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Developing and Using an All-Payer Database: Kansas’

Experience

State Coverage Institute MeetingAlbuquerque, New Mexico

July 31, 2009

Andy Allison, PhDExecutive Director

Kansas Health Policy Authority

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Overview

• Origins of Kansas’ All-Payer Database• New data regime initiated in 2005• KHPA’s plans to manage and use the data• Challenges and hurdles• Lessons learned• Next steps and expected milestones

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Origins of Kansas’ All-Payer Database

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Created in 1994 in the Wake of Clinton Health Reform Era

• Statutory purpose is to collect information from state-regulated carriers – “…in such form and detail as may be necessary to …determin[e]

whether rates and rating systems…produce premiums and subscriber charges…that are reasonable in relation to the benefits provided and to identify any….insurance benefits that may be unduly influencing the cost.”

• Named the Kansas Health Insurance Information System (KHIIS)

• Funded by a small premium assessment• Dataset is the property of the Kansas Insurance

Department, but the state’s health agency was assigned in statute as the statistical agent

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First Ten Years’ Experience

• Limited use of data for estimates of insurance mandates• No published studies of premiums nor its determinants• Data managed by state agency staff as a collection of

files rather than a database• Reporting inconsistencies and incomplete data in core

fields such as monthly premiums• Limited and laborious access to data• Eroding support among carriers for the administrative

premium assessment and mandatory collection

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KHIIS' Contents

• Data from the major health insurance carriers in Kansas (Commercial group insurance plans)

• Health benefit, enrollment and claims data• Payment data includes charges and write-offs,

copays and deductibles• 700,000+ members represented• Examples of aggregate reports shared publicly:

– Payment Summaries for Providers by Specialty– Payment Summaries for Hospitals by Service– Claims & Charges for Services Affected by Mandates

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New Data Regime Initiated in 2005

Reorganization of Kansas’ Health Programs

• KHPA created in 2005 Legislative Session• Built on Governor Sebelius’ “Executive

Reorganization Order” – Combine administration of state health insurance programs and

state health databases– To be housed in quasi-independent cabinet agency

• Modified by State Legislature to:– Create a nine member governing Board– Executive Director reports to Board– Added a specific focus on coordinating state health policy, health

promotion and data-driven policy making

• Assumed management for Medicaid, SCHIP and state employee health plan in July 2006

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Broad Legislative Intent for Health Data

• ..”urgent need to provide health care consumers, third-party payers, providers and health care planners with information regarding the trends in use and cost of health care services in this state for improved decision-making

• “it is the intent of the legislature to require that the information necessary for a review and comparison of utilization patterns, cost, quality and quantity of health care services be supplied to [KHPA] by all providers of health care services and third-party payers“

Source: KSA 65-6801

KHPA’s Responsibilities: Collect, Govern, and Use

• “… [collect and compile] a uniform set of data and establish mechanisms through which the data will be disseminated

• “… develop or adopt health indicators• “… may appoint a task force or task forces … for the

purpose of studying technical issues relating to the collection of health care data

• “… develop policy regarding the collection of health care data

• “… coordinate … analysis of health data for the state of Kansas with respect to [its] health programs“

Source: KHPA Authorizing Statute, 2005

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Summary of Statutory Framework for Management of Public Health Care Data

• Broad legislative intent• Public governance through independent board-run

agency• Clear accountability for KHPA• Huge stock of available data in one agency:

– Medicaid/SCHIP– State Employee Health Plan (SEHP)– Private group insurance data from major carriers (KHIIS)– Licensure information from 8 boards– Hospital Inpatient Claims

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KHPA’s Plans to Manage and Use the Data

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Guiding Model of Data Use and Development

Description, documentation, and manipulation

Initial policy + Consumer application(foster understanding)

Data development

Addl. policy + Consumer application(facilitate choice)

Description, documentation, and manipulation

Policy &Consumer application

Data development

Increa

sing

dem

and

Principal Strategies for Managing and Using Data

1. Establish public governance of health data– to create statewide health indicators– to develop guidelines for the use of data– to drive expanded collection and use of data

2. Make existing data accessible and informative– User-friendly interface with core datasets– Combined administration of core datasets to enable comparisons across

payers

3. Make use of available data for policy and programs– Produce data-intensive program evaluations to drive policy– Tie data sources to program management and public expenditures– Organize agency to emphasize outcomes and facilitate use of data– Create venues for dissemination to the public

