mmpc - National Indian Health Board

Findings
Figure 5. Adjusted Mean Total Payment per Recipient for IHS AIAN in Figure 3 which excluded recipients in the state of
Arizona divided into the 3 IHS AIAN groups in Figure 4. Other AIAN and Whites of Figure 3 are also shown.
Aberdeen
Alaska
Albuquerque
Bemidji
Billings
California
Nashville
Navajo
Oklahoma
Phoenix
Portland
Tucson
$- $2,000 $4,000 $6,000 $8,000 $10,000
In all Areas except the Nashville Area, payments for IHS Active Users who did not have any Medicaid IHS
Program claims (Group 3) were lower or about the same (Alaska and Portland Areas) as those of Whites (Figure
4).
Payments for Outpatient Services had Largest Effect on Total Payments
We investigated whether there were payments for particular types of services that explained the higher
payments for IHS AIAN with IHS Program claims (Groups 1 and 2). The cleanest way to investigate this was to
successively exclude 1) clinic and physician outpatient payments (Figure 6), then 2) hospital payments (Figure
7), and finally 3) prescription drug payments (Figure 8). These three categories of services were uniformly
defined by the Medicaid data extraction process into separate MAX claims files.
Excluding outpatient clinic and physician payments (Figure 6) had the largest impact of the three general types
of service on reducing the differences in mean total payments per recipient between IHS AIAN with IHS
Program claims (Groups 1 and 2) and IHS AIAN Group 3 without IHS Program claims and Whites. The average
decline in adjusted mean payments for Group 1 was $2,960, Group 2 was $2,520, while that for Group 3 was
$680 and Whites was $750 (difference in values of Figure 6 and Figure 4). Particularly large differences remain
for Groups 1 and 2 for the Areas with Arizona state recipients (Navajo, Phoenix and Tucson Areas). For hospital
services the average decline in adjusted mean payments for Group 1 was $1068, Group 2 was $992, while that
23
1.IHS Program claims
& Active User
2.IHS Program claims
but Not Active User
3.IHS Active User with
no IHS Program claims
Other AIAN
Whites