Providers
AsdetailedfurtherintheBeneficiaryEngagementchapterofthisreport,NewHampshireMedicaid
maintainsaClientServicesunitwithatollfreenumberthatrespondstobeneficiaryrequestsfor
assistanceinfindingproviders.ClientServicessystematicallytracksinformationabouttheserequestsin
adatabase.Anincreasingtrendinrequestsforassistancefindingaprovidercouldbeanindicationthat
thereisanemergingaccessproblemtriggeringtheneedforfurtherresearch.ClientServicesalsooften
receivesinformationfrombeneficiariesregardingthereasontheyneedhelpfindingaprovider.While
thisinformationisanecdotal,ittoomayleadtofurtherresearch.
TheinformationfromClientServicesisavailableonatimelierbasisthanutilizationdatathatrequiresa
lagperiodtoallowforclaimstobesubmittedandprocessed.Inthisreport,andinfuturereporting,
ClientServicesdatawillbeonequartermorecurrentthaninformationbasedonclaimsdata.Becauseof
this,ClientServicesinformationprovidesthebestearlywarningindicatorofpotentialaccessproblem.
Thefigurebelowshowsthetrendinbeneficiaryrequestsforassistancefindingaprovider.MajorNew
HampshireMedicaidpaymentchangesareindicatedandcontrollimitsatthethirdstandarddeviationof
thehistoricaldataareincludedtoprovideatriggerindicatingapotentialaccessproblemrequiring
furtherinvestigation.Theoveralltrendispresented,followedbydetailonthetrendsbymetropolitan
andnonmetropolitanareasoftheState.
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Foroverallcalldataanddatafrommemberslivinginmetropolitancountiesatnopointduringthetime
perioddoesthecontrolchartindicateapotentialaccessissuerequiringfurtherresearch.However,the
datafornonmetropolitancountiesinthefourthquarterofCY2011didcrossthecontrollimit,which
resultedinfurtherresearchandaction.
ResearchdeterminedthatthespikeincallsaskingforproviderassistancewasbecauseoftheLakes
RegionGeneralHospital'sdecisiontoclosesomeoftheirpracticestoadultMedicaidbeneficiaries.In
lateOctober,2011,ClientServiceshad32callsfromadultMedicaidbeneficiariesintheLakesRegion
needingnewprimarycarephysicians.AfterClientServicesperformedtelephoneoutreachtothesame
population,wehadanadditional79callstofindordiscussprovidersintheLakesRegion.Theabove
calls,totaling111,were35%ofthecallsfromnonmetropolitanareasrequiringassistancewith
providers.
Sincethattime,aftertheassistancewasprovided,thesetypesofcallshavereturnedtothenormal
volume.
Figure55. BeneficiaryRequestsforAssistanceAccessingProvidersper1,000NHMedicaid
Beneficiaries,CY20072012:TotalPopulation
3.5
3.1

3.0

2.5
2.2
2.0

1.5
1.2
1.0

0.5

HospitalRateReductions

DSHRedesign

DSHReduction

0.0
2007 2007 2007 2008 2008 2008 2008 2009 2009 2009 2009 2010 2010 2010 2010 2011 2011 2011 2011 2012
QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4 QTR1
Rateper1,000

MeanRate

ControlLimit

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Figure56. BeneficiarryRequestsfo
orAssistance
eAccessingPrrovidersper1,000NHMeedicaid
Beneficiarries,CY20072012:Metro
opolitanCoun
nties
4.5
4.0

3.8

3.5
3.0
2.7
2.5
2.0
1.6

1.5
1.0
0.5

Hosp
pitalRateReductio
ons

DSHRedessign

D
DSHReduction

0.0
200
07 2007 2007 2008 2008 2008 2008 2009 200
09 2009 2009 22010 2010 20100 2010 2011 2011 2011 2011 2012
QTR
R2 QTR3 QTR4 QT
TR1 QTR2 QTR3 QTR4 QTR1 QTR
R2 QTR3 QTR4 Q
QTR1 QTR2 QTR33 QTR4 QTR1 QTR2 QTR3 QTR4 Q
QTR1
Raateper1,000

MeanRate

ControlLLimit

Figure57. BeneficiarryRequestsfo
orAssistance
eAccessingPrrovidersper1,000NHMeedicaid
Beneficiarries,CY20072012:NonM
Metropolitan Counties
3.0

2.5
2.4
2.0

1.6

1.5

1.0
0.6
0.5
Hosp
pitalRateReductio
ons

DSHRedessign

D
DSHReduction

0.0
07 2007 2007 2008 2008 2008 2008 2009 200
09 2009 2009 22010 2010 20100 2010 2011 2011 2011 2011 2012
200
QTR
R2 QTR3 QTR4 QT
TR1 QTR2 QTR3 QTR4 QTR1 QTR
R2 QTR3 QTR4 Q
QTR1 QTR2 QTR33 QTR4 QTR1 QTR2 QTR3 QTR4 Q
QTR1
Raateper1,000

MeanRate

ControlLLimit

MONITORINGACCESSSTOCAREINNEWHAMPSHIRESMEDDICAIDPROGRAM:REVIEWOFKEYINDDICATORS,JUNE20012
NeewHampshireDep
partmentofHealth
handHumanServvices
OffficeofMedicaidB
BusinessandPolicyy

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Beneficiary Satisfaction Survey


NewHampshireMedicaidhasrecentlycontractedwithavendortoadministerandreporttheresults
fromthecoreAdultandChildversionsoftheAgencyforHealthcareResearchandQualitys(AHRQ)
ConsumerAssessmentofHealthcareProvidersandSystems(CAHPS)SurveyforMedicaidpopulations.
ThesurveywillbeadministeredinJuly2012withdatatobepresentedinafutureupdatetothisreport,
alongwithnationalbenchmarks,onthefollowingmeasures:

RatingofDoctorsChildren
RatingofDoctorsAdults
GettingNeededCareChildren
GettingNeededCareAdults
GettingCareQuicklyChildren
GettingCareQuicklyAdults

Conclusion
Atthistime,allmeasuresarewithinnormallimits,withnodetectablenegativetrends.Thisreport
includes56measuresofbeneficiaryenrollmenttrends,provideravailability,utilizationofhospitaland
primarycareservices,andbeneficiaryengagementtrendsoverthemostrecentfiveyearperiod.With
theexceptionofonedatapoint,allmeasuresarewithinnormallimits.OnedatapointinFigure57,
BeneficiaryRequestforAssistance,inthefourthquarterof2011exceedsthecontrollimit.This
situationwasrelatedtoLakesRegionGeneralHealthcareredirectingitsadultpatientstootherlocal
practices.Correctiveactionwastakenasdescribedintheintroductiontothatmeasure.Asaresult,call
volumereturnedtoanormallevelinthefollowingquarter,indicatingresolutionoftheLRGHevent.
Insomecases,trendsareimproving.Theratioofbeneficiariestoactiveinstateprimarycareproviders
inFigure10indicatesthatanincreasingnumberofprovidersareofferingprimarycareservicesto
Medicaidbeneficiaries.Emergencyroomutilizationforconditionspotentiallytreatableinaprimary
caresettinginFigure22throughFigure27isimproving,mostnotablyinFigure24,blindanddisabled
adultcategories,Figure25,adultsinthechildrenandfamilyaidcategories,andFigure27,thenon
metropolitanareas.ThetrendsintotalemergencyroomuseinFigure28throughFigure36arealso
improvinginsomecategories,mostnotablyinFigure31,fosterchildren,andFigure36,non
metropolitanareas.NineoftheelevenwellchildmeasuresinFigures42through48showupward
improvementsoverthepastfiveyears,withtheremainingtwomeasuresabovenationalaverage.
Figure13throughFigure21,SeasonallyAdjustedPhysician/APRN/ClinicUtilizationper1,000,indicatea
spikeinutilizationduringthe2009timeperiodandasteadylevelingoffsincethattime.Thespike
relatestotheH1N1pandemicthatoccurredthen,withthelevelingoffofutilizationdemonstratinga
returntononpandemiclevelsofutilization.Atalltimes,thedatapointsdidnotexceedthecontrol
limits.

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4. Beneficiary Engagement
NewHampshireMedicaidengagesbeneficiariesinavarietyofwaystokeepabreastofmedicalneeds,
populationcharacteristics,andbeneficiarysatisfactionwithprovideravailabilityandqualityofservices.
TheMedicalCareAdvisoryCommitteeandtheNewHampshireMedicaidClientServicesUnithelpNew
HampshireMedicaidunderstandtheneedsofMedicaidbeneficiaries,monitorbeneficiarytrends,and
respondwithcorrectiveactionasneeded.

New Hampshire Medicaid Client Services Unit


Forthepasttwentyyears,NewHampshireMedicaidhasoperatedaclientservicescallcenterasa
servicetobeneficiaries,andalsoasameansofengagingwithbeneficiariestodetermineandassistwith
beneficiaryneeds.Ithasalsobeenusedtomonitoraccessproblemsasphonecallsfrombeneficiaries
alertstafftodisruptionstoaccessandprovideravailability.TheNewHampshireMedicaidClient
ServicesUnitengageswithMedicaidbeneficiariesonadailybasis.Theymanagebeneficiariesconcerns,
requestsforinformation,provideraccessandavailabilitydifficulties,andasaresult,areontheforefront
ofNewHampshireMedicaidseffortstounderstandbeneficiariesneeds,andmonitor,identifyand
respondtoprovideraccessdifficulties.Inadditiontoanecdotalevidenceofaccessconcerns,theClient
ServicesUnitsystematicallyprovidesNewHampshireMedicaidwithaweeklybeneficiarycallreportin
ordertomonitorbeneficiaryconcerns.
NewHampshireMedicaidsClientServicesUnitengagesMedicaidbeneficiariesbyphoneandinwriting
regardingservicesavailabletothem.Allbeneficiariesareinformedfromtheoutsetthatassistanceis
availablefromtheClientServicesUnitshouldtheyhaveanydifficultywithprovideraccessand
availabilityorwithschedulingappointments.Beneficiariesmembershipcardsaresenttothemina
cardcarrierthatcontainsthetollfreetelephonenumberoftheClientServicesUnit,aswellas
informationconcerningtheavailabilityofassistancefindingdoctorsanddentists.Themailingalso
informsbeneficiariesoftheavailabilityofassistancewithtransportationoptionsandcostsand
professionalinterpretationservicessothatthesecommondifficultiesdonotbecomebarriersto
healthcareaccess.Additionally,theMedicaidClientServicesUnitsendsanyfamilywherethenew
enrolleeisachildawelcomepacketwithaninformationalflyer.Thisflyerprovidesbasicinformation
concerningMedicaidservicesandproviders.NewHampshireMedicaidcontactinformationisprovided
onthebackofthisflyer.
TheClientServicesUnitcallsallnewenrolleestodetermineiftheclientscurrenthealthcareproviders
areenrolledintheMedicaidprogram.Ifanyclientsneedhelpaccessingneworadditionalproviders,
thatneedwillbedeterminedduringthisinitialphonecall.Ifhelpisneeded,ClientServiceswillprovide
theclientswithalist(viaemail,verbally,byregularmail,orfax)ofcurrentlyenrolledMedicaid
providerswhoareabletoservethem.

