Record of August 22, 2014 Healthcare Transformation Learning Session Improving transparency in healthcare …exploring the opportunities and challenges for consumers, providers, and purchasers WHY: Transparency in healthcare is essential for moving towards a higher performing healthcare system in the United States. The potential benefits from increased healthcare transparency include: •
Improved availability of information needed by consumers to make informed healthcare choices
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Increased trust in the patientphysician relationship and health care systems
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Improved quality, safety and efficiency throughout the healthcare system due to competition and/or the availability of clinical benchmarks. Featured Speaker • Josephine Porter, MPH, Deputy Director for the Institute for Health Policy and Practice at the University of New Hampshire and the cochair of the national All-Payer Claims Database (APCD) Council. Discussion Panel • Tom Hadley, Senior Vice President, Employee Benefits, 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
Click here to view learning session packet. Click here to view presentation slides. Click here to listen to recording of learning session. www.hcgc.org
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What are the opportunities and challenges of implementing an All-Payer Claims Database (APCD) in Greater Columbus/Ohio? The Healthcare Collaborative of Greater Columbus will utilize learning from the session to shape its strategies for catalyzing improved healthcare transparency in Greater Columbus. The following reflections were captured from the diverse participants at the learning session. Consumer – Opportunities • Ability to be active participant in their care • Become more powerful to make informed decisions • Better shopping capabilities given to high deductible health plans • Better understand cost before nonemergency service • Can shop around for most cost effective procedures • Choice • Combination of data from purchasers and providers would present the whole picture of a group of people and their health status. • Consumers could demand APCDs which would drive their creation. • Educate consumers to the new and improved focus on taking charge in their healthcare • Efficient care without duplication of services. • Enable patient to get access to their own records and to their referral www.hcgc.org
Consumer – Challenges • Big brother mentality. • Capturing consumer out-of-pocket spending for real healthcare costs • Choice of not wanting data to be shared. • Claims show cost not quality • Comprehension of language used especially among uneducated patients who are not literate. • Consumers at all levels must understand. • Cost data without quality can be misleading. • Data may not reflect quality and value • Data overload? • Education • Getting consumers to use the tool without being inundated. • How/when to navigate • Info is currently not available • Knowledge of the data • Lack of knowledge about how to use the info—health literacy. • Lag between gathering and posting… a lot can change • Learning how to navigate the electronic 2
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authorization documents Enable/promote shopping Engaged consumers Exceedingly larger network of options Full integration of healthcare services Good comparison Have choices if available data tied in and made meaningful. Helps drive patient involvement Inform of resources available. More comparison/competition for individual’s needs as a consumer Offers tools for those with high deductible health plans Open options/clarity of costs and services Price transparency especially in light of high deductible health plans Providers being accountable for service provided. Publish APCD data to help make better informed decisions about future care and care options Quality scores as well as cost information in order to make financial decision and clinical decision. Standardized access tools that are available instantly Steer consumers to take control of their health in all aspects Treat healthcare expenses like all other consumer expenses. Want more info on cost and quality
Providers – Opportunities • Accountability • Apply the denominator to the value prop of healthcare (cost) • Beneficial to risk assumption • Best practices/value • Better patient care by knowing details. • Chances to show quality of service and win new clients • Communicate/tell success stories and www.hcgc.org
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system Need clinical, not just cost Needs to be aligned economics to provide consumers with a reason to be interested. No data on uninsured People will select provider based on price— absent quality data Presented in a format that is user friendly and sustainable. Put price data ahead of value and quality Sharing of data and risks of data breaches Using it to their benefit What is affordable for receiving care
Providers – Challenges • Collaborating and receiving patient choice as acceptable. • Combining claims based data with health record information in a meaningful way. • Competition concerns • Data may be misleading • EMRs don’t talk with other data systems • Enable/promote shopping • Encouraging engagement 3
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learn collaboratively Data allows for bench marks and opportunity to id areas of growth. Drives competitiveness Easier to compare to peers Encourages a shared care arrangement. Further identify efficient use of pharmacists in a multi-disciplinary team. Gaining an understanding of what the consumer faces Helps allow providers to be informed about patients who travel out of state. ID gaps in preventative care Increased knowledge of costs for recommended care Join and promote this effort and incorporate into practices and policies. Larger network of possible clients Learn from patients Linking APCD with HIE data to get complete picture of outcomes May lead to minor improvements More ammunition for negotiations Performance improvement Potential to improve data collected and reported to carriers and other providers. Supports need to improve cost and qualityvalue Using the data to target population
Purchasers – Opportunities • As a medical MCP, if there is a way to use this tool for quality • Benchmark data • Bring greater transparency to the public sector employer who spends a large amount on healthcare • Collaborative relationships • Consumer tools • Could require payment of Medicaid & HMOs be tied to providers with APCDS • Create new medical/disease management programs based on results of data. • Discount variations www.hcgc.org
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Fear of having legal hurdles Fear of it being used against me/my organization Fear of what data reveals. How do we access the data? If risk assessment not accurate could yield misleading results; academic medical threatened. Inaccurate information/reporting Increased expense to comply Incremental reporting burden Interpreting the data and finding its utility Majority of physicians do not have an EMR. Making data meaningful to their patients More time spent on data reporting/review Need to learn how an APCD would benefit their practice, rather than perceiving that it would shed a negative light on their practice. Pharmacists in Ohio are not fully recognized as providers. Many clinical pharmacy services will not be captured. Providers referring to all networks or to providers that are cost efficient with location and availability. Reluctance to want information shared. Services vs. payments (navigating costs)
Purchasers – Challenges • Competitive edge decrease • Concerns that system is too complex—no buy in • Convincing the purchaser that the data has integrity for most of their needs. • Creation of additional administration fees • Fear of it being used against me/my organization • Hesitancy of carriers to want their provider reimbursements exposed • How would we use the data if it was available? • Incremental reporting burden. • Lack of IT infrastructure 4
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Enable/promote shopping Get buy in that this is good transparency tool Greater transparency—critical for decision making. Have more informed dialog with insurance companies and providers, as well as their employees. Help design wellness plans/education programs. Helps drive down cost Levels field for smaller payers Leverage APCD data to in provider/purchaser decisions Most efficient providers raise health plans Negotiate better deals and coverage? Purchase quality care. Regional HIE Share common need for info Streamlined payments/standardized
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Loss of competitive advantage Meeting the needs of various employers and other types of purchasers for a one-stop transparency model. Patients are purchasers too! Purchaser reliance on their carriers to lead the way Sacrifice competitive advantage. Variation in state databases decreases value for large multi-state purchasers
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The Healthcare Collaborative of Greater Columbus thanks the following public-private partners for participating at the session and sharing their diverse perspectives. Paul David Jason Amy Amy Nancie Berna Lynn Jeff Tim Jane Cristin Robyn Lakeisha Linda Sue Tamara Cindy Madeleine Meghan Jan Sarah Connie Linda Jill Myra Judy Rick Cheri Thomas David Kelly Doug Veronica Donna Kevin Aaron Mike Jeff www.hcgc.org
Altman Aufdencamp Bainum Bashforth Becher Bechtel Bell Bessant Bierbower Borcherding Brody Caryl Chatman Clark Clem Conner Davis Deep Devitt Dougherty Dufour Durfee Emerson Felix Fetzer Gagliardi Gerber Gideon Gillfillan Hadley Hafler Hamilton Haupt Hawkins Hedrick Hinkle Hoops Hossenlopp Hoston
Abbvie Mount Carmel Health PBSAI Ohio Department of Health Amethyst/ Southeast Columbus Public Health Ohio Hospital Association STRS Ohio Riverside Radiology and Interventional Associates Ohio State University Medical Mutual Physician Cognosante Mount Carmel Health PBSAI The Ohio State University Anthem Medical Mutual Employers Health Cigna OPERS Concord Counseling Services Novo Nordisk Faith Mission Clinic Reach Out of Montgomery County Medical Mutual HealthCare Too One Source Advisors, Inc. Wells Fargo Insurance Services Healthcare OSU Health Plan GSK Medical Mutual HCGC Consultant Anthem Blue Cross and Blue Shield OSU Health Plan GSK abbvie 6
Wayne Leroy Isi Erin Lisa Lynne Joel Joe Patricia Tien John Marcia Matthew Steven Brigid Lori Mike MIchelle Kathy Kay Tracy Margaret Lynn Jeri Elizabeth Jayne Kathleen Gregory Eileen Jan Patty Colleen Joyce Kevin Joe Tim Cathy Brian Jo Malcolm Larke Mark Kathy Jennifer www.hcgc.org
Howlett Hushak Ikharebha, MPH Jech Kaiser Kantura Kauffman Kenney Lattimer Le Leite Lemen Lengel Liao Long Lopez Lorz Love Maedecker Mavko McAllister McDonald Miller Milstead Mitchell Moreau Morris Myers Myers Neefe Nussle O'Brien O'Daniel Orr Parent Perry Phillips Pierson Porter Porter Recchie Ridenour Ritchey Rodis
Comprehensive Healthcare Advisors, LLC BREAD Physicians CareConnection Ohio Academy of Family Physicians HAC Cigna Oakhill Medical Associates Medical Mutual mount carmel health system The Ohio State University Healthcare Collaborative of Greater Columbus AbbVie Kroger STRS Ohio Kroger Pharmacy Employers Health Lorz communications Inc. Mount Carmel Medical Group Ohio State University Ohio Academy of Nutrition and Dietetics Ohio State University Janssen New Directions Healthcare Consultants, LLC Self NRHI Columbus Public Health ONA Medical Mutual The Little Clinic Mount Carmel Health System Ohio Department of Medicaid The Ohio State University Wexner Medical Center Anthem Blue Cross and Blue Shield Pfizer Medical Mutual of Ohio HealthCare Too Columbus Cancer clinic Mount Carmel All-Payer Claims Database (APCD) Council HCGC Ohio Association of Area Agencies on Aging the Ridenour Group Syntero The Ohio State University College of Pharmacy 7
Becky Joshua Jeremy Greg Susan Jason Crystal Geoff Lindsay Sharon Shawn Kaitlin Michelle
Roe Rouch Sampson Sawchyn, MD Scheer Scherzinger Schlicher Sharp Sharrock Sherlock Smith Smith Smith
Andy Scott Adam Rod Tanya Krista Mariah King Rebecca Staci Karen Bruce Lisa Kim Marisa Tracy Gregory Emily Paul Lisa William Matthew
Smith Solsman Spidel Sprang Stamp Stock Stuckey Stumpp Sustersic Swenson Vogel Wall, MD Watkins Weimer Weisel Whalen Whisman, MD Williams Wong Workman Wulf MD Yannie
www.hcgc.org
School Employees Retirement System of Ohio Kroger/ONU Molina Healthcare Inc. OhioHealth AEP Anthem Medical Mutual Medical Mutual of Ohio Mount Carmel Health Plan Reach Out of Montgomery County Abbvie Ohio Academy of Family Physicians OSU Wexner Medical Center PCMH Care Coordinator Sanofi Navigator State of Ohio: DAS Sanofi Sanofi Healthcare Collaborative of Greater Columbus Columbus Public Health Netcare Access Ohio Bureau of Workers' Compensation Mental Health America of Franklin County OhioHealth OSU Health Plan Ohio State University ODH/BCMH Ohio State Medical Association Cognosante The Medical Group of Ohio Pfizer CHP Minuteclinic Central Ohio Primary Care United Way of Central Ohio
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