Medical Trading Areas

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Medical Trading Areas

• Presented by Tom McRae

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PURPOSE OF REVIEW

• Propose potential boundaries for Medical Trading
  Areas (MTAs)
• Provide underlying Medicaid paid claims data
  (summarized at county level) so others can
  analyze as well

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REVIEW CRITERIA

• Review period is calendar year 2005
• Only Fee-For-Service (FFS) paid claims are
  reviewed no HMO data
• Pharmacy and dental claims are excluded
• Elderly and Disabled Waiver claims are excluded
• Nursing home residents are excluded

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CY 2005 TRANSACTION VOLUMES

• 20.7 million FFS transactions included in review
• Managed Care (HMO) transactions (46 million) are
  not included in review
• Pharmacy (14.6 million), HMO capitation payments
  (11.5 million), claims for nursing home residents
  (5 million), FFS dental (4.1 million), and
  Elderly and Disabled waiver payments (0.7
  million) are not included in this review

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STARTING POINTS

• Michigan counties, rather than cities or zip
  codes, are used as basic units of aggregation
• Each region (MTA) should have a population of at
  least 500,000 persons
• Each region is to be centered around a
  metropolitan area
• The Upper Peninsula (UP) and Northern Michigan
  are treated as distinct regions

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NINE POTENTIAL MTAs

• Wayne - 4.4 million residents
• Kent 1.5 million
• Washtenaw 0.8 million
• Kalamazoo 0.8 million
• Saginaw 0.7 million
• Genesee 0.6 million
• Northern Michigan 0.5 million
• Ingham 0.5 million
• Upper Peninsula 0.3 million

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SPLIT COUNTIES

• There are a limited number of counties where
  residents receive significant portions of their
  services from two different regions
• Sanilac Saginaw / Wayne regions
• Barry Kent / Kalamazoo regions
• Shiawassee Genesee / Ingham regions
• Arenac Saginaw / N. Michigan regions
• Zip code analysis may shed light on where this
  split occurs

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SOUTHEAST MICHIGAN

• Wayne, Oakland, Macomb, St. Clair, and Monroe
  counties were initially analyzed as a single MTA
• A second analysis treated Wayne, Oakland, and
  Macomb counties as three separate and distinct
  trading areas
• This second analysis showed that Oakland county
  draws beneficiaries from Macomb, and to a lesser
  extent, Wayne county

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WAYNE, OAKLAND, MACOMB BENEFICIARIES AND WHERE
THEY TRAVEL TO RECEIVE SERVICES

• Wayne 81 in Wayne, 12 to Oakland, 3 to
  Macomb
• Oakland 72 in Oakland, 13 to Macomb, 10 to
  Wayne
• Macomb 53 in Macomb, 27 to Oakland, 17 to
  Wayne

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BENEFICIARY versus PROVIDER PATTERNS

• Based on beneficiaries county of residence,
  where do beneficiaries go to receive medical
  care?
• Based on the providers county location, where do
  providers draw their patients from?
• Which counties draw patients from outside their
  own county?

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IN-MIGRATION

• Among the large, urbanized counties, Washtenaw
  and Oakland county providers perform more than
  half their services for out-of-county residents
• In northern Michigan, Emmet, Alpena, and Grand
  Traverse county providers render more than half
  their services for beneficiaries from outside
  their own county

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DIFFERING IN-MIGRATION PATTERNS

• OAKLAND
• Medical Supplies 33
• Physician services 31
• Outpt. Hospital 14
• Independent Lab 13
• Inpt. Hospital 5

• WASHTENAW
• Outpt. Hospital 41
• Physician Services 35
• Inpt. Hospital 14
• Medical Supplies 7
• Independent Lab - 0

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OUT-MIGRATION

• Most residents in the northern lower Michigan
  counties receive most of their services outside
  their own county
• Residents in rural counties adjacent to urbanized
  counties receive most services in the nearby
  urban county

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STAYING HOME

• Residents of the largest counties (with the
  exception of Macomb) receive 70 or more of their
  services within their own county.
• Wayne County 81
• Oakland County 72
• Kent County 90
• Genesee County 86
• Ingham County 90
• Macomb County 53
• Muskegon County 81
• Saginaw County 74

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COUNTIES AND OUT OF STATE PROVIDERS

• Counties with the largest of services rendered
  by out-of-state providers are
• Menominee 37
• Monroe 11
• Gogebic 9

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SUMMARY

• Medicaid beneficiaries in the largest populated
  counties tend to receive services in their own
  county
• Northern Michigan region has three hubs which
  draw patients from across the region
• Macomb, Oakland, and Wayne counties are
  inter-related in that order
• There may be 4 to 6 counties where splitting
  between two MTAs may be warranted.