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TheMedicaidClientServicesUnitsweeklyreportisproducedeveryMondayforthepreviousweek.The
keycomponentsofthisreportarethenumberofbeneficiarycalllogsstartedandcompleted,the
numberofincomingbeneficiarycallstakenliveorsenttovoicemail,andthenumberofbeneficiaryfrom
clientsseekingassistancefindingaprovider.
Thereisaseparatelogforeachcall,detailingtheissuespresented,discussed,andresolved.Client
Servicesstrivestorespondtoallcallsastheycomein.Forthosebeneficiarycallsthatgotovoicemail,
staffreturnsmorethan98%ofthecallsthesameday.
BeneficiarycallstotheClientServicesUnitaskingforassistancetolocateaprovideraretrackedby
requestedprovidertype.Thenumberofcallsisgiven,aswellasthetotalnumberofMedicaid
beneficiariesrequestingproviders.Forexample,onecallermayaskforthenameofadentistforher4
children.Thisrequestisloggedinasonecallandfourbeneficiaries.
Fromtheperiodof20072011,NewHampshireMedicaidhasseennosignificantspikesinbeneficiary
callsrequestingassistancefindingproviderswhoacceptMedicaid,withtheexceptionofthetimeperiod
whenoneofthestateshospitalsystems,LakesRegionGeneralHospital(LRGH),notifiedbeneficiariesin
November2011thatitwouldbeclosingitsphysicianpracticestosomeMedicaidbeneficiaries.
MedicaidbeneficiarieswerethefirsttoalertNewHampshireMedicaidofthisclosurenotificationand
potentialdisruptioninbeneficiariesaccesstocare.ClientServicesUnitstaffimmediatelyinformedthe
MedicaidDirector,MedicaidFinanceDirector,andotherMedicaidstaffoftheLRGHaction.Acorrective
actionplanwasimmediatelydevelopedandimplemented.TheClientServicesUnithelpedeach
beneficiarywhoneededhelpfindingalternativeproviders.Engagingwithbeneficiariesthroughtheir
phonecallsandreviewingthebeneficiarycallcenterreporthelpsNewHampshireMedicaidmonitors
accesstocare.
WhenabeneficiarycallsNewHampshireMedicaidrequestingassistancefindingaprovider,theClient
ServicesUnitlocatesproviders,throughasearchofitsproviderdatabasebyprovidertype,withina25
mileradiusofthebeneficiaryshome.ClientServicesprovidesthelistofappropriateproviderstothe
beneficiaryoverthephone,bypostalmail,email,orfax,accordingtoeachbeneficiaryspreference.
Theproviderlistincludesprovidersnames,streetaddresses,andphonenumbers.
NewHampshireMedicaid,throughitsClientServicesUnit,hasfoundalternativeprovidersforevery
beneficiarytoldbytheirprovidersthattheynolongeracceptMedicaid.ClientServicesmaintainsa
databaseofproviderswhoacceptnewMedicaidpatients,byregularlycallingprovidersofficesfor
updatedinformation.Alldifficultiespresentedbybeneficiariesconcerninghealthcareaccessissues
havebeensuccessfullyaddressedandresolvedbytheMedicaidClientServicesUnit.
NewHampshireMedicaidalsoengagesbeneficiariesandpotentialbeneficiariesbyprovidingbrochures
andotherinformationalmaterialstoapproximately1,900locationsstatewide,includingschools,
hospitals,town/citywelfareoffices,courthouses,legalassistanceprogramsandunemploymentoffices.
Additionaldistributionpointsincludechildcareproviders,soupkitchens/foodpantries,homeless
shelters,andhealthcareproviders(obgyn,pediatricandprimarycare).Targetedoutreachiscurrently
beingconductedforadolescents,culturally/raciallydiversegroups,andtherecentlyunemployed.New
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HampshireMedicaidalsohelpsfamiliesaccesshealthcarecoverageatthecommunitylevelthroughits
ApplicationAssistorsprogram.Applicationassistorsarestationedatnineteenhospitals,eleven
FederallyQualifiedHealthCenters(FQHC)andcommunityhealthcenters,andotherprimarycare
providerandreferralorganizationsites.

Medical Care Advisory Committee (MCAC)


NewHampshireMedicaidcreatedtheNewHampshireMedicalAdvisoryCommittee(MCAC),wellover
twentyyearsago,toadvisetheMedicaiddirectoraboutNewHampshireMedicaidhealthpolicy,
planning,andmedicalcareservices.TheprimarypurposeofNewHampshiresMCACistoserveasa
sourceofconsumerandstakeholderinvolvementintheMedicaidprogram.TheMCAChasalsohadan
advisoryroleinthedesignandimplementationofMedicaidManagedCareinNewHampshire.New
HampshiresMCACmeetsonamonthlybasisand,amongotherthings,reviewsandrecommends
Medicaidpolicyandplanningproposals;discussesvariousMedicaidproviderandbeneficiaryissues;and
ensurescommunicationbetweenMCACmembersandtheNewHampshireMedicaidleadership.Ithas
beenandwillcontinuetobeusedtoprovideaforumforreviewingdataandanalysisthataddresses
issuesrelatedtoMedicaidbeneficiaryaccesstocareinNewHampshireandforplanningStepTwoofthe
transitiontomanagedcare.
TheNewHampshireMCAChas21members,comprisedofMedicaidbeneficiaries[5],
beneficiary/consumeradvocacygroupsmembersofthegeneralpublicconcernedabouthealthservice
deliverytoMedicaidBeneficiaries[4];healthcareprofessionalswhoserveMedicaidbeneficiaries[8],
andotherknowledgeableindividualswithexperienceinhealthcare,ruralhealth,Medicaidlawand
policy,healthcarefinancing,qualityassurance,patient'srights,healthplanning,pharmacycare[4],and
thosefamiliarwiththehealthcareneedsoflowincomepopulationgroupsandtheMedicaidpopulation.
Thesemeetingsareopentothepublic,androutinely,threerepresentativesofthegeneralpublicarein
attendance.Inaddition,DHHSprogramstaffmembersfromallaspectsoftheNewHampshireMedicaid
programareinattendance.

Stakeholder Meetings
Asapartoftheprocessofdeterminingand/orimplementingmajorpolicychangeattheDepartmentof
HealthandHumanServices,astakeholderengagementprocessisusedwherebycommunityforumsare
heldthroughouttheStatetoprovideinformationtoandsolicitinputfromcommunitypartners,
providers,institutions,andbeneficiaries.Thepurposeofstakeholdermeetingsareto:1.Beginthe
processofsustaineddialogueleadingtosharedunderstanding;2.Setprinciplesandstrategiestoguide
transformation;and3.Outlinetheapproachformovingforward.
Stakeholdermeetingshaveoccurredmultipletimesonavarietyofsubjectsoverthepastseveralyears.
Mostrelevanttothisreportingarethefollowing:In2008,stakeholderswerebroughttogetherto
engageinaHealthcaretransformationprojectdesignedtoexaminebusinessprocessestostreamline
anddriveoutnonvalueaddedactivitiesthatcontributetocoststhatcouldbetterbedirectedtothe
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careofclients.Thestakeholdercouncilmeetingswereorganizedintothreesubjectmattergroupsof
publichealth/medicalservices,humanservices,andlongtermcareservices.Ultimately,thediscussions
ledtothe"FrontDoor"project,whichstreamlineshowclientsenterandaccessservicesinNew
Hampshire.
In2009andinto2010,chiefexecutiveandfinanceofficersfromNewHampshires26acutecare
hospitalsandtworehabilitationhospitalswerebroughttogetherinaseriesofmeetingstoexplore
alternativepaymentmethodsintheDisproportionateShareProgramwhichultimatelyresultedina
reviseddistributionmethodologyofavailableDSHdollarsproportionaltotheamountof
uncompensatedcareprovidedbyhospitals.
Currently,TheNewHampshireDepartmentofHealthandHumanServicesisholdingeleveninformation
sessionsthroughouttheStateonthenewMedicaidCareManagementprogram.Themeetingsarefor
thosewhouseMedicaidservicesaswellasfamilymembersandcaregiversandforhumanservice
agencycasemanagersorservicecoordinatorswhoworkwiththem.Informationcoveredisonthefirst
stepofthenewMedicaidCareManagementprogramscheduledtolaunchlaterthisyear.Thefirststep
encompassesthoseMedicaidservicesthataddressmedicalneeds,suchasdoctorvisits,inpatientand
outpatienthospitalvisits,prescriptions,mentalhealthservices,homehealthservices,speechtherapy,
andaudiologyservices.
Insummary,

NewHampshireMedicaidregularlyengageswithMedicaidbeneficiariesdirectlyand
indirectly,viabeneficiaryadvocatesandMedicaidproviders,throughitsparticipationinthe
MedicalCareAdvisoryCommittee.TheMCACmeetsonamonthlybasis.
InadditiontoMCACmeetings,DHHSholdsstakeholdermeetingsfromtimetotimewhen
consideringorimplementingmajorpolicychanges.
NewHampshireMedicaidregularlyengageswithMedicaidbeneficiarieswhocallthehotline
managedbytheMedicaidClientServicesUnit.TheUnitentertainsabout800callsperweek
toandfrombeneficiariesposingavarietyofquestionsrangingfrombenefitverificationsto
assistancefindingtransportationoradoctor.

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5. Plan for Monitoring Access


Updates to Monitoring
Aspartofitsaccessmonitoringstrategy,NewHampshireMedicaidwillconducttheseperiodicreviews
ofaccesscompliance.Dataanalysisandreportingwillbeconductedquarterlyandwithinfortyfivedays
afterthecloseofthequarter.NewHampshireMedicaidwillcontinuetoreviewandrevisethe
MonitoringPlanitselftoensurethecontinuedrelevanceoftheselectedindicators,andtoexpandit
overtimetoincludeotherMedicaidbenefits,includingbehavioralhealth,longtermcareservices,and
managedcare.

Investigation of Access Issues and Corrective Actions


NewHampshireMedicaidhasatwotierdetectionsysteminplace.Thefirstdetectionmethodisbased
onthesystematic,ongoingmonitoringasdisplayedinthisreport.Thesecondmethodistherealtime
andindividualizeddetectionandresolutionthatoccursbytheMedicaidClientServicesUnit.
ShouldasystemicaccessissuebedetectedthroughNewHampshiresquarterlyaccessmonitoring
report,NewHampshireMedicaidwouldactivateaCorrectiveActionResponseTeamtoresearchthe
specificcause(s)oftheproblemandmakerecommendationsforcorrectiveactiontotheStateMedicaid
DirectorandtheDepartmentsMedicaidExecutiveTeamwithin45daysofdiscoveringtheproblem.
Themultidisciplinaryresponseteamshallconsistofamemberofeachofthefollowingunits:the
MedicaidClientServicesUnit,theFinancialManagementandReimbursementUnit,theBenefits
ManagementUnit,theProviderNetworkManagementUnit,andtheHealthDataandAnalyticsUnit.Its
rolewouldbetocommunicatewithbeneficiariesandproviders,asnecessary,toassessadditionaldata
todeterminethecauseoftheaccessissue,proposecorrectiveactions,anddevelopadditional
monitoringsystemsasnecessarytomonitorprogresstowardaccesscompliance.TheexistingMCACwill
alsoprovideareadilyavailableresourcetoengagestakeholdersinthisprocess.Thetimingandnature
ofanycorrectiveactionstakenwillnecessarilydependupontheparticularnatureandmagnitudeofthe
accessproblemidentifiedandthebeneficiarypopulationaffected.
Correctiveactionsshallsetatargetforcompliancewithaccessrequirementsassoonaspossible,butno
laterthanwithinoneyearofthecorrectiveactionplanapproval,dependingonthecomplexityand
magnitudeoftheproblem.Possiblecorrectiveactionsincludebutarenotlimitedto:

Resolvingprovideradministrativeburdens,suchasclaimssubmissionandpaymentissues;
Assistingbeneficiariesinobtainingnecessaryprimaryorspecialtycareservicesthroughprovider
referral,transportationassistance,orenrollmentinMedicaidManagedCare;
Assessingandrealigningcoveredbenefitssothatadditionalresourcescanbedirectedtowarda
resourcechallengedarea.
IncentivizingtheexpansionofhealthcareprovidersinunderservedareasintheState.

