August 22nd Learning Session Presentation Slides by Healthcare Collaborative of Greater Columbus

Healthcare Transformation Learning Session August 22, 2014 Improving Healthcare Transparency in Greater Columbus …exploring the opportunities and challenges for consumers, providers, and purchasers Medical claims …Commercial, Medicare, Medicaid

Clinical data

…electronic medical records

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

Patient surveys

www.hcgc.org

…experiences

Improved healthcare transparency

Our Public-Private Funding Partners Lead Supporter

Major Supporters

Additional Supporters 100% of our Board of Directors & Staff www.hcgc.org

Individual & Corporate Donations

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

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

Healthcare Transformation Learning Session August 22, 2014

â&#x20AC;Ś please introduce yourself to someone you do not know and share why you joined us today!

www.hcgc.org

Overview August 2014

HEALTHCARE DELIVERY SHARED RESPONSIBILITY …improve …improve the engagement value of between healthcare consumers, providers, and purchasers …exploring and catalyzing best \practices to strengthen engagement between consumers, providers, and purchasers LEARNING HEALTHCARE TRANSPARENCY COLLABORATIVE …improve the …improve application of access to price learning in Greater and quality Columbus information

www.hcgc.org

Collaborative Transformational Activities SHARED RESPONSIBILITY

Patient-Centered Medical Home (PCMH)

Choosing Wisely®

Medical Neighborhood Pilot

Patient Engagement Education & Training

Physical-Behavioral Integration Pilot

Open Notes® emerging

HEALTHCARE DELIVERY

active

emerging

active

…exploring and catalyzing best practices to strengthen engagement between consumers, providers, and purchasers COLLABORATIVE LEARNING HEALTHCARE TRANSPARENCY Public-Private Board of Directors

Primary Care Quality Reporting Pilot

Healthcare Improvement Collaboratives Transformation Learning Sessions Speaking Engagements Learning Groups

emerging www.hcgc.org

active

emerging

active

www.hcgc.org

Patient surveys …experiences

Clinical data …electronic medical records

Improved healthcare transparency

www.hcgc.org

Patient surveys …experiences

Clinical data …electronic medical records

Improved healthcare transparency

current activity with patientcentered medical homes

Primary Care Quality Reporting Pilot

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

www.hcgc.org

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)

EMERGING NEXT STEPS – TO BE ANNOUNCED IN SEPTEMBER 2014

Healthcare Transformation Learning Session August 22, 2014 Improving Healthcare Transparency in Greater Columbus …exploring the opportunities and challenges for consumers, providers, and purchasers

Today’s Focus: All-Payer Claims Database (APCD)

Medical claims …Commercial, Medicare, Medicaid

www.hcgc.org

Patient surveys …experiences

Clinical data …electronic medical records

Improved healthcare transparency

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, nonprofit, 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/attributionpolicy. Thank You!

Background APCDs: What and Why

Our Work

• Early Stage Technical Assistance to States • Shared Learning • Catalyzing States to Achieve Mutual Goals www.apcdcouncil.org www.apcdshowcase.org

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 / SCHIP

APCD FUTURE: Medicare Parts A &B

TRICARE & VA & IHS & FEHB

ELIGIBILITY FILE

PROVIDER FILE

Typical APCD Data Sets

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 21

– 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 © 2009-2014, 2009-2012, APCD Council, NAHDO, UNH. All Rights Reserved.

Typically Not Included Information – – – – – – – – – – – 22

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 © 2009-2014, 2009-2012, 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? 23

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 27

learn from diverse perspectives of participants

APCDs: What and Why From the perspective of consumers, providers and purchasersâ&#x20AC;Ś What are your questions to improve clarity on What and Why of APCDs? What has been your major learning, insight, or discovery so far?

www.hcgc.org

Update on emerging initiative in Greater Columbusâ&#x20AC;Ś

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 33

Source: http://www.dhhs.nh.gov/ombp/documents/respiratory.pdf 34

State Agencies

Source: http://nhmedicaidquality.org/ 36

SOURCE: CIVHC, www.cohealthdata.org 37

Tri-State Variation in Health Services Utilization & Expenditures in Northern New England, June 2010 Advanced Imaging – MRIs

Keene (90.8)

Greenville (46.2)

Middlebury (53.3) Rutland (73.8)

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 39

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 40

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

Source: NH Insurance Department, August 2, 2010 41

Consumers

Source: New Hampshire Insurance Department, HealthCost: http://www.nhhealthcost.org 43

Source: Maine HealthCost: https://mhdo.maine.gov/healthcost2014/CostCompare 44

Purchasers

SOURCE: CIVHC, www.cohealthdata.org 46

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

Source: NH Purchasers Group on Health; UNH Center for Health Analytics 47

Reform

Source: NH Accountable Care Project; www.nhaccountablecare.org 49

Source: NH Accountable Care Project; www.nhaccountablecare.org 50

learn from diverse perspectives of participants

Usage Examples: How are APCDs being used? From the perspective of consumers, providers and purchasersâ&#x20AC;Ś 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? www.hcgc.org

Healthcare Transformation Learning Session August 22, 2014

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 www.hcgc.org