August 22nd Learning Session Presentation Slides
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Transcript of August 22nd Learning Session Presentation Slides
Healthcare Transformation Learning Session August 22, 2014
www.hcgc.org
Improving Healthcare Transparency in Greater Columbus
…exploring the opportunities and challenges for consumers, providers, and purchasers
Upcoming Learning Sessions
9/24/14 Webinar 1:00 - 2:00p Topic: Consumer Reports - Better Health Care - Changes to Learn About Now
10/22/14 Webinar 1:00-2:00p Topic: Pharmacists expanded roles in value-based healthcare
12/5/14 In-Person, 8:30-11:30a Topic: Annual showcase of best practices and lessons learned featuring our pubic-private partners
Register today!
www.hcgc.org/registration Patient surveys …experiences
Clinical data …electronic
medical records
Medical claims …Commercial, Medicare, Medicaid
Improved healthcare
transparency
Lead Supporter
Major Supporters
Individual & Corporate Donations
100% of our Board of Directors
& Staff
Additional Supporters
www.hcgc.org
Our Public-Private Funding Partners
AGENDA
Objectives • AWARENESS on All-Payer Claims Database (APCD) – transparency area with the most activity and learning available
• EXPLORE opportunities and challenges for consumers, providers, purchasers • LEARN from diverse perspectives of participants
8:30-8:50a Welcome & Briefing • Krista Stock & Jeff Biehl, Healthcare Collaborative of Greater Columbus
8:50-10:50a APCD Overview • APCD -- What and Why • Usage Examples – How are APCDs being used? Featured Speaker • Jo Porter, MPH, Deputy Director for the Institute for Health Policy and
Practice at the University of New Hampshire and the co-chair of the national All-Payer Claims Database (APCD) Council.
Discussion Panel • Tom Hadley, Senior Vice President, Wells Fargo Insurance Services • Kevin Hinkle, Regional Vice President, Anthem Blue Cross and Blue Shield • Isi Ikharebha, MPH, Executive Director, Physicians Care Connection • Bill Wulf, MD, CEO, Central Ohio Primary Care
10:50-11:00a Next Steps
Healthcare Transformation Learning Session August 22, 2014
www.hcgc.org
The Healthcare Collaborative of Greater Columbus is a non-profit, public-private partnership. We serve as a catalyst, convener, and coordinator of healthcare transformation & learning in Greater Columbus.
Healthcare Transformation Learning Session August 22, 2014
www.hcgc.org
… please introduce yourself to someone you do not know and share why you joined us today!
Overview August 2014
www.hcgc.org
…exploring and catalyzing best \practices to strengthen engagement between consumers, providers, and purchasers
SHARED RESPONSIBILITY HEALTHCARE DELIVERY
COLLABORATIVE LEARNING HEALTHCARE TRANSPARENCY
…improve engagement between consumers, providers, and purchasers
…improve the value of healthcare
…improve access to price and quality information
…improve the application of learning in Greater Columbus
Collaborative Transformational Activities
www.hcgc.org
…exploring and catalyzing best practices to strengthen engagement between consumers, providers, and purchasers
SHARED RESPONSIBILITY HEALTHCARE DELIVERY
COLLABORATIVE LEARNING HEALTHCARE TRANSPARENCY
emerging active
Choosing Wisely®
Patient Engagement Education & Training
Open Notes®
emerging active
emerging active
emerging active
Patient-Centered Medical Home (PCMH)
Medical Neighborhood Pilot
Physical-Behavioral Integration Pilot
Primary Care Quality Reporting Pilot
Public-Private Board of Directors
Healthcare Improvement Collaboratives
Transformation Learning Sessions
Speaking Engagements
Learning Groups
Healthcare Transformation Learning Session August 22, 2014
www.hcgc.org
Improving Healthcare Transparency in Greater Columbus …exploring the opportunities and challenges
for consumers, providers, and purchasers
Patient surveys …experiences
Clinical data …electronic
medical records
Medical claims …Commercial, Medicare, Medicaid
Improved healthcare
transparency www.hcgc.org
Healthcare Transformation Learning Session August 22, 2014
www.hcgc.org
Improving Healthcare Transparency in Greater Columbus …exploring the opportunities and challenges
for consumers, providers, and purchasers
Patient surveys …experiences
Clinical data …electronic
medical records
Medical claims …Commercial, Medicare, Medicaid
Improved healthcare
transparency
current activity
with patient-centered medical homes
www.hcgc.org
Primary Care Quality Reporting Pilot • Based on national standards • Clinical measures from electronic
medical records • A good place to start demonstrating
meaningful use of health information technology
Adult Measure • Diabetes: Hemoglobin A1c Poor
Control • Diabetes: Low Density Lipoprotein
(LDL) Management • Diabetes: Blood Pressure
Management • Controlling High Blood Pressure
Current Pilot Participants (65 sites)
• Central Ohio Primary Care (35 practice sites)
• Mount Carmel Medical Group (17 practice sites)
• The Ohio State University Wexner Medical Center (13 practice sites)
Primary Care Quality Reporting Pilot
www.hcgc.org
EMERGING NEXT STEPS – TO BE ANNOUNCED IN SEPTEMBER 2014
Healthcare Transformation Learning Session August 22, 2014
www.hcgc.org
Improving Healthcare Transparency in Greater Columbus …exploring the opportunities and challenges
for consumers, providers, and purchasers
Patient surveys …experiences
Clinical data …electronic
medical records
Medical claims …Commercial, Medicare, Medicaid
Improved healthcare
transparency
Today’s Focus:
All-Payer Claims
Database (APCD)
www.hcgc.org
All-Payer Claims Database
Featured Speaker • Josephine Porter, MPH, Deputy Director for the Institute for Health Policy
and Practice at the University of New Hampshire and the co-chair of the national All-Payer Claims Database (APCD) Council. The APCD Council is learning collaborative of government, private, non-profit, and academic organizations focused on improving healthcare transparency.
Discussion Panel • Tom Hadley, Senior Vice President, Wells Fargo Insurance Services
• Kevin Hinkle, Regional Vice President, Anthem Blue Cross and Blue Shield
• Isi Ikharebha, MPH, Executive Director, Physicians Care Connection
• Bill Wulf, MD, CEO, Central Ohio Primary Care
www.hcgc.org
© 2009-2012, APCD Council, NAHDO, UNH. All Rights Reserved.
© 2009-2014, APCD Council, NAHDO, UNH. All Rights Reserved.
APCD Overview Jo Porter, MPH
August 22, 2014
For redistribution or reproduction of these materials, please see the APCD Council Attribution Policy: http://apcdcouncil.org/attribution-policy.
Thank You!
© 2009-2012, APCD Council, NAHDO, UNH. All Rights Reserved.
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© 2009-2014, APCD Council, NAHDO, UNH. All Rights Reserved.
Background
APCDs: What and Why
© 2009-2012, APCD Council, NAHDO, UNH. All Rights Reserved.
© 2009-2014, APCD Council, NAHDO, UNH. All Rights Reserved.
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• Early Stage Technical Assistance to States
• Shared Learning • Catalyzing States to Achieve Mutual
Goals www.apcdcouncil.org www.apcdshowcase.org
Our Work
© 2009-2012, APCD Council, NAHDO, UNH. All Rights Reserved.
© 2009-2014, APCD Council, NAHDO, UNH. All Rights Reserved.
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Backdrop 2005-2013 • Increased Transparency Efforts (state,
consumer, employer, etc.) • Health Information Exchange (HITECH) • Health Reform (PPACA) • Payment Reform
– Patient Centered Medical Home – Accountable Care Organizations
© 2009-2012, APCD Council, NAHDO, UNH. All Rights Reserved.
© 2009-2014, APCD Council, NAHDO, UNH. All Rights Reserved.
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Definition of APCDs • Databases, created by state mandate,
that typically include data derived from medical, pharmacy, and dental claims with eligibility and provider files from private and public payers: – Insurance carriers (medical, dental, TPAs,
PBMs) – Public payers (Medicaid, Medicare)
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© 2009-2012, APCD Council, NAHDO, UNH. All Rights Reserved.
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© 2009-2014, APCD Council, NAHDO, UNH. All Rights Reserved.
Commercial / TPAs / PBMs /
Dental / Medicare Parts C & D
Medicaid FFS / Managed Care /
SCHIP
Medicare Parts A & B
FUTURE: TRICARE & VA &
IHS & FEHB
APCD
Typical APCD Data Sets PR
OVI
DER
FILE
ELIGIBILITY FILE
© 2009-2012, APCD Council, NAHDO, UNH. All Rights Reserved.
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© 2009-2014, APCD Council, NAHDO, UNH. All Rights Reserved.
Typically Included Information – Encrypted ID* – Patient demographics(date
of birth, gender, residence, relationship to subscriber)
– Type of product (HMO, POS, Indemnity, etc.)
– Type of contract (single person, family, etc.)
– Diagnosis codes (including E-codes)
– Procedure codes (ICD, CPT, HCPC, CDT)
– NDC code / generic indicator / other Rx
– Revenue codes – Service dates – Service provider (name,
tax id, payer id, specialty code, city, state, zip code)
– Prescribing physician – Plan charges & payments – Member liabilities (co-pay,
coinsurance, deductible) – Date paid – Type of bill – Facility type – Other 835/837 fields
© 2009-2012, APCD Council, NAHDO, UNH. All Rights Reserved.
© 2009-2014, APCD Council, NAHDO, UNH. All Rights Reserved.
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Typically Not Included Information – Services provided to uninsured – Denied claims – Workers’ compensation claims – Referrals – Test results from lab work, imaging, etc. – Provider affiliations – Premium information – Capitation fees – Administrative fees – Back end settlement amounts – Back end P4P or PCMH payments
© 2009-2012, APCD Council, NAHDO, UNH. All Rights Reserved.
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© 2009-2014, APCD Council, NAHDO, UNH. All Rights Reserved.
Evolution of Data Sets for States Administrative Data Sets
• Hospital Discharge • Medicaid • Medicare • All-Payer Claims
Databases
Clinical Data Sets
• Public Health Registries • Clinical Registries • Electronic Health
Records • Laboratory Systems • Health Information
Exchanges
Linkage?
© 2009-2012, APCD Council, NAHDO, UNH. All Rights Reserved.
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© 2009-2014, APCD Council, NAHDO, UNH. All Rights Reserved.
May 2014 State Progress Map
© 2009-2012, APCD Council, NAHDO, UNH. All Rights Reserved.
© 2009-2014, APCD Council, NAHDO, UNH. All Rights Reserved.
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All-Payer Road Map
© 2009-2012, APCD Council, NAHDO, UNH. All Rights Reserved.
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© 2009-2014, APCD Council, NAHDO, UNH. All Rights Reserved.
State Experiences and
Lessons Learned
© 2009-2012, APCD Council, NAHDO, UNH. All Rights Reserved.
© 2009-2014, APCD Council, NAHDO, UNH. All Rights Reserved.
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Lessons Learned by States • Develop Multi-Stakeholder Approach
• Form Provider Relationships • Form Payer Relationships
• Be Transparent and Document • Understand Uses and Limitations • Seize Integration & Linkage
Opportunities • Develop Use Cases
learn from diverse perspectives of participants
www.hcgc.org
From the perspective of consumers, providers and purchasers…
What are your questions to improve clarity on What and Why of APCDs?
What has been your major learning,
insight, or discovery so far?
APCDs: What and Why
Update on emerging initiative in Greater Columbus…
Patient Engagement Education & Training
www.hcgc.org
© 2009-2012, APCD Council, NAHDO, UNH. All Rights Reserved.
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© 2009-2014, APCD Council, NAHDO, UNH. All Rights Reserved.
Usage Examples: How are APCDs being used?
www.apcdshowcase.org
© 2009-2012, APCD Council, NAHDO, UNH. All Rights Reserved.
© 2009-2014, APCD Council, NAHDO, UNH. All Rights Reserved.
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Something for Everyone
HEALTH DEPARTMENT
INSURANCE DEPARTMENT
POLICY MAKERS
MEDICAID PURCHASERS RESEARCHERS
PROVIDERS PAYERS CONSUMERS
© 2009-2012, APCD Council, NAHDO, UNH. All Rights Reserved.
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© 2009-2014, APCD Council, NAHDO, UNH. All Rights Reserved.
Population Health
© 2009-2012, APCD Council, NAHDO, UNH. All Rights Reserved.
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© 2009-2014, APCD Council, NAHDO, UNH. All Rights Reserved.
Source: http://www.nhhealthwrqs.org
© 2009-2012, APCD Council, NAHDO, UNH. All Rights Reserved.
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© 2009-2014, APCD Council, NAHDO, UNH. All Rights Reserved.
Source: http://www.dhhs.nh.gov/ombp/documents/respiratory.pdf
© 2009-2012, APCD Council, NAHDO, UNH. All Rights Reserved.
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© 2009-2014, APCD Council, NAHDO, UNH. All Rights Reserved.
State Agencies
© 2009-2012, APCD Council, NAHDO, UNH. All Rights Reserved.
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© 2009-2014, APCD Council, NAHDO, UNH. All Rights Reserved.
Source: http://nhmedicaidquality.org/
© 2009-2012, APCD Council, NAHDO, UNH. All Rights Reserved.
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© 2009-2014, APCD Council, NAHDO, UNH. All Rights Reserved.
SOURCE: CIVHC, www.cohealthdata.org
© 2009-2012, APCD Council, NAHDO, UNH. All Rights Reserved.
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© 2009-2014, APCD Council, NAHDO, UNH. All Rights Reserved.
Tri-State Variation in Health Services Utilization & Expenditures in Northern New England, June 2010
Advanced Imaging – MRIs
Greenville (46.2) Keene
(90.8)
Rutland (73.8)
Middlebury (53.3)
Source: State of Vermont: http://apcdcouncil.org/sites/apcdcouncil.org/files/OnPoint%20Act49-Tri-State-Commercial-Variation.pdf
© 2009-2012, APCD Council, NAHDO, UNH. All Rights Reserved.
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© 2009-2014, APCD Council, NAHDO, UNH. All Rights Reserved.
Source: https://chhs.unh.edu/sites/chhs.unh.edu/files/docs/nhihpp/2008-12_NH-Patient-Migration-Analysis.pdf
© 2009-2012, APCD Council, NAHDO, UNH. All Rights Reserved.
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© 2009-2014, APCD Council, NAHDO, UNH. All Rights Reserved.
NH Carrier Discounts – 2009 Commercial
Source: NH Insurance Department
Source: https://chhs.unh.edu/sites/chhs.unh.edu/files/docs/nhihpp/2008-12_NH-Patient-Migration-Analysis.pdf
© 2009-2012, APCD Council, NAHDO, UNH. All Rights Reserved.
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© 2009-2014, APCD Council, NAHDO, UNH. All Rights Reserved.
NH vs. Out -of- State Spending 2009 Commercial Membership
Source: NH Insurance Department, August 2, 2010
© 2009-2012, APCD Council, NAHDO, UNH. All Rights Reserved.
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© 2009-2014, APCD Council, NAHDO, UNH. All Rights Reserved.
Consumers
© 2009-2012, APCD Council, NAHDO, UNH. All Rights Reserved.
© 2009-2014, APCD Council, NAHDO, UNH. All Rights Reserved.
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Source: New Hampshire Insurance Department, HealthCost: http://www.nhhealthcost.org
© 2009-2012, APCD Council, NAHDO, UNH. All Rights Reserved.
© 2009-2014, APCD Council, NAHDO, UNH. All Rights Reserved.
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Source: Maine HealthCost: https://mhdo.maine.gov/healthcost2014/CostCompare
© 2009-2012, APCD Council, NAHDO, UNH. All Rights Reserved.
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© 2009-2014, APCD Council, NAHDO, UNH. All Rights Reserved.
Purchasers
© 2009-2012, APCD Council, NAHDO, UNH. All Rights Reserved.
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© 2009-2014, APCD Council, NAHDO, UNH. All Rights Reserved.
SOURCE: CIVHC, www.cohealthdata.org
© 2009-2012, APCD Council, NAHDO, UNH. All Rights Reserved.
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© 2009-2014, APCD Council, NAHDO, UNH. All Rights Reserved.
Rx Volume by Type – NH 3 Largest Payers 2009 and 2010
Source: NH Purchasers Group on Health; UNH Center for Health Analytics
© 2009-2012, APCD Council, NAHDO, UNH. All Rights Reserved.
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© 2009-2014, APCD Council, NAHDO, UNH. All Rights Reserved.
Reform
© 2009-2012, APCD Council, NAHDO, UNH. All Rights Reserved.
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© 2009-2014, APCD Council, NAHDO, UNH. All Rights Reserved.
Source: NH Accountable Care Project; www.nhaccountablecare.org
© 2009-2012, APCD Council, NAHDO, UNH. All Rights Reserved.
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© 2009-2014, APCD Council, NAHDO, UNH. All Rights Reserved.
Source: NH Accountable Care Project; www.nhaccountablecare.org
learn from diverse perspectives of participants
www.hcgc.org
From the perspective of consumers, providers and purchasers…
What are your questions to improve
clarity on Use of APCDs?
What are the opportunities and challenges of implementing an APCD
in Greater Columbus/Ohio?
Usage Examples: How are APCDs being used?
Healthcare Transformation Learning Session August 22, 2014
www.hcgc.org
Thank you for participating today!
Next Steps Today: Email you a link to
presentation slides, recording, and evaluation survey
Next Week: Email you record of learning
Application of Learning: We will incorporate into our collaborative planning process
Upcoming Learning Sessions
9/24/14 Webinar 1:00 - 2:00p Topic: Consumer Reports - Better Health Care - Changes to Learn About Now
10/22/14 Webinar 1:00-2:00p Topic: Pharmacists expanded roles in value-based healthcare
12/5/14 In-Person, 8:30-11:30a Topic: Annual showcase of best practices and lessons learned featuring our pubic-private partners
Register today!
www.hcgc.org/registration
www.hcgc.org