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Restructuringratesandtargetingthemtoaddresstheparticularunderservedareas.

SurveillancebytheMedicaidClientsServicesUnitisasecondmethodofdetectinganyissuestoaccess
ofcareandprovidingproblemresolution/correctiveactiononarealtime,casebycasebasis.New
Hampshirehaslonghadinplacean800telephonenumberthatbeneficiariescancallforassistance.
ThephonenumberappearsontheMedicaidmembercard,intheMemberwelcomepacket,andinall
beneficiarycommunicationsandoutreachmaterials.TheMedicaidClientServicesUnitmanagesacall
center,providingombudsmanservicestoclientswhoneedassistance,maintaininganuptodate
networkreferenceguide,andofferingreferralstoprovidersuponrequest,andprovidingtransportation
assistanceandtransportationreimbursement.Inadditiontocasebycaseproblemresolution,the
MedicalClientServicesunitmaintainscalllogsandisalertforanyaccumulationofsimilarcomplaints
thatindicateatrend.
Shouldanacuteaccessissuebedetected(asinthecaseofLRGH),theStateMedicaidDirectorwillbe
notifiedimmediately.TheMedicaidDirectorwillberesponsibleforalertingtheDepartment'sExecutive
TeamandtheCMSRegionalOffice.TheMedicaidDirectorwillactivateaCorrectiveActionResponse
Teamtoresearchthespecificcausesincludinggatheringfactsdirectlyfromthoseprovidersimplicated
intheaccessissue,analyzetoprojectpotentialclientimpact,confirmrealtimeavailablealternative
provideravailability,andaugmentstaffingtotheClientServicesUnittoincludeadditionalstaffand
extendedhoursofoperations.SpecificmessagingtoMedicaidbeneficiariespotentiallyimpactedwillbe
issuedviamediaoutlets,communitynetworkpartners,andsocialmediaincludingFacebookand
Twitter.TheseresponsestrategieswillbeimplementedonthesamedaythatNewHampshireMedicaid
becomesawareofapotentialacuteaccessissue.Forthefirst3dayspostanacuteevent,theMedicaid
DirectorwillconductaconferencecallupdatewiththeCorrectiveActionResponseTeammembersat
8:00a.m.eachday.InadditiontheMedicaidDirectorwillprovidestatusreportsviaemailby12:00
Noonand4:30p.m.eachday.Asthetimegoeson,thereportingschedulewillbemodifiedas
appropriate.AwrittensynopsisoftheacuteaccessissueandtheNewHampshireMedicaidprogram's
responsewillbemadeavailabletoCMSandthegeneralpublic30daysaftertheMedicaidDirectorhas
deemedtheacuteincidenttoberesolvedandincludedinthenextpublishedaccessmonitoringreport.

Access Monitoring under Medicaid Managed Care


In2011,theNewHampshireLegislaturedirectedtheCommissioneroftheDepartmentofHealthand
HumanServices(DHHS)todevelopacomprehensive,statewidemanagedcareprogramforallMedicaid
beneficiaries.UponCMSapprovalandsuccessfulreadinessreviews,DHHSwillbeginenrollingMedicaid
beneficiariesintooneofthreeManagedCareOrganizations(MCOs)byOctober1,2012.Itisanticipated
thatbyDecember1,2012,NewHampshireMedicaidexpectstohavetransitionedmostofitsMedicaid
andCHIPbeneficiariesintoamanagedcareprogram.ManagedCarecontractorsarecurrently
developingtheirnetworksinresponsetotheState'sdesireforadequateaccesswithinthemanaged
careprogram,andarerequiredtodemonstratecompliancepriortobeingapprovedtoproceedwith
enrollment.TheMCOswillprovideacomprehensiveriskbased,capitatedprogramforproviding

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healthcareservicestobeneficiariesenrolledintheNewHampshireMedicaidProgramandprovidefor
allaspectsofmanagingsuchprogram.
WiththisnewCareManagementprogram,DHHShastheopportunitytodevelopacomprehensiveNew
HampshireMedicaidQualityStrategy,buildingonNewHampshirelegislativegoalsofvalue,quality
assurance,andefficiency,andfocusedonthehealthofMedicaidbeneficiaries.DHHSQualityStrategy,
currentlyinthereviewandapprovalprocess,willservetoassurestakeholdersthatNewHampshires
managedcareorganizations(MCOs)areincontractcompliance,havecommittedadequateresourcesto
performinternalmonitoringandongoingqualityimprovement,andactivelycontributetohealthcare
improvementfortheStatesmostvulnerablecitizens.NewHampshireiscreatingacomprehensive
outreachandeducationplantoassurediversemethodsofengagingclients.AllNewHampshire
Medicaidbeneficiarieswillbeencouragedtoenrollinmanagedcareandwillbegiventheopportunityto
choosethemanagedcareplanthatbestsuitstheirneeds.TheQualityStrategyarticulatestheMCO
reportingthatwillprovidedatadrivenanalysistoNewHampshireMedicaidandCMSofMCOprovider
networkadequacy.Inaddition,NewHampshiresExternalQualityReviewOrganization(EQRO),which
willbeprocuredintheFallof2012,throughvalidationofMCOdataandreporting,willserveasan
additionallevelofprovidernetworkadequacyandaccessoversight.
BeginninginDecember2012,accessissueswillbeaddressedbytheMCOsinthefirstinstance.New
HampshireMedicaidwillmonitorcompliancewitheachMCOscontractualresponsibilities,including,
responsibilitiesforassuringaccessandquality,andwillcontinuetoassureaccesstocareforNew
HampshireMedicaidbeneficiaries.
TohelpensureappropriateaccesstohealthcareservicesforMedicaidbeneficiariesinitsmanagedcare
programandpursuanttoDHHSCareManagementContractwiththeMCOs,theMCOsarerequired,
interalia,to:

implementproceduresthatensurethatMedicaidbeneficiarieshaveaccesstoanongoing
sourceofprimarycareappropriatetotheirindividualneeds;
providenonemergentmedicaltransportationtoensureMedicaidbeneficiariesreceive
medicallynecessaryservicesandensurethatabeneficiaryslackoftransportationisnota
barriertoaccessingcare;
maintainaMemberServicesDepartmenttoassistMedicaidbeneficiariesandtheirfamily
membersobtainservicesundertheCareManagementProgram;
operateaNewHampshirespecificcallcentertohandlememberinquiries;
developandfacilitateaMedicaidmemberadvisoryboardcomposedofmemberswho
representanMCOsmemberpopulation;
holdbiannual,inpersonregionalmembermeetingstoobtainfeedbackandtakequestions
frommembers;
conductamembersatisfactionsurvey(CAHPS)togainabroaderperspectiveofmember
opinions;
ensurethatservicesareprovidedinaculturallycompetentmannertoallMedicaid
members,includingthosewithlimitedEnglishproficiency;

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developappropriatemethodsofcommunicatingandworkingwithitsmemberswhodonot
speakEnglishasafirstlanguage,aswellasmemberswhoarevisuallyandhearingimpaired,
andaccommodatingmemberswithphysicalandcognitivedisabilitiesanddifferentliteracy
levels,learningstyles,andcapabilities;

develop,implement,andmaintainaGrievanceSystemunderwhichMedicaidmembers,or
providersactingontheirbehalf,maychallengethedenialofcoverageorpaymentfor
medicalassistanceandwhichincludesagrievanceprocess,anappealprocess,andaccessto
theStatesfairhearingsystem;and

publishaProviderDirectorythatshallbeapprovedbyDHHS.

Inadditiontothememberfocusedprovisionsinthemanagedcarecontracts,DHHSwillrequire
eachMCOtoensureprovideravailabilityforitsMedicaidbeneficiariesandto:

haveprovidernetworkswithasufficientnumberofproviderswithsufficientcapacity,
expertiseandgeographicdistribution,toprovideforallMedicaidcoveredservices,andwith
reasonablechoiceforbeneficiariestomeettheirneeds;

submittoannual,external,independentreviewofthetimelinessofandaccesstoservices
coveredundereachMCOcontractwithDHHS;

developandmaintainastatewideprovidernetworkthatadequatelymeetsthephysicaland
behavioralhealthneedsofenrolledMedicaidbeneficiaries;

reportsignificantchangestotheprovidernetworktoDHHS,withatransitionplanto
addressmemberaccesstoneededservices,withinsevendaysofanysignificantchange;

developanactiveprovideradvisoryboardcomposedofabroadspectrumofprovidertypes;
developaprovidersatisfactionsurvey,whichisrequiredtobeapprovedbyDHHSand

administeredbythirdpartysemiannually;

providetheresultsoftheprovidersatisfactionsurveytoDHHSandpostontheMCOs
website;

meetcontractualgeographicaccessstandardsforallMedicaidbeneficiariesinadditionsto
maintainingaprovidernetworksufficienttoprovideallservicestoallofitsMedicaid
members;

makeservicesavailableforbeneficiariestwentyfourhoursaday,sevendaysaweek,when
medicallynecessary;and

developandmaintainastatewideprovidernetworkthatadequatelymeetsallcovered
physicalandbehavioralhealthneedsofthecoveredpopulationthatprovidesfor
coordinationandcollaborationamongprovidersanddisciplines.SeefulltextofAccessand
NetworkManagementmanagedcarecontractprovisionsattachedasAppendixB.
NewHampshireMedicaidwillmanageandmonitorMCOperformanceandcompliancewithall
contractprovisions,includingthoseaddressingaccess,provideravailabilityanddeliveryofquality
care.Withaprimarygoalofqualitycare,NewHampshireMedicaidrequirestheMCOsto:

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provideforthedeliveryofqualitycaretoimprovethehealthstatusofbeneficiaries,orifa
beneficiaryshealthconditionissuchthatitcannotbeimprovedthentomaintainthe
beneficiaryshealth;
complywiththeQualityStrategyfortheNewHampshireMedicaidCareManagement
Program;
haveanongoingqualityassessmentandperformanceimprovementprogramforthe
servicesitprovidesbeneficiaries;
approachallclinicalandnonclinicalaspectsofqualityassessmentandperformance
improvementbasedonContinuousQualityImprovement(CQI)/TotalQualityManagement
(TQM);
havemechanismsinplacethatdetectbothunderandoverutilizationofservices;
developandoperateaQualityAssessmentandPerformanceImprovement(QAPI)Program
andtosubmitaQAPIProgramAnnualSummaryasspecifiedbyDHHS;
maintainaQAPIstructurethatincludesaplannedsystematicapproachtoimprovingclinical
andnonclinicalprocessesandoutcomes;
adoptevidencebasedclinicalpracticeguidelinesbuiltuponhighqualitydataandstrong
evidenceconsideringtheneedsofMedicaidbeneficiaries;
collaboratewithDHHSsExternalQualityReviewOrganization(EQRO)todevelopstudies,
surveys,andotheranalyticactivitiestoassessthequalityofcareandservicesprovidedto
beneficiaries,andshallsupplydatatotheEQRO.

