mmpc - National Indian Health Board

Findings
Figure 1. Adjustment of Mean Total Payment per Recipient for IHS AIAN, Other AIAN and Whites less than 65 years of age
enrolled 12 months with FFS medical care (successive adjustments for age and sex, disability, & morbidity). Payments include
FFS claims for medical services and either FFS claims or managed care plan premiums for non-medical services (behavioral
health or dental).
$10,000
$9,000
$8,000
$7,000
$6,000
$5,000
$4,000
$3,000
$2,000
$1,000
$-
$5,104
$3,670
$4,960
$7,052
$5,567
$6,369
$9,999
The further adjustment for the variation in morbidity among the three groups reduces the differences between
IHS AIAN and Whites, and between IHS AIAN and Other AIAN, but substantial differences remain (Figure 1).
The mean total payment for IHS AIAN is higher for Whites ($5,865 compared to $4,689, or a $1,176 difference)
and for Other AIAN ($4,453, or a $1,412 difference). The morbidity scores for the low income Medicaid eligible
Whites (1.013 with 90% Confidence Limits, C.L., from1.011 to 1.015) were actually worse than those of IHS
AIAN (0.954 with 90% C.L. 0.949 to 0.959) and Other AIAN (0.880 with 90% C.L. 0.875 to 0.885). We
investigated whether the lack of diagnosis codes on claims paid to Indian health care providers could explain
the morbidity scores and found that it did not. More diagnosis codes per recipient were used to determine
morbidity for IHS AIAN recipients with Indian health care provider claims than for Whites or Other AIAN in all
Areas except Aberdeen Area (Attachment Tables D.1 and D.2).
Payments across IHS Areas still Vary Substantially after Adjustments
Fee-for Service payments are higher for IHS AIAN than Whites in two-thirds of the IHS Areas (Alaska, Bemidji,
Billings, California, Phoenix, Portland and Tucson Areas, Figure 2). But the payments are lower for IHS AIAN in
Aberdeen and Albuquerque Areas, and about the same for IHS AIAN and whites in Nashville and Oklahoma
Areas. The mean adjusted total payments for Whites in the Tucson Area are exceptionally low (less than $1000
per recipient) while payments for IHS AIAN are exceptionally high, so we investigated payments in Arizona
more closely.
20
$7,884
$7,319
Unadjusted Age*Sex Adjusted Disabled*Medicare,
Age*Sex Adjusted
$5,865
$4,453
$4,689
& Morbidity Adjusted
IHS AIAN
Other AIAN
Whites