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

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.

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

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

www.hcgc.org

Improving Healthcare Transparency in Greater Columbus …exploring the opportunities and challenges

for consumers, providers, and purchasers

Patient surveys …experiences

medical records

Improved healthcare

transparency www.hcgc.org

www.hcgc.org

medical records

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

www.hcgc.org

medical records

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

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!

Background

APCDs: What and Why

• Early Stage Technical Assistance to States

• Shared Learning • Catalyzing States to Achieve Mutual

Goals www.apcdcouncil.org www.apcdshowcase.org

Our Work

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

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)

Commercial / TPAs / PBMs /

Dental / Medicare Parts C & D

Medicaid FFS / Managed Care /

Medicare Parts A & B

FUTURE: TRICARE & VA &

IHS & FEHB

Typical APCD Data Sets PR

ELIGIBILITY FILE

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

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

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?

May 2014 State Progress Map

All-Payer Road Map

State Experiences and

Lessons Learned

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

Usage Examples: How are APCDs being used?

www.apcdshowcase.org

Something for Everyone

HEALTH DEPARTMENT

INSURANCE DEPARTMENT

POLICY MAKERS

MEDICAID PURCHASERS RESEARCHERS

PROVIDERS PAYERS CONSUMERS

Population Health

Source: http://www.nhhealthwrqs.org

Source: http://www.dhhs.nh.gov/ombp/documents/respiratory.pdf

State Agencies

Source: http://nhmedicaidquality.org/

SOURCE: CIVHC, www.cohealthdata.org

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

Source: https://chhs.unh.edu/sites/chhs.unh.edu/files/docs/nhihpp/2008-12_NH-Patient-Migration-Analysis.pdf

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

NH vs. Out -of- State Spending 2009 Commercial Membership

Source: NH Insurance Department, August 2, 2010

Consumers

Source: New Hampshire Insurance Department, HealthCost: http://www.nhhealthcost.org

Source: Maine HealthCost: https://mhdo.maine.gov/healthcost2014/CostCompare

Purchasers

SOURCE: CIVHC, www.cohealthdata.org

Rx Volume by Type – NH 3 Largest Payers 2009 and 2010

Source: NH Purchasers Group on Health; UNH Center for Health Analytics

Reform

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?

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

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