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Public Governance through the new “Data Consortium”

• Chartered by the Board in April 2006 to: – Guide KHPA in the management of programmatic and

non-programmatic health data– Advise the Board as to the appropriate collection and

use of health data– Ensure continued public and private stakeholder

investment in the use of data to advance health policy– Disseminate Agency’s wealth of data in partnership

with stakeholders

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Consortium’s Progress to Date

• December 2007 – First meeting of Data Consortium• December 2007 to October 2008 – Development of statewide

health indicator recommendations • November 2008 – Recommendations presented to and

approved by Board• January 2009 – Kansas Health Indicators Document

published online (1st Release – Tier I)• March 2009 – Unsolicited reports using private insurance data

shared publicly for first time

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Elements of Successful Management of KHIIS

• Respond to analytic questions and requests for information from diverse stakeholders

• Access to data by staff with different levels of need and skill• Rapid response to wide range of questions and data requests

• User-friendly, intuitive access to information

• Data-sharing (with suitable privacy controls) with other state agencies and external researchers

• Modern analytic tools• Episode groupers

• Record linkage to create master patient/provider index

• Built-in calculation of widely-accepted measures for acute/long-term healthcare quality

• Allow benchmarking of Kansas data to other states and payers

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Solution: “Data Analytic Interface” (DAI)

• Repository for three data sets– Medicaid-400,000+ enrollees annually– State Employee Health-90,000+ enrollees– Private Insurance -700,000+ enrollees– Additional data as available

• Web based interface with data– Easily accessed by most staff– Quick response time– User friendly– Accurate reporting with ability to change and save queries

• Meet needs of administrators, program staff, analytical staff

• Training for each level of staff

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DAI Timeline and Status

• First proposed to KHPA Board in August 2006• Funded by Legislature in 2007• Procured by KHPA in 2008 – Contract to Thomson

Reuters (Medstat)• Currently in testing and implementation phase• Anticipated Go-Live dates

– November 2009 - Medicaid and state employee data available to staff

– February 2010 – First installments of private insurance data available to some staff

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Challenges and Hurdles

Challenges of the New Environment in Kansas

• A new economy– Large reductions in agency resources

– Large structural deficit in state budget

– Large structural deficit in federal budget

– Increasing levels of need for access to care and health insurance coverage

• New political leadership in Kansas– Limited success for comprehensive health reform agenda

– Legislative founders no longer in leadership role

– Some legislative interest in revisiting KHPA’s governance model

• KHPA response: refocus resources on core program operations– Scale back communications, outreach and policy capacity, and executive leadership

capacity

– Accelerate focus on data-driven, outcomes-oriented management

– Develop new savings and efficiencies through program evaluation process and remake the agency to engage in continual review and improvement

→ Data is no frill!

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Hurdles in Developing and Using the KHIIS

• Data quality and integrity issues• Resource and budget restrictions• Political barriers

– Provider-oriented state– Optimizing the governance model for effective multi-

stakeholder data policy development– Inertia in use of price and quality data

• Obtaining stakeholder buy-in and addressing privacy and trade-secret protection concerns

• Identifying sustained demand for information

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Lessons Learned

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Key Success Factors

• Successful governance of KHIIS and other health data– Clear legislative mandate– Clear vision for intended uses– Inclusive process through the Data Consortium– Public governance of KHPA provides sustained impetus

• Successful management of KHIIS– Requires strategy for using data– Recruitment of key staff to a leading-edge effort– Requires capacity to monitor, understand and communicate

information – Adequate and sustained funding

• Successful use of KHIIS– Fostering demand for new data– Public venue for sharing and improving data– Political accountability to the use of health data– Application of data to management of taxpayer-funded programs

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Next steps and expected milestones

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Next Steps in Management and Use of KHIIS

• Implement new data submission requirements – Summer 2009

• Overcome questions of the use of proprietary data and successfully share data with external researchers- Summer 2009

• Receive legislative requests for information from the all-payer database – Spring 2010

• Implement web-based, user-friendly data warehouse to enable comparisons of public and private payers – 2010

• Compile regular report of insurance benefits -- 2010 or 2011• Use comparative data to develop cost-saving program

initiatives in Medicaid or the state employee health plan – Summer 2011

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http://www.khpa.ks.gov/