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6. Summary and Conclusion


EnsuringaccesstocareisapriorityoftheNewHampshireMedicaidprogram.Theforegoingreport
providesspecificdataandanalysisthatestablishhistoricalandcurrentaccesslevelsforphysician
services,inpatientandoutpatientservices,ratestructures,andtheimpactofDSHpayments,allof
whichestablishthefollowing:

Thedatashowinghistoricalandcurrentaccesslevelsforphysicianservices,inpatientand
outpatientservices,setforthinreportChapter3,arewithinnormallimits,withno
detectablenegativetrends.
Thedatashowingthehistoricalaccesstocarebasedonparticipatingprovidernetworksize
andcapacity,serviceutilizationtrends,andratelevels,setforthinreportChapter3,are
withinnormallimits,withnodetectablenegativetrends.
Thetrendanalysisondataelementsdemonstratethatratechangeswhichoccurredin2008
andDisproportionateShareProgramchanges(describedinChapter2)havenotchanged
accesslevels.
NewHampshireMedicaidpresentedevidence,setforthinChapter5ofthereport,that
indicatesthatithasregular,ongoingengagementwithMedicaidbeneficiariesinorderto
assesstheuniquecharacteristicsandneedsofbeneficiaries,tomonitoraccesstohealthcare
andotherissuesofconcerntobeneficiariesandtointerveneonthebehalfofany
beneficiaryrequestingassistancewithprovideravailabilityandaccess,orwithanyother
issuecreatingabarriertoaccess.
Provideraccessmonitoringplansandprocedures,setforthinChapter5,indicatethatNew
Hampshireiswellpositionedtosystematicallymonitorbeneficiaryneeds,thestrengthand
availabilityoftheprovidernetwork,andbeneficiaryutilizationofhealthcareservices.
NewHampshireMedicaidssystematicmonitoringofaccessindicatorshelpidentifyaccess
problemsforbeneficiaries.Shouldaccessissuesarise,NewHampshireMedicaidwilltake
correctiveactions,assetforthinChapter5,toresolveaccessissuesforNewHampshire
Medicaidbeneficiaries.

Inconclusion,NewHampshireMedicaidthedataindicatesthatMedicaidbeneficiarieshavesimilar
accesstohealthcareasthegeneralpopulationinNewHampshire.Alldatacollectedandanalyzedfalls
withincontrolchartparameters.Alldatacollectedandanalyzedfallswithincontrolchartparameters.
Nothinghasbeendetectedinthosecontrolchartsthatwouldindicateanegativehealthcareaccess
trend.Totheextentpotentialprovideraccessissueshavebeenidentifiedatanypointduringthetime
periodexamined,i.e.20072011,NewHampshireMedicaidhasintervenedandresolvedthem.
NewHampshireMedicaidroutinelymonitorsaccessindicators,i.e.beneficiaryenrollmentand
demographics,providerenrollmentandavailability,andbeneficiaryutilizationofhealthcareservices
andwillproduceaquarterlydatareportsimilartothereportsetforthabovetomeasureandmonitor

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beneficiaryaccesstohealthcareinNewHampshire.Withtheabilitytoidentifyaccessissuesasthey
arisecomestheconcomitantabilityofNewHampshireMedicaidtorespondeffectivelytocorrectthose
issues.Althoughthedataindicatenoexistingorprojectedaccessproblems,shouldanaccessissuebe
identifiedthroughthesemonitoringsystems,DHHSisreadytotakecorrectiveactionmeasuresonboth
alocalizedandsystemwidebasisthroughtheprocessessetforthinthisreport.
ByincreasingNewHampshireMedicaidsmonitoringofthestrengthofprovidernetworkactivity;
surveyingnetworkcapacity;conductingclientsurveystoassesstheirexperienceswithprovidersand
theirneedsrelativetoaccess;increasingoutreachtoprovidersandbeneficiaries;andtransformingthe
NewHampshireMedicaidprogramfromafeeforserviceplantoamanagedcareapproach,New
HampshirewillcontinuetoensureaccessforitsMedicaidbeneficiaries.

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7. Appendices

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Appendix A: New Hampshire Medicaid Community Health


Center Access and Capacity
DatawascollectedinMay2012withtheassistanceofBiStatePrimaryCareAssociation.

Facility

Current
Medicaid
Patient
Count

Capacityfor
additionalpatients

Waittimeforroutine
appointments

LampreyNewmarket

847

250

10days

LampreyRaymond

932

300

FamilyHealthCenter
(ConcordHospital)

3,708

10perweek

FamilyHealthCenter
(Hillsborough)

686

1perweek

15days
Samedaytowithin90
dayscomplete
physicalforallpatients
Within2weeks:OB
intakeappt
Sameday
Samedaytowithin90
dayscomplete
physicalforallpatients
Within2weeks:OB
intakeappt
Sameday

ManchesterCommunity
HealthCenter

3,553

HarborCareClinicHarbor
HomesNashua

88

FamiliesFirstinPortsmouth
WhiteMountainCHCin
Conway

1,500

1,334

134

MidstateHealthCenter
Plymouth

900

CoosCountyFamilyHealth
Services

1,742

500
Openavailability
foradditional
clients

Waittimeforurgent
appointments

Notes
Couldaddprovider
Samedayorwithin24
capacityandtake
hours:Sickoracute
1,300inexisting
patients space
Samedayorwithin24
Additionalstaff
hours:Sickoracute
Couldaccommodate
patients another800

1,500Pediatric
patientscurrently
enrolledinNHHKwill
New:Prenatal12
transitionfrom
days
Pediatrics12weeks Walkins:Notavailable DartmouthtoMCHC.
Willprobablyhave
Adults68weeks Urgentcare:12days
roomforanother500
Established:Routine1
basedontheurgency;
week
ifthesituationwarrants Medicaidpatients
givencurrent
PhysicalExams4
it,urgentneedsare
providercapacity
6weeks
triagedtolocalER

Sameday
Sameday:Children
andadults
2morningsaweek:
Pregnantwomenseen
forroutinevisits

Immediate

2morningsaweek:
Walkin's
Samedayslots:Every
dayforanyonewho
callsinthemorning

Sameday

Significantorgood
capacitytosee
morepatients

2weeks
Samedayorafew
days.
Someclinicianscould
beamonth

1,000

Child.&preg.women:
Sameday
Adults:07days

100patients/300
inOct.w/new
physician

NewHampshireDepartmentofHealthandHumanServices
OfficeofMedicaidBusinessandPolicy

Samedayornextday

Urgent:Sameday;4hrs
aweekJuly:
Everyafternoon
openedforsameday
andforwalkins(witha
FamilyNurse
Practitionerthathas
justbeenhired)
Rightnow,4hours/wk
ofopenslotsforwalk
ins/samedays.

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Facility

AmmonoosucComm.Health
SrvsLittleton

Current
Medicaid
Patient
Count

Capacityfor
additionalpatients

924<
age19;
393>
age20

Dependingonthe
site,theaccessis
variable,however
whensentthere,
willworktowards
accommodating.

Waittimeforroutine
appointments
Samedayvisitper
needbasis:ACHS&
nonACHSpatients.
Medicalrecordsneed
tobereceived&
reviewedpriorto
establishingthe
patientasahealth
homepatient.Each
providerhowever
basedonapanelsize
mayhavevariable
capacitytoaccept
morepatients.

Sameday/maybeat
alternativesite

3wks:Routinefollow
up&nonacuteappt
4wks:Fullentryvisits
newpatients
5wks:Fullphysicals

Samedayornextday.
Duringpeakdays,Mon.
&Fri.maybetwodays.
NewNPonstafffor
acutepatients.

HealthFirstinFranklin

1,391

600

GoodwinCommunityHealth
inSomersworth

3,099

2,500
35days

2,628

2,000andcould
addprovider
capacitytotake
3,000moreif
necessary

LampreyHealthCareNashua

Waittimeforurgent
appointments

Sameday

Within48hours:new
mother/child
10days:Adults,non
Within24hours:acute
urgentenrollvisitor
visitSame
reguEFlarcheckup
day:Whenpossible

Notes

499outof1,391new
clientsthatcame
afterLRGHstopped
seeingMedicaid
adultsinregular
outpatientpractices
andhad302new
uninsuredclients
Slotskeptopendaily
foracutesandwillbe
startingwalkintimes

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Appendix B: Tabular Version of Data in Trend Charts


Figure4.
TimePeriod
2007QTR1
2007QTR2
2007QTR3
2007QTR4
2008QTR1
2008QTR2
2008QTR3
2008QTR4
2009QTR1
2009QTR2
2009QTR3
2009QTR4
2010QTR1
2010QTR2
2010QTR3
2010QTR4
2011QTR1
2011QTR2
2011QTR3
2011QTR4

Figure5.

NHMedicaidEnrollment,CY20072011:TotalPopulation
AverageMembers
82,880
83,462
83,444
83,391
84,380
85,632
86,783
88,024
90,866
94,059
96,178
97,444
98,287
99,162
99,813
99,974
100,362
100,922
100,952
100,675

NHMedicaidEnrollment,CY20072011:Child,FamiliesandChildrenEligibilityGroup
and

Figure6.
TimePeriod
2007QTR1
2007QTR2
2007QTR3
2007QTR4
2008QTR1
2008QTR2
2008QTR3
2008QTR4
2009QTR1
2009QTR2
2009QTR3
2009QTR4
2010QTR1
2010QTR2
2010QTR3
2010QTR4
2011QTR1
2011QTR2
2011QTR3
2011QTR4

Figure7.
TimePeriod
2007QTR1
2007QTR2
2007QTR3
2007QTR4
2008QTR1

NHMedicaidEnrollment,CY20072011:ChildFosterCareandBlindandDisabled
Population
BlindandDisabled
522
526
515
525
536
564
580
599
604
618
619
628
605
596
597
613
598
611
597
606

FamiliesandChildren
60,041
60,522
60,448
60,383
60,962
61,879
62,672
63,478
65,423
67,856
69,560
70,597
71,192
71,756
72,260
72,450
72,788
73,199
73,450
73,447

FosterCare
1,935
1,981
1,944
1,940
1,953
1,966
1,908
1,890
1,867
1,878
1,805
1,814
1,793
1,781
1,717
1,739
1,720
1,745
1,663
1,668

NHMedicaidEnrollment,CY20072011:AdultPopulationbyEligibilityGroup
Aged
672
668
681
690
713

BlindandDisabled
7,080
7,238
7,351
7,486
7,682

Families andChildren
12,630
12,528
12,506
12,367
12,535

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TimePeriod
2008QTR2
2008QTR3
2008QTR4
2009QTR1
2009QTR2
2009QTR3
2009QTR4
2010QTR1
2010QTR2
2010QTR3
2010QTR4
2011QTR1
2011QTR2
2011QTR3
2011QTR4

Figure8.
TimePeriod
2007QTR1
2007QTR2
2007QTR3
2007QTR4
2008QTR1
2008QTR2
2008QTR3
2008QTR4
2009QTR1
2009QTR2
2009QTR3
2009QTR4
2010QTR1
2010QTR2
2010QTR3
2010QTR4
2011QTR1
2011QTR2
2011QTR3
2011QTR4

Figure9.

