Statewide Measures of Commercial Health Care Quality HB128
Doug Hasbrouck, MD
Barry Nangle, PhD
Executive Director, HealthInsight
Director, Center for Health Data Utah Department of Health
Health System Reform Task Force November 16, 2011
House Bill 128 (summary) Required changes to the Utah Health Data Committee HDC chair reports to UDOH director Added 2 new representatives Required state-wide reporting of quality measures Nationally recognized Selected by HealthInsight’s reporting task force
Quality Measures Nationally recognized health plan quality measures
(HEDIS) 3 diabetes measures: Blood sugar screening Cholesterol screening Kidney function screening
Well-child visits for infants Breast cancer screening
Using the All Payer Claims Database
Other measures added each year
Utah’s All Payer Claims Dataset Est. by Utah legislature Data collection began in 2009 Database of claims data from health plans Enrollment, medical claims, pharmacy
Allows view of covered care including amount paid Across time, site of care, providers, and payers Analysis by episode of care Excludes: Medicare, Wk Comp, administrative costs, premiums, capitation Care to uninsured Clinical information (results, findings)
Utah’s APCD Covered Lives 19 plans engaged with the APCD: 8 in full production 2 enrollment and pharmacy only 6 enrollment only 3 in testing phase (no data)
2.1 million covered lives representing 93% of the
commercially insured market
Plans in Full Production Altius CIGNA Behavioral Health DMBA Meritain Health PEHP Regence BlueCross/Blue Shield of UT SelectHealth
UnitedHealthcare
About the Data Commercial data ONLY Representative of 90% of the commercially insured
market Includes large and small carriers Analyzed using nationally-recognized quality measures
Measure Release Timeline July 2011 – HealthInsight finalizes measures to be
reported December 2011 – First quality measure report includes state-wide reporting July 2012 – Quality measure reporting at the clinic level December 2012 – 5 new measures added and reported at state-wide level
Diabetes: Blood Sugar Screening • This measure tracks all of the diabetic individuals who have had their HbA1c screened within the measurement year.
• Who is eligible? This measure examines all members 18 to 75 years of age who have been diagnosed with diabetes (type 1 and 2). • Why is this measure important? Patients with diabetes who maintain near normal HbA1c levels can gain an average extra five years of life, eight years of sight and six years free from kidney disease.
According to data in the APCD, just over half of eligible Utahns with diabetes get their HbA1c screenings.
Diabetes: Cholesterol Screening • This measure tracks all of the diabetic individuals who have had their LDL-C screened within the measurement year. • Who is eligible? This measure examines all members 18 to 75 years of age who have been diagnosed with diabetes (type 1 and 2). • Why is this measure important? People with diabetes have a higher-than-average risk of having a heart attack or stroke. These conditions strike people with diabetes more than twice as often as people without diabetes.
According to data in the APCD, just below half of eligible Utahns with diabetes get their LDL-C screenings.
Diabetes: Kidney Function Testing • This measure tracks all of the diabetics who have had a nephropathy screening, or had evidence of nephropathy during the measurement year. • Who is eligible? This measure examines all members 18 to 75 years of age who have been diagnosed with diabetes (type 1 and 2). • Why is this measure important? Diabetes accounts for almost 45 percent of new cases of kidney failure.
According to data in the APCD, nearly one-third of eligible Utahns with diabetes receive nephropathy screenings.
Breast Cancer Screening • This measure tracks women who have received at least one mammogram in the past two measurement years. • Who is eligible? This measure includes all women 40 to 69 years of age. This measure does not include other biopsies, or other methods of imaging. • