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Maryland’s APCD

Linda BartnyskaActing Director, Center for Analysis & Information Services

NAHDO APCD MeetingOctober 25, 2012

January 23, 2012

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Legislative History

• MCDB created by the Maryland Legislature in 1993

• Requires private carriers (with ≥ $1 million in premiums) to submit paid claims information for Maryland residents to the MHCC

• Originally limited to paid claims for professional services (for possible rate-setting)– Authority was expanded in 1999 to include prescription drug claims– In 2007, authority was expanded to permit collection of institutional

claims, eligibility information, health plan descriptions

• Required to issue annual reports on cost & utilization of services

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Data Flows• Annual private insurer (MCDB) data submissions

– Content for each year set by MHCC, with carrier input– 20 Payer Units, representing 11 carriers, submit data– Created as of April 30th; due to vendor by June 30th

– Professional (78.8 million); Institutional (3.7 million); Rx (21.0 million); Eligibility (3.6 million)

• Other components of our APCD– Annual Medicare data files (eligibility, all service types except Rx)– Soon will incorporate:

• Medicaid managed care data• PBM Rx data using Master Patient Index (with CCIIO funding)

• Currently sharing MCDB data with:– Hospital Rate-setting Commission– Maryland Insurance Administration

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Data Analysis from APCDMission: The mission for the APCD is to be the source of information on health care payments

and services that could be used to support the development of cost containment strategies and assist payers, policymakers, practitioners, and the public in health care decision-making.

Current Uses:• Legislatively required analyses• MHCC programs

• Small group market• PCMH program functions – patient attribution and shared savings

• Commission-originated studies (with vendor use in ‘incubator projects’)

The glory: new use focuses on measurement • Source for risk adjustment under the Health Benefit Exchange• Provider measurement • Monitor transition in insurance coverage (churn)

The dream: Broader studies for building on health reform • Population health -- monitoring health status of smaller areas -- Hot spotting• Tool to examine value-based benefits

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Reports and Issue BriefsSpending per capita for professional services, payment per standardized unit of care (RVU). Comparisons by patient risk status, market segment, payer size (large and other), network participation. Annually, spring.

Focused research applying recognized research methods to issues of importance to Maryland policymakers and consumers.

Describes total spending for health care services in fully insured market with private insurance. Spending by market segment, including shares paid by insurer and patient. Spending by patient risk status. Annually, summer.

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Useful Measures• Payment Rate Comparisons: across years and by payer market share,

physician network participation and specialty • Average payment per RVU (standardized unit of care)• Ratio of average private payer payment per patient to average payment per

patient using Medicare payment rates

• Utilization/Payment Comparisons: across years and by patient risk status, by insurance market (individual, small group, etc.) and payer market share • Average payment per patient, # of services per patient• Average # of RVUs per service (service complexity)• Average payment per patient within main service categories• Average out-of-pocket (copays, deductibles) share of total payment per patient

• Patient Risk Status: across years and insurance markets, payer market share• CDPS – Chronic Illness & Disability Payment System: free, numeric score, use

your payments or theirs (common set of payment rates)• Chronic illness definitions: AHRQ HCUP; Medicare CCW flags