Aged
711
723
746
760
767
776
779
792
802
815
826
848
849
884
902

BlindandDisabled
7,894
8,102
8,354
8,653
8,898
9,116
9,157
9,287
9,400
9,488
9,576
9,702
9,872
9,945
9,953

Families andChildren
12,618
12,798
12,956
13,559
14,043
14,301
14,469
14,619
14,827
14,934
14,768
14,705
14,646
14,411
14,098

NHMedicaidEnrollment,CY20072011:MetropolitanandNonMetropolitanCounties
MetroCounties
45,220
45,484
45,606
45,716
46,166
46,796
47,454
48,272
49,874
51,925
53,131
53,878
54,421
54,926
55,541
55,813
56,115
56,510
56,626
56,778

NonMetroCounties
35,115
35,459
35,297
35,214
35,661
36,284
36,687
37,090
38,250
39,364
40,115
40,489
40,864
41,228
41,423
41,606
41,917
42,366
42,541
42,687

ActiveNHMedicaidInStatePhysicianProvidersComparedtoLicensedProvidersWithNH
BillingAddress,2012

ActiveMedicaidProviders
3,793

ActiveNonMedicaidProviders
254

Figure10. RatioofNHMedicaidBeneficiariestoActiveInStatePrimaryCareProviders(Internal
Medicine,FamilyPractice,GeneralPractice,Pediatricians),CY20072011
TimePeriod
2007QTR1
2007QTR2
2007QTR3
2007QTR4
2008QTR1
2008QTR2
2008QTR3
2008QTR4
2009QTR1
2009QTR2
2009QTR3
2009QTR4
2010QTR1

Providers
1862
1920
1965
2032
2044
2098
2095
2186
2195
2262
2375
2433
2467

AverageMembers
82,880
83,462
83,444
83,391
84,380
85,632
86,783
88,024
90,866
94,059
96,178
97,444
98,287

Rateper1,000
44.5
43.5
42.5
41.0
41.3
40.8
41.4
40.3
41.4
41.6
40.5
40.1
39.8

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TimePeriod
2010QTR2
2010QTR3
2010QTR4
2011QTR1
2011QTR2
2011QTR3
2011QTR4

Providers
2503
2584
2584
2594
2607
2659
2621

AverageMembers
99,162
99,813
99,974
100,362
100,922
100,952
100,675

Rateper1,000
39.6
38.6
38.7
38.7
38.7
38.0
38.4

Figure11. RatioofNHMedicaidChildBeneficiariestoActiveInStatePediatricians,CY20072011
TimePeriod
2007QTR1
2007QTR2
2007QTR3
2007QTR4
2008QTR1
2008QTR2
2008QTR3
2008QTR4
2009QTR1
2009QTR2
2009QTR3
2009QTR4
2010QTR1
2010QTR2
2010QTR3
2010QTR4
2011QTR1
2011QTR2
2011QTR3
2011QTR4

Providers
243
245
245
250
267
252
247
255
250
255
269
269
266
270
278
276
277
278
281
283

0to18members
62,498
63,029
62,907
62,848
63,451
64,409
65,159
65,967
67,894
70,351
71,983
73,039
73,589
74,133
74,574
74,801
75,106
75,555
75,710
75,722

Rateper1,000
257.2
257.3
256.8
251.4
237.6
255.6
263.8
258.7
271.6
275.9
267.6
271.5
276.7
274.6
268.3
271.0
271.1
271.8
269.4
267.6

Figure12. RatioofNHMedicaidAdultFemaleBeneficiariesAge18to64toActiveInState
Obstetricians/Gynecologists,CY20072011
TimePeriod
2007QTR1
2007QTR2
2007QTR3
2007QTR4
2008QTR1
2008QTR2
2008QTR3
2008QTR4
2009QTR1
2009QTR2
2009QTR3
2009QTR4
2010QTR1
2010QTR2
2010QTR3
2010QTR4
2011QTR1
2011QTR2
2011QTR3
2011QTR4

Providers
169
165
163
165
162
168
167
160
167
163
168
171
167
163
168
174
174
170
169
172

F1964Members Rateper1,000
49,295
291.7
49,244
298.4
49,510
303.7
49,344
299.1
49,885
307.9
50,891
302.9
51,444
308.0
52,068
325.4
53,781
322.0
55,346
339.5
56,338
335.3
56,503
330.4
56,770
339.9
57,327
351.7
57,780
343.9
57,583
330.9
57,359
329.6
339.4
57,695
57,271
338.9
56,662
329.4

Figure13. SeasonallyAdjustedPhysician/APRN/ClinicUtilizationper1,000NHMedicaid
Beneficiaries,CY20072011:TotalPopulation
TimePeriod
2007QTR1
2007QTR2

Visits
95006
86942

MemberMonths
248641
250387

Rateper1,000
382
347

AdjustedRateper1,000
361
350

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TimePeriod
2007QTR3
2007QTR4
2008QTR1
2008QTR2
2008QTR3
2008QTR4
2009QTR1
2009QTR2
2009QTR3
2009QTR4
2010QTR1
2010QTR2
2010QTR3
2010QTR4
2011QTR1
2011QTR2
2011QTR3
2011QTR4

Visits
82644
90983
98124
91854
90591
96665
109231
110575
105470
117563
119994
113349
107316
112532
118182
112857
104176
112266

MemberMonths
250333
250172
253141
256897
260349
264072
272598
282178
288533
292332
294860
297486
299440
299922
301086
302767
302856
302025

Rateper1,000
330
364
388
358
348
366
401
392
366
402
407
381
358
375
393
373
344
372

AdjustedRateper1,000
351
360
366
361
370
362
378
395
389
398
384
385
381
371
371
376
366
368

Figure14. SeasonallyAdjustedPhysician/APRN/ClinicUtilizationper1,000NHMedicaid
Beneficiaries,CY20072011:Children,BlindandDisabledAidCategories
TimePeriod
2007QTR1
2007QTR2
2007QTR3
2007QTR4
2008QTR1
2008QTR2
2008QTR3
2008QTR4
2009QTR1
2009QTR2
2009QTR3
2009QTR4
2010QTR1
2010QTR2
2010QTR3
2010QTR4
2011QTR1
2011QTR2
2011QTR3
2011QTR4

Visits
793
766
611
709
762
775
681
621
752
853
750
920
878
775
707
784
743
809
671
843

MemberMonths
1565
1579
1545
1574
1607
1691
1739
1797
1813
1853
1856
1885
1814
1788
1791
1838
1795
1832
1791
1819

Rateper1,000
507
485
395
450
474
458
392
346
415
460
404
488
484
433
395
427
414
442
375
463

AdjustedRateper1,000
472
462
436
462
442
437
432
355
386
439
446
501
451
413
436
438
385
421
413
476

Figure15. SeasonallyAdjustedPhysician/APRN/ClinicUtilizationper1,000NHMedicaid
Beneficiaries,CY20072011:Children,ChildrenandFamiliesAidCategories
TimePeriod
2007QTR1
2007QTR2
2007QTR3
2007QTR4
2008QTR1
2008QTR2
2008QTR3
2008QTR4
2009QTR1
2009QTR2
2009QTR3
2009QTR4
2010QTR1
2010QTR2

Visits
60965
53953
48844
57054
62666
56420
53514
59431
69033
67568
60991
72941
74682
68549

MemberMonths
180123
181565
181344
181148
182886
185637
188016
190435
196269
203568
208680
211791
213575
215267

Rateper1,000
338
297
269
315
343
304
285
312
352
332
292
344
350
318

AdjustedRateper1,000
309
300
300
309
313
307
317
306
322
335
325
338
320
322

MONITORINGACCESSTOCAREINNEWHAMPSHIRESMEDICAIDPROGRAM:REVIEWOFKEYINDICATORS,JUNE2012
NewHampshireDepartmentofHealthandHumanServices
OfficeofMedicaidBusinessandPolicy

64

TimePeriod
2010QTR3
2010QTR4
2011QTR1
2011QTR2
2011QTR3
2011QTR4

Visits
62693
69305
74702
70082
62464
71122

MemberMonths
216779
217350
218364
219597
220350
220342

Rateper1,000
289
319
342
319
283
323

AdjustedRateper1,000
322
312
313
323
316
316

Figure16. SeasonallyAdjustedPhysician/APRN/ClinicUtilizationper1,000NHMedicaid
Beneficiaries,CY20072011:Children,FosterCareAidCategories
TimePeriod
2007QTR1
2007QTR2
2007QTR3
2007QTR4
2008QTR1
2008QTR2
2008QTR3
2008QTR4
2009QTR1
2009QTR2
2009QTR3
2009QTR4
2010QTR1
2010QTR2
2010QTR3
2010QTR4
2011QTR1
2011QTR2
2011QTR3
2011QTR4

Visits
1928
1853
1575
1825
1947
1964
1724
1725
1955
1934
1738
1925
1841
1735
1689
1810
1813
1891
1568
1664

MemberMonths
5806
5942
5831
5821
5859
5899
5723
5670
5600
5633
5414
5441
5378
5344
5152
5216
5160
5235
4990
5004

Rateper1,000
332
312
270
314
332
333
301
304
349
343
321
354
342
325
328
347
351
361
314
333

AdjustedRateper1,000
319
309
289
310
319
330
322
301
335
340
343
350
328
322
350
343
337
358
336
329

Figure17. SeasonallyAdjustedPhysician/APRN/ClinicUtilizationper1,000NHMedicaid
Beneficiaries,CY20072011:Adults,AgedAidCategories
TimePeriod
2007QTR1
2007QTR2
2007QTR3
2007QTR4
2008QTR1
2008QTR2
2008QTR3
2008QTR4
2009QTR1
2009QTR2
2009QTR3
2009QTR4
2010QTR1
2010QTR2
2010QTR3
2010QTR4
2011QTR1
2011QTR2
2011QTR3
2011QTR4

Visits
956
970
1074
1084
1056
1152
1167
1223
1287
1315
1388
1426
1386
1429
1537
1492
1378
1424
1383
1625

MemberMonths
2015
2003
2042
2070
2138
2134
2170
2239
2280
2300
2329
2336
2376
2405
2446
2479
2544
2546
2652
2705

Rateper1,000
474
484
526
524
494
540
538
546
564
572
596
610
583
594
628
602
542
559
521
601

AdjustedRateper1,000
498
491
510
509
519
547
522
531
593
580
578
593
613
602
610
585
569
567
506
584

Figure18. SeasonallyAdjustedPhysician/APRN/ClinicUtilizationper1,000NHMedicaid
Beneficiaries,CY20072011:Adults,BlindandDisabledAidCategories
TimePeriod
2007QTR1
2007QTR2

Visits
11172
11037

MemberMonths
21241
21713

Rateper1,000
526
508

AdjustedRateper1,000
533
524

MONITORINGACCESSTOCAREINNEWHAMPSHIRESMEDICAIDPROGRAM:REVIEWOFKEYINDICATORS,JUNE2012
NewHampshireDepartmentofHealthandHumanServices
OfficeofMedicaidBusinessandPolicy

65

TimePeriod
2007QTR3
2007QTR4
2008QTR1
2008QTR2
2008QTR3
2008QTR4
2009QTR1
2009QTR2
2009QTR3
2009QTR4
2010QTR1
2010QTR2
2010QTR3
2010QTR4
2011QTR1
2011QTR2
2011QTR3
2011QTR4

Visits
12127
12171
12502
12587
13842
13768
14572
15464
17183
17137
17493
16967
17593
17140
17252
17031
17232
17128

MemberMonths
22052
22458
23046
23682
24307
25063
25958
26695
27348
27471
27860
28199
28463
28727
29105
29615
29835
29858

Rateper1,000
550
542
542
532
569
549
561
579
628
624
628
602
618
597
593
575
578
574

AdjustedRateper1,000
532
537
550
548
551
544
569
598
608
618
637
621
598
591
601
593
559
568

Figure19. SeasonallyAdjustedPhysician/APRN/ClinicUtilizationper1,000NHMedicaid
Beneficiaries,CY20072011:Adults,FamiliesandChildren
TimePeriod
2007QTR1
2007QTR2
2007QTR3
2007QTR4
2008QTR1
2008QTR2
2008QTR3
2008QTR4
2009QTR1
2009QTR2
2009QTR3
2009QTR4
2010QTR1
2010QTR2
2010QTR3
2010QTR4
2011QTR1
2011QTR2
2011QTR3
2011QTR4

Visits
19192
18362
18413
18140
19191
18956
19663
19896
21632
23441
23420
23214
23714
23894
23097
22001
22294
21620
20857
19884

MemberMonths
37891
37585
37518
37101
37605
37854
38393
38868
40678
42129
42904
43408
43857
44482
44803
44305
44115
43939
43234
42294

Rateper1,000
507
489
491
489
510
501
512
512
532
556
546
535
541
537
516
497
505
492
482
470

AdjustedRateper1,000
501
485
492
497
505
497
513
521
526
553
547
544
535
533
516
505
500
489
483
478

Figure20. SeasonallyAdjustedPhysician/APRN/ClinicUtilizationper1,000NHMedicaid
Beneficiaries,CY20072011:MetropolitanAreas
TimePeriod
2007QTR1
2007QTR2
2007QTR3
2007QTR4
2008QTR1
2008QTR2
2008QTR3
2008QTR4
2009QTR1
2009QTR2
2009QTR3
2009QTR4
2010QTR1
2010QTR2
2010QTR3
2010QTR4

Visits
55229
50733
48469
53232
57652
54524
52955
56662
64205
64932
62730
70363
70953
67423
63938
66462

MemberMonths
135660
136451
136818
137148
138497
140389
142363
144815
149621
155774
159393
161634
163264
164779
166623
167439

Rateper1,000
407
372
354
388
416
388
372
391
429
417
394
435
435
409
384
397

AdjustedRateper1,000
385
374
376
385
394
391
395
388
406
420
418
431
411
412
408
393

MONITORINGACCESSTOCAREINNEWHAMPSHIRESMEDICAIDPROGRAM:REVIEWOFKEYINDICATORS,JUNE2012
NewHampshireDepartmentofHealthandHumanServices
OfficeofMedicaidBusinessandPolicy

66

TimePeriod
2011QTR1
2011QTR2
2011QTR3
2011QTR4

Visits
69820
67126
62117
67274

MemberMonths
168346
169531
169878
170333

Rateper1,000
415
396
366
395

AdjustedRateper1,000
392
399
388
391

Figure21. SeasonallyAdjustedPhysician/APRN/ClinicUtilizationper1,000NHMedicaid
Beneficiaries,CY20072011:NonMetropolitanAreas
TimePeriod
2007QTR1
2007QTR2
2007QTR3
2007QTR4
2008QTR1
2008QTR2
2008QTR3
2008QTR4
2009QTR1
2009QTR2
2009QTR3
2009QTR4
2010QTR1
2010QTR2
2010QTR3
2010QTR4
2011QTR1
2011QTR2
2011QTR3
2011QTR4

Visits
39537
35953
33930
37521
40227
37075
37317
39773
44812
45414
42562
46958
48819
45668
43136
45836
48149
45523
41811
44787

MemberMonths
105344
106376
105891
105642
106982
108853
110061
111271
114750
118093
120344
121467
122591
123685
124270
124819
125751
127098
127623
128061

Rateper1,000
375
338
320
355
376
341
339
357
391
385
354
387
398
369
347
367
383
358
328
350

AdjustedRateper1,000
353
342
341
351
354
345
361
353
367
389
377
382
375
374
370
363
360
363
349
346

Figure22. SeasonallyAdjustedEmergencyDepartmentUtilizationforConditionsPotentially
TreatableinPrimaryCareper1,000NHMedicaidBeneficiaries,CY20072011:Total
Population
TimePeriod
2007QTR1
2007QTR2
2007QTR3
2007QTR4
2008QTR1
2008QTR2
2008QTR3
2008QTR4
2009QTR1
2009QTR2
2009QTR3
2009QTR4
2010QTR1
2010QTR2
2010QTR3
2010QTR4
2011QTR1
2011QTR2
2011QTR3
2011QTR4

Visits
5185
4257
3502
4795
5823
4399
4189
4955
6014
5467
4603
6727
6283
5144
4479
5359
6047
5749
4481
5978

MemberMonths
248641
250387
250333
250172
253141
256897
260349
264072
272598
282178
288533
292332
294860
297486
299440
299922
301086
302767
302856
302025

Rateper1,000
21
17
14
19
23
17
16
19
22
19
16
23
21
17
15
18
20
19
15
20

AdjustedRateper1,000
18
18
17
18
20
18
20
18
19
20
19
22
18
18
18
17
17
20
18
19

Figure23. SeasonallyAdjustedEmergencyDepartmentUtilizationforConditionsPotentially
TreatableinPrimaryCareper1,000NHMedicaidBeneficiaries,CY20072011:Children,
ChildrenandFamiliesAidCategories
TimePeriod
2007QTR1

Visits
3538

MemberMonths
180123

Rateper1,000
20

AdjustedRateper1,000
16

MONITORINGACCESSTOCAREINNEWHAMPSHIRESMEDICAIDPROGRAM:REVIEWOFKEYINDICATORS,JUNE2012
NewHampshireDepartmentofHealthandHumanServices
OfficeofMedicaidBusinessandPolicy

67

2007QTR2
2007QTR3
2007QTR4
2008QTR1
2008QTR2
2008QTR3
2008QTR4
2009QTR1
2009QTR2
2009QTR3
2009QTR4
2010QTR1
2010QTR2
2010QTR3
2010QTR4
2011QTR1
2011QTR2
2011QTR3
2011QTR4

2691
2032
3222
3920
2754
2529
3048
4091
3532
2704
4472
4204
3186
2587
3356
4202
3803
2725
3969

181565
181344
181148
182886
185637
188016
190435
196269
203568
208680
211791
213575
215267
216779
217350
218364
219597
220350
220342

15
11
18
21
15
13
16
21
17
13
21
20
15
12
15
19
17
12
18

16
15
17
17
16
18
15
17
18
17
20
16
16
16
14
15
18
16
17

Figure24. SeasonallyAdjustedEmergencyDepartmentUtilizationforConditionsPotentially
TreatableinPrimaryCareper1,000NHMedicaidBeneficiaries,CY20072011:Adults,
BlindandDisabledAidCategories
TimePeriod
2007QTR1
2007QTR2
2007QTR3
2007QTR4
2008QTR1
2008QTR2
2008QTR3
2008QTR4
2009QTR1
2009QTR2
2009QTR3
2009QTR4
2010QTR1
2010QTR2
2010QTR3
2010QTR4
2011QTR1
2011QTR2
2011QTR3
2011QTR4

Visits
505
525
563
537
635
555
626
650
630
693
756
846
809
718
781
741
660
742
676
767

MemberMonths
21241
21713
22052
22458
23046
23682
24307
25063
25958
26695
27348
27471
27860
28199
28463
28727
29105
29615
29835
29858

Rateper1,000
24
24
26
24
28
23
26
26
24
26
28
31
29
25
27
26
23
25
23
26

AdjustedRateper1,000
24
25
25
23
27
25
25
25
24
27
27
30
29
27
27
25
23
26
22
25

Figure25. SeasonallyAdjustedEmergencyDepartmentUtilizationforConditionsPotentially
TreatableinPrimaryCareper1,000NHMedicaidBeneficiaries,CY20072011:Adults,
ChildrenandFamiliesAidCategories
TimePeriod
2007QTR1
2007QTR2
2007QTR3
2007QTR4
2008QTR1
2008QTR2
2008QTR3
2008QTR4
2009QTR1
2009QTR2
2009QTR3
2009QTR4
2010QTR1

Visits
1057
972
850
953
1166
994
966
1160
1186
1151
1086
1316
1170

MemberMonths
37891
37585
37518
37101
37605
37854
38393
38868
40678
42129
42904
43408
43857

Rateper1,000
28
26
23
26
31
26
25
30
29
27
25
30
27

AdjustedRateper1,000
26
26
25
25
29
27
28
28
27
28
28
29
25

MONITORINGACCESSTOCAREINNEWHAMPSHIRESMEDICAIDPROGRAM:REVIEWOFKEYINDICATORS,JUNE2012
NewHampshireDepartmentofHealthandHumanServices
OfficeofMedicaidBusinessandPolicy

68

TimePeriod
2010QTR2
2010QTR3
2010QTR4
2011QTR1
2011QTR2
2011QTR3
2011QTR4

Visits
1164
1048
1186
1099
1122
1027
1148

MemberMonths
44482
44803
44305
44115
43939
43234
42294

Rateper1,000
26
23
27
25
26
24
27

AdjustedRateper1,000
27
26
26
23
26
26
26

Figure26. SeasonallyAdjustedEmergencyDepartmentUtilizationforConditionsPotentially
TreatableinPrimaryCareper1,000NHMedicaidBeneficiaries,CY20072011:
MetropolitanAreas
TimePeriod
2007QTR1
2007QTR2
2007QTR3
2007QTR4
2008QTR1
2008QTR2
2008QTR3
2008QTR4
2009QTR1
2009QTR2
2009QTR3
2009QTR4
2010QTR1
2010QTR2
2010QTR3
2010QTR4
2011QTR1
2011QTR2
2011QTR3
2011QTR4

Visits
2595
2079
1666
2353
3027
2214
2109
2443
3130
2832
2401
3585
3342
2702
2424
2988
3371
3349
2621
3514

MemberMonths
135660
136451
136818
137148
138497
140389
142363
144815
149621
155774
159393
161634
163264
164779
166623
167439
168346
169531
169878
170333

Rateper1,000
19
15
12
17
22
16
15
17
21
18
15
22
20
16
15
18
20
20
15
21

AdjustedRateper1,000
16
16
15
16
18
17
18
16
18
19
19
21
17
17
18
17
17
21
19
19

Figure27. SeasonallyAdjustedEmergencyDepartmentUtilizationforConditionsPotentially
TreatableinPrimaryCareper1,000NHMedicaidBeneficiaries,CY20072011:Non
MetropolitanAreas
TimePeriod
2007QTR1
2007QTR2
2007QTR3
2007QTR4
2008QTR1
2008QTR2
2008QTR3
2008QTR4
2009QTR1
2009QTR2
2009QTR3
2009QTR4
2010QTR1
2010QTR2
2010QTR3
2010QTR4
2011QTR1
2011QTR2
2011QTR3
2011QTR4

Visits
2575
2162
1817
2420
2781
2169
2057
2491
2874
2618
2189
3122
2920
2425
2039
2358
2658
2385
1844
2441

MemberMonths
105344
106376
105891
105642
106982
108853
110061
111271
114750
118093
120344
121467
122591
123685
124270
124819
125751
127098
127623
128061

Rateper1,000
24
20
17
23
26
20
19
22
25
22
18
26
24
20
16
19
21
19
14
19

AdjustedRateper1,000
21
21
21
22
22
21
23
21
21
23
22
24
20
20
20
18
18
20
17
18

MONITORINGACCESSTOCAREINNEWHAMPSHIRESMEDICAIDPROGRAM:REVIEWOFKEYINDICATORS,JUNE2012
NewHampshireDepartmentofHealthandHumanServices
OfficeofMedicaidBusinessandPolicy

69

Figure28. SeasonallyAdjustedTotalEmergencyDepartmentUtilizationper1,000NHMedicaid
Beneficiaries,CY20072011:TotalPopulation
TimePeriod
2007QTR1
2007QTR2
2007QTR3
2007QTR4
2008QTR1
2008QTR2
2008QTR3
2008QTR4
2009QTR1
2009QTR2
2009QTR3
2009QTR4
2010QTR1
2010QTR2
2010QTR3
2010QTR4
2011QTR1
2011QTR2
2011QTR3
2011QTR4

Visits
17222
16748
15941
16757
18374
17808
18419
18006
20153
21464
20619
23071
21792
21481
21069
20200
21318
22616
21039
21087

MemberMonths
248641
250387
250333
250172
253141
256897
260349
264072
272598
282178
288533
292332
294860
297486
299440
299922
301086
302767
302856
302025

Rateper1,000
69
67
64
67
73
69
71
68
74
76
71
79
74
72
70
67
71
75
69
70

AdjustedRateper1,000
68
67
65
67
71
69
72
69
72
76
73
79
72
72
72
68
69
74
71
70

Figure29. SeasonallyAdjustedTotalEmergencyDepartmentUtilizationper1,000NHMedicaid
Beneficiaries,CY20072011:Children,BlindandDisabledAidCategories
TimePeriod
2007QTR1
2007QTR2
2007QTR3
2007QTR4
2008QTR1
2008QTR2
2008QTR3
2008QTR4
2009QTR1
2009QTR2
2009QTR3
2009QTR4
2010QTR1
2010QTR2
2010QTR3
2010QTR4
2011QTR1
2011QTR2
2011QTR3
2011QTR4

Visits
85
76
81
81
106
103
83
98
92
123
104
125
124
106
86
95
130
118
105
96

MemberMonths
1565
1579
1545
1574
1607
1691
1739
1797
1813
1853
1856
1885
1814
1788
1791
1838
1795
1832
1791
1819

Rateper1,000
54
48
52
51
66
61
48
55
51
66
56
66
68
59
48
52
72
64
59
53

AdjustedRateper1,000
51
46
58
52
62
59
53
55
48
64
62
67
64
57
53
52
68
62
65
53

Figure30. SeasonallyAdjustedTotalEmergencyDepartmentUtilizationper1,000NHMedicaid
Beneficiaries,CY20072011:Children,ChildrenandFamiliesAidCategories
TimePeriod
2007QTR1
2007QTR2
2007QTR3
2007QTR4
2008QTR1
2008QTR2
2008QTR3
2008QTR4
2009QTR1
2009QTR2

Visits
9445
8798
7888
9037
9914
9282
9212
9140
11013
11527

MemberMonths
180123
181565
181344
181148
182886
185637
188016
190435
196269
203568

Rateper1,000
52
48
43
50
54
50
49
48
56
57

AdjustedRateper1,000
49
48
47
50
51
49
53
48
53
56

MONITORINGACCESSTOCAREINNEWHAMPSHIRESMEDICAIDPROGRAM:REVIEWOFKEYINDICATORS,JUNE2012
NewHampshireDepartmentofHealthandHumanServices
OfficeofMedicaidBusinessandPolicy

70

TimePeriod
2009QTR3
2009QTR4
2010QTR1
2010QTR2
2010QTR3
2010QTR4
2011QTR1
2011QTR2
2011QTR3
2011QTR4

Visits
10353
12879
11870
11277
10210
10290
11796
12438
10815
11601

MemberMonths
208680
211791
213575
215267
216779
217350
218364
219597
220350
220342

Rateper1,000
50
61
56
52
47
47
54
57
49
53

AdjustedRateper1,000
54
61
52
52
51
47
51
56
53
53

Figure31. SeasonallyAdjustedTotalEmergencyDepartmentUtilizationper1,000NHMedicaid
Beneficiaries,CY20072011:Children,FosterCareAidCategories
TimePeriod
2007QTR1
2007QTR2
2007QTR3
2007QTR4
2008QTR1
2008QTR2
2008QTR3
2008QTR4
2009QTR1
2009QTR2
2009QTR3
2009QTR4
2010QTR1
2010QTR2
2010QTR3
2010QTR4
2011QTR1
2011QTR2
2011QTR3
2011QTR4

Visits
271
287
302
299
309
327
285
268
319
326
245
277
272
293
249
254
258
257
207
208

MemberMonths
5806
5942
5831
5821
5859
5899
5723
5670
5600
5633
5414
5441
5378
5344
5152
5216
5160
5235
4990
5004

Rateper1,000
47
48
52
51
53
55
50
47
57
58
45
51
51
55
48
49
50
49
41
42

AdjustedRateper1,000
46
46
54
53
52
52
52
49
56
55
47
52
50
52
51
50
49
46
43
43

Figure32. SeasonallyAdjustedTotalEmergencyDepartmentUtilizationper1,000NHMedicaid
Beneficiaries,CY20072011:Adult,AgedAidCategories
TimePeriod
2007QTR1
2007QTR2
2007QTR3
2007QTR4
2008QTR1
2008QTR2
2008QTR3
2008QTR4
2009QTR1
2009QTR2
2009QTR3
2009QTR4
2010QTR1
2010QTR2
2010QTR3
2010QTR4
2011QTR1
2011QTR2
2011QTR3
2011QTR4

Visits
70
94
92
110
120
106
102
104
128
127
117
113
126
131
133
140
125
120
143
157

MemberMonths
2015
2003
2042
2070
2138
2134
2170
2239
2280
2300
2329
2336
2376
2405
2446
2479
2544
2546
2652
2705

Rateper1,000
35
47
45
53
56
50
47
46
56
55
50
48
53
54
54
56
49
47
54
58

AdjustedRateper1,000
35
46
46
52
57
49
48
46
57
54
52
48
54
53
56
56
50
46
55
57

MONITORINGACCESSTOCAREINNEWHAMPSHIRESMEDICAIDPROGRAM:REVIEWOFKEYINDICATORS,JUNE2012
NewHampshireDepartmentofHealthandHumanServices
OfficeofMedicaidBusinessandPolicy

71

Figure33. SeasonallyAdjustedTotalEmergencyDepartmentUtilizationper1,000NHMedicaid
Beneficiaries,CY20072011:Adult,BlindandDisabledAidCategories
TimePeriod
2007QTR1
2007QTR2
2007QTR3
2007QTR4
2008QTR1
2008QTR2
2008QTR3
2008QTR4
2009QTR1
2009QTR2
2009QTR3
2009QTR4
2010QTR1
2010QTR2
2010QTR3
2010QTR4
2011QTR1
2011QTR2
2011QTR3
2011QTR4

Visits
2541
2780
2975
2728
2959
3136
3597
3335
3264
3714
4126
3932
4013
4154
4478
4088
3754
4216
4338
3980

MemberMonths
21241
21713
22052
22458
23046
23682
24307
25063
25958
26695
27348
27471
27860
28199
28463
28727
29105
29615
29835
29858

Rateper1,000
120
128
135
121
128
132
148
133
126
139
151
143
144
147
157
142
129
142
145
133

AdjustedRateper1,000
127
129
125
124
136
133
137
135
133
140
140
146
153
148
146
145
137
143
135
136

Figure34. SeasonallyAdjustedTotalEmergencyDepartmentUtilizationper1,000NHMedicaid
Beneficiaries,CY20072011:Adult,FamiliesandChildrenAidCategories
TimePeriod
2007QTR1
2007QTR2
2007QTR3
2007QTR4
2008QTR1
2008QTR2
2008QTR3
2008QTR4
2009QTR1
2009QTR2
2009QTR3
2009QTR4
2010QTR1
2010QTR2
2010QTR3
2010QTR4
2011QTR1
2011QTR2
2011QTR3
2011QTR4

Visits
4810
4713
4603
4502
4966
4854
5140
5061
5337
5647
5674
5745
5387
5520
5913
5333
5255
5467
5431
5045

MemberMonths
37891
37585
37518
37101
37605
37854
38393
38868
40678
42129
42904
43408
43857
44482
44803
44305
44115
43939
43234
42294

Rateper1,000
127
125
123
121
132
128
134
130
131
134
132
132
123
124
132
120
119
124
126
119

AdjustedRateper1,000
127
126
121
123
132
128
132
132
131
134
130
135
123
124
130
122
119
125
124
121

Figure35. SeasonallyAdjustedTotalEmergencyDepartmentUtilizationper1,000NHMedicaid
Beneficiaries,CY20072011:MetropolitanCounties
TimePeriod
2007QTR1
2007QTR2
2007QTR3
2007QTR4
2008QTR1
2008QTR2
2008QTR3
2008QTR4
2009QTR1
2009QTR2

Visits
9230
8834
8178
8884
10058
9807
10160
9707
11032
11803

MemberMonths
135660
136451
136818
137148
138497
140389
142363
144815
149621
155774

Rateper1,000
68
65
60
65
73
70
71
67
74
76

AdjustedRateper1,000
66
64
61
65
71
69
73
67
72
75

MONITORINGACCESSTOCAREINNEWHAMPSHIRESMEDICAIDPROGRAM:REVIEWOFKEYINDICATORS,JUNE2012
NewHampshireDepartmentofHealthandHumanServices
OfficeofMedicaidBusinessandPolicy

72

TimePeriod
2009QTR3
2009QTR4
2010QTR1
2010QTR2
2010QTR3
2010QTR4
2011QTR1
2011QTR2
2011QTR3
2011QTR4

Visits
11477
13003
12204
12200
12070
11744
12220
13275
12330
12486

MemberMonths
159393
161634
163264
164779
166623
167439
168346
169531
169878
170333

Rateper1,000
72
80
75
74
72
70
73
78
73
73

AdjustedRateper1,000
74
81
73
74
74
70
71
78
75
73

Figure36. SeasonallyAdjustedTotalEmergencyDepartmentUtilizationper1,000NHMedicaid
Beneficiaries,CY20072011:NonMetropolitanCounties
TimePeriod
2007QTR1
2007QTR2
2007QTR3
2007QTR4
2008QTR1
2008QTR2
2008QTR3
2008QTR4
2009QTR1
2009QTR2
2009QTR3
2009QTR4
2010QTR1
2010QTR2
2010QTR3
2010QTR4
2011QTR1
2011QTR2
2011QTR3
2011QTR4

Visits
7929
7847
7680
7810
8262
7932
8193
8228
9070
9600
9094
10012
9519
9198
8914
8401
9026
9289
8636
8541

MemberMonths
105344
106376
105891
105642
106982
108853
110061
111271
114750
118093
120344
121467
122591
123685
124270
124819
125751
127098
127623
128061

Rateper1,000
75
74
73
74
77
73
74
74
79
81
76
82
78
74
72
67
72
73
68
67

AdjustedRateper1,000
73
73
74
75
75
73
76
75
77
81
77
83
75
74
73
68
70
73
69
67

Figure37. SeasonallyAdjustedInpatientHospitalUtilizationforAmbulatoryCareSensitive
Conditionsper1,000NHMedicaidBeneficiaries,CY20072011:TotalPopulation
TimePeriod
2007QTR1
2007QTR2
2007QTR3
2007QTR4
2008QTR1
2008QTR2
2008QTR3
2008QTR4
2009QTR1
2009QTR2
2009QTR3
2009QTR4
2010QTR1
2010QTR2
2010QTR3
2010QTR4
2011QTR1
2011QTR2
2011QTR3
2011QTR4

Visits
194
148
121
175
196
140
178
161
213
152
146
190
210
143
146
161
182
164
130
214

MemberMonths
248641
250387
250333
250172
253141
256897
260349
264072
272598
282178
288533
292332
294860
297486
299440
299922
301086
302767
302856
302025

Rateper1,000
0.78
0.59
0.48
0.70
0.77
0.54
0.68
0.61
0.78
0.54
0.51
0.65
0.71
0.48
0.49
0.54
0.60
0.54
0.43
0.71

AdjustedRateper1,000
0.63
0.68
0.55
0.69
0.62
0.62
0.78
0.60
0.63
0.62
0.58
0.64
0.57
0.55
0.56
0.53
0.49
0.62
0.49
0.70

MONITORINGACCESSTOCAREINNEWHAMPSHIRESMEDICAIDPROGRAM:REVIEWOFKEYINDICATORS,JUNE2012
NewHampshireDepartmentofHealthandHumanServices
OfficeofMedicaidBusinessandPolicy

73

Figure38. SeasonallyAdjustedInpatientHospitalUtilizationper1,000NHMedicaidBeneficiaries,CY
20072011:TotalPopulation
TimePeriod Visits MemberMonths
2007QTR1 2682
248641
2007QTR2 2905
250387
2007QTR3 2756
250333
2007QTR4 2571
250172
2008QTR1 2795
253141
2008QTR2 2639
256897
2008QTR3 2869
260349
2008QTR4 2580
264072
2009QTR1 2978
272598
2009QTR2 2841
282178
2009QTR3 2952
288533
2009QTR4 2901
292332
2010QTR1 3136
294860
2010QTR2 2884
297479
2010QTR3 2918
299413
2010QTR4 2933
299880
301002
2011QTR1 2995
2011QTR2 3000
302620
2011QTR3 2859
302696
2011QTR4 2878
301843
Note:excludesnewborns

Rateper1,000
11
12
11
10
11
10
11
10
11
10
10
10
11
10
10
10
10
10
9
10

AdjustedRateper1,000
10
12
11
11
11
10
11
10
10
10
10
10
10
10
10
10
10
10
9
10

Figure39. PercentofContinuouslyEnrolledNHMedicaidBeneficiariesWithSixorMoreWellChild
VisitsintheFirst15MonthsofLife,CY20072011:TotalPopulation
TimePeriod
CY2007
CY2008
CY2009
CY2010
CY2011

6+Visits
2558
2632
2907
3103
3062

Members
3418
3478
3817
4003
3969

Percent
74.8%
75.7%
76.2%
77.5%
77.1%

Figure40. PercentofContinuouslyEnrolledNHMedicaidBeneficiariesWithSixorMoreWellChild
VisitsintheFirst15MonthsofLife,CY20072011:MetropolitanCounties
TimePeriod
CY2007
CY2008
CY2009
CY2010
CY2011

6+Visits
1359
1452
1570
1711
1711

Members
1868
1965
2105
2222
2233

Percent
72.8%
73.9%
74.6%
77.0%
76.6%

Figure41. PercentofContinuouslyEnrolledNHMedicaidBeneficiariesWithSixorMoreWellChild
VisitsintheFirst15MonthsofLife,CY20072011:NonMetropolitanCounties
TimePeriod
CY2007
CY2008
CY2009
CY2010
CY2011

6+Visits
1114
1088
1236
1305
1298

Members
1433
1397
1569
1655
1664

Percent
77.7%
77.9%
78.8%
78.9%
78.0%

Figure42. PercentofContinuouslyEnrolledNHMedicaidBeneficiariesintheThirdThroughSixth
YearsofLifeWithaWellChildVisit,CY20072011:TotalPopulation
TimePeriod
CY2007

MemberswithVisit
8857

Members
12099

Percent
73.2%

MONITORINGACCESSTOCAREINNEWHAMPSHIRESMEDICAIDPROGRAM:REVIEWOFKEYINDICATORS,JUNE2012
NewHampshireDepartmentofHealthandHumanServices
OfficeofMedicaidBusinessandPolicy

74

CY2008
CY2009
CY2010
CY2011

9360
11033
11938
12247

12758
14390
15552
15920

73.4%
76.7%
76.8%
76.9%

Figure43. PercentofContinuouslyEnrolledNHMedicaidBeneficiariesintheThirdThroughSixth
YearsofLifeWithaWellChildVisit,CY20072011:MetropolitanCounties
TimePeriod
2007
2008
2009
2010
2011

MemberswithVisit
4902
5262
6250
6846
7159

Members
6582
7033
7952
8702
9108

Percent
74.5%
74.8%
78.6%
78.7%
78.6%

Figure44. PercentofContinuouslyEnrolledNHMedicaidBeneficiariesintheThirdThroughSixth
YearsofLifeWithaWellChildVisit,CY20072011:NonMetropolitanCounties
TimePeriod
2007
2008
2009
2010
2011

MemberswithVisit
3675
3823
4459
4821
4970

Members
5144
5339
5971
6471
6630

Percent
71.4%
71.6%
74.7%
74.5%
75.0%

Figure45. PercentofContinuouslyEnrolledAdolescentNHMedicaidBeneficiariesWithaWellCare
Visit,CY20072011:TotalPopulation
TimePeriod
CY2007
CY2008
CY2009
CY2010
CY2011

MemberswithVisit
9559
8671
10292
10684
10588

Members
20356
18208
20102
21007
20850

Percent
47.0%
47.6%
51.2%
50.9%
50.8%

Figure46. PercentofContinuouslyEnrolledAdolescentNHMedicaidBeneficiariesWithaWellCare
Visit,CY20072011:MetropolitanCounties
TimePeriod
CY2007
CY2008
CY2009
CY2010
CY2011

MemberswithVisit
5267
4834
5808
6124
5942

Members
10730
9751
10717
11450
11406

Percent
49.1%
49.6%
54.2%
53.5%
52.1%

Figure47. PercentofContinuouslyEnrolledAdolescentNHMedicaidBeneficiariesWithaWellCare
Visit,CY20072011:NonMetropolitanCounties
TimePeriod
CY2007
CY2008
CY2009
CY2010
CY2011

MemberswithVisit
4282
3824
4474
4554
4638

Members
9196
8080
8932
9211
9294

Percent
46.6%
47.3%
50.1%
49.4%
49.9%

Figure48. PercentofContinuouslyEnrolledNHMedicaidChildBeneficiariesWithaPreventiveor
OtherAmbulatoryService,SFY20072011byAge:0to11Months
TimePeriod
SFY2007
SFY2008

PercentwithVisit
98.5%
98.2%

MONITORINGACCESSTOCAREINNEWHAMPSHIRESMEDICAIDPROGRAM:REVIEWOFKEYINDICATORS,JUNE2012
NewHampshireDepartmentofHealthandHumanServices
OfficeofMedicaidBusinessandPolicy

75

SFY2009
SFY2010
SFY2011

98.7%
97.9%
97.4%

Figure49. PercentofContinuouslyEnrolledNHMedicaidChildBeneficiariesWithaPreventiveor
OtherAmbulatoryService,SFY20072011byAge:12to24Months
TimePeriod
SFY2007
SFY2008
SFY2009
SFY2010
SFY2011

PercentwithVisit
97.6%
97.5%
98.0%
97.4%
96.6%

Figure50. PercentofContinuouslyEnrolledNHMedicaidChildBeneficiariesWithaPreventiveor
OtherAmbulatoryService,SFY20072011byAge:25Monthsto6Years
TimePeriod
SFY2007
SFY2008
SFY2009
SFY2010
SFY2011

PercentwithVisit
88.9%
88.9%
90.0%
90.8%
89.8%

Figure51. PercentofContinuouslyEnrolledNHMedicaidChildBeneficiariesWithaPreventiveor
OtherAmbulatoryService,SFY20072011byAge:7to11Years
TimePeriod
SFY2007
SFY2008
SFY2009
SFY2010
SFY2011

PercentwithVisit
86.6%
85.9%
87.2%
88.1%
87.5%

Figure52. PercentofContinuouslyEnrolledNHMedicaidChildBeneficiariesWithaPreventiveor
OtherAmbulatoryService,SFY20072011byAge:12to18Years
TimePeriod
SFY2007
SFY2008
SFY2009
SFY2010
SFY2011

PercentwithVisit
91.2%
90.9%
92.0%
93.2%
93.2%

Figure53. PercentofContinuouslyEnrolledNHMedicaidAdultBeneficiariesWithaPreventiveor
OtherAmbulatoryService,SFY20072011byAge:20to44Years
TimePeriod
CY2004
CY2005
CY2006
CY2007
CY2008
CY2009
CY2010

MemberswithVisit
7,184
7,319
7,834
7,615
7,913
9,165
9,755

Members
8,454
8,850
8,824
8,718
9,041
10,465
11,377

Percent
85.0
82.7
88.8
87.3
87.5
87.6
85.7

MONITORINGACCESSTOCAREINNEWHAMPSHIRESMEDICAIDPROGRAM:REVIEWOFKEYINDICATORS,JUNE2012
NewHampshireDepartmentofHealthandHumanServices
OfficeofMedicaidBusinessandPolicy

76

Figure54. PercentofContinuouslyEnrolledNHMedicaidAdultBeneficiariesWithaPreventiveor
OtherAmbulatoryService,SFY20072011byAge:45to64Years
TimePeriod
CY2004
CY2005
CY2006
CY2007
CY2008
CY2009
CY2010

Numerator
2,865
3,016
3,230
3,389
3,683
4,160
4,421

Denominator
3,196
3,424
3,491
3,642
3,949
4,523
4,770

Percent
89.6
88.1
92.5
93.1
93.3
92.0
92.7

Figure55. BeneficiaryRequestsforAssistanceAccessingProvidersper1,000NHMedicaid
Beneficiaries,CY20072012:TotalPopulation
TimePeriod
2007QTR1
2007QTR2
2007QTR3
2007QTR4
2008QTR1
2008QTR2
2008QTR3
2008QTR4
2009QTR1
2009QTR2
2009QTR3
2009QTR4
2010QTR1
2010QTR2
2010QTR3
2010QTR4
2011QTR1
2011QTR2
2011QTR3
2011QTR4
2012QTR1

Calls
674
489
422
416
481
472
499
610
667
696
748
638
613
714
702
495
678
656
703
792
673

MemberMonths
248,641
250,387
250,333
250,172
253,141
256,897
260,349
264,072
272,598
282,178
288,533
292,332
294,860
297,486
299,440
299,922
301,086
302,767
302,856
302,025
300,366

Rateper1,000
2.7
2.0
1.7
1.7
1.9
1.8
1.9
2.3
2.4
2.5
2.6
2.2
2.1
2.4
2.3
1.7
2.3
2.2
2.3
2.6
2.2

Figure56. BeneficiaryRequestsforAssistanceAccessingProvidersper1,000NHMedicaid
Beneficiaries,CY20072012:MetropolitanCounties
TimePeriod
2007QTR1
2007QTR2
2007QTR3
2007QTR4
2008QTR1
2008QTR2
2008QTR3
2008QTR4
2009QTR1
2009QTR2
2009QTR3
2009QTR4
2010QTR1
2010QTR2
2010QTR3
2010QTR4
2011QTR1
2011QTR2
2011QTR3
2011QTR4
2012QTR1

Calls
454
329
285
303
333
349
348
431
471
494
498
492
422
496
488
348
460
423
475
470
458

MemberMonths
135,660
136,451
136,818
137,148
138,497
140,389
142,363
144,815
149,621
155,774
159,393
161,634
163,264
164,779
166,623
167,439
168,346
169,531
169,878
170,333
170,262

Rateper1,000
3.3
2.4
2.1
2.2
2.4
2.5
2.4
3.0
3.1
3.2
3.1
3.0
2.6
3.0
2.9
2.1
2.7
2.5
2.8
2.8
2.7

MONITORINGACCESSTOCAREINNEWHAMPSHIRESMEDICAIDPROGRAM:REVIEWOFKEYINDICATORS,JUNE2012
NewHampshireDepartmentofHealthandHumanServices
OfficeofMedicaidBusinessandPolicy

77

Figure57. BeneficiaryRequestsforAssistanceAccessingProvidersper1,000NHMedicaid
Beneficiaries,CY20072012:NonMetropolitanCounties
TimePeriod
2007QTR1
2007QTR2
2007QTR3
2007QTR4
2008QTR1
2008QTR2
2008QTR3
2008QTR4
2009QTR1
2009QTR2
2009QTR3
2009QTR4
2010QTR1
2010QTR2
2010QTR3
2010QTR4
2011QTR1
2011QTR2
2011QTR3
2011QTR4
2012QTR1

Calls
206
152
130
108
140
117
144
178
194
200
241
139
184
211
201
134
207
225
223
318
204

MemberMonths
105,344
106,376
105,891
105,642
106,982
108,853
110,061
111,271
114,750
118,093
120,344
121,467
122,591
123,685
124,270
124,819
125,751
127,098
127,623
128,061
128,001

Rateper1,000
2.0
1.4
1.2
1.0
1.3
1.1
1.3
1.6
1.7
1.7
2.0
1.1
1.5
1.7
1.6
1.1
1.6
1.8
1.7
2.5
1.6

MONITORINGACCESSTOCAREINNEWHAMPSHIRESMEDICAIDPROGRAM:REVIEWOFKEYINDICATORS,JUNE2012
NewHampshireDepartmentofHealthandHumanServices
OfficeofMedicaidBusinessandPolicy

78

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