Determining Disability and Health Program Value

National Center on Birth Defects and Developmental Disabilities

Division of Human Development and Disability

2013 Annual Disability Statistics Compendium:

Improving Disability Statistics: Recent and Future Developments

Brian S. Armour, Ph.D. 

December 11, 2013
D&H Program Value -- Questions

 Challenge – 18 D&H state programs ‘are doing 

good work’ but their value is not understood

 How do we demonstrate state program value?

 How can we integrate what the state programs 

and Public Health Prevention Resource Centers 

(PHPRCs) are doing?
What do we know about our State Populations?

 PWDs are disproportionately

 Obese, Physically inactive, Cigarette smokers 

 Less likely to receive preventive services 

• Mammograms

• Oral health care

 Are these findings generalizable to people living 

with Limb Loss (LL), Intellectual Disability (ID), 

Paralysis (PS)?

 We do not know at a population level
Integrating D&H State and PRCs

 When we go out to various CDC programs and ask 

them to include these populations it is a challenge 

because we cannot say how many people have 

 Limb Loss (LL)

 Intellectual Disability (ID)

 Paralysis (PS)

 In summary, we are hampered by a lack of info

 What we have is not intuitive
The Problems

 View can’t drill down – “Disability definition is too broad”

• People with ID, LL , etc. are not represented in national surveys

• The state level view we have (PWDs) is from 40,000 feet

• ACS Questions will help a little (30,000 feet)

 Many people with limiting conditions might not identify with 

disability

 Small budget

 Access

• We talk about removing barriers to care in the hope that it will 

float all boats in terms of Health Improvement for PWDs ... but 

this is problematic in that we do not have defined population(s) 

so we cannot gauge the waterline 

• Access info is limited in state-based pop. surveys
Problem Solving

 The Solution must

 Define Value

• Have a $ component

 Define our population

• Use diagnoses (Dx.)

 Integrate States and PHPRCs

• Population(s) level
Defining Value and our Populations

 Defining Value

 Intersection of cost and quality 

• Cost ($)

• Quality of care

 List or Defined Population 

 Medicaid Population (Dx. driven)

• Intellectual Disability

• Limb Loss

• Paralysis
Why Medicaid?

 State-based

 Each state has its own claims data 

 Claims data

 Will give us $ and Dx. 

 Vulnerable population

 Disproportionately poor

 Many have disabilities
Medicaid Expenditures, 2010

 Medicaid MSIS Selected States, 2010 (Annual)1,2.

State Population

(thousands)

Disability No. 

(thousands) (%)

Exp.

(billions $)

Disability Exp. 

(billions $) (%)

IL 2,758 332 (12%) $11.6 $4.9 (42%)

MT 126 20 (16%) $0.8 $0.3 (38%)

NY 5,011 735 (15%) $42.7 $20.1 (47%)

SC 953 154 (16%) $5.1 $1.8 (35%)

1.Disability defined using Medicaid blind/disabled basis of eligibility

2. Estimates rounded

In NY, PWDs represent ≈15% of MA pop. but account for ≈ 47% of Exps.
‘Disability’ Costs and Average Costs

 For Each State might want to determine (e.g. NY)

Medicaid

Number

Medicaid Exp.

(billions $)

Avge. Total ‘Cost’ 

($)

Total -- 5,011,087 Total -- $42.7 $8,521

Disability -- 735,190 Disability -- $20.1 $27,340 

Disability Type

 ID -- ? ? $100,000+*

 LL -- ? ? ?

 PS -- ? ? ?

*Supplemental info NY (illustrative): “ID/DD Medicaid HCBS or ICF

represent <5% of population and ≈20% of expenditures.” 
Money’s Worth – State Program Value

 Medicaid Intellectual Disability (ID)

 Average Cost $100,000+ 

 CDC Breast Cancer Program

 ≈$200 million to identify 400,000 people and have them 

screened

 Average Cost per identification and screening is $500

 Disability and Health Program

 <$5 million to describe x? number of people with ID, LL, and 

PS and opportunities to improve quality of care

 Example 1: Partner state ≈$300k ID ≈30,000 people

• $10 per identification 
D&H State Pilot Program working with Medicaid Data

 To analyze claims data to determine

MI Medicaid Program ID Dx. LL Dx. PS Dx. Total

Number

Demographics

 Age, Gender, Race, DE

Health Characteristics

 Mammograms

 Oral Health

 Hypertension

 Beh. Risks (MRR?)
Limb Loss Example

 People with LL Dx. 

Male Female Total

Coexisting Conditions*

Diabetes (yes)

 Quality of Care Diabetes Measures

 AIC

 Eye Exams

 Foot Exams

 Pre-diabetes

 * Can we ascertain if the LL is linked to diabetes? 
Benefits

 Integrates State Program and PHPRCs

 Data driven and Dx based

 Get cost estimates (money’s worth analyses)

 Might help reduce the disability causality issue

 Potentially add (characterize) other populations over time

• Hearing impaired; Visually impaired; Children with disabilities

 Won’t alienate groups that don’t see themselves as having a disability 

 Evidence based

 Nothing about us without us
Other Benefits -- Questions

 Answer questions for each state

 What are the leading causes of disability that Medicaid covers? 

 What are the costs associated with the leading causes of disability 

(e.g. Top 10)?

 What are hospitalization and ED use rates for people with the 

aforementioned conditions?

 What are the leading (e.g. Top 10) causes of ED use among people 

with ID?
In Summary

 Program value

 Few understand what we do

 Not integrated

 No list or defined population -- not population based

• “Disability definition too broad”

• “Lack disability/condition specific data to inform program efforts”

 Solution proposed i.e. focusing on 4 sub-populations (ID, LL, 

PS, SB) within State Medicaid Programs

 Defines value and would allow us to make impact statements

 Integrates states and PHPRCs

 Population-based AND evidence-based

 Has the potential to integrate across CDC teams and programs
Brian Armour

Centers for Disease Control and Prevention 

1600 Clifton Road NE,

Mail Stop E-88

Atlanta, GA 30333

Tel. 404 – 498-3014

Email. barmour@cdc.gov

For more information please contact Centers for Disease Control and Prevention

1600 Clifton Road NE, Atlanta, GA 30333

Telephone: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348

E-mail: cdcinfo@cdc.gov Web: http://www.cdc.gov

Disclaimer: The findings and conclusions in this presentation are those of the author 

and do not necessarily represent the official position of the Centers for Disease 

Control and Prevention.

National Center on Birth Defects and Developmental Disabilities

Division of Human Development and Disability

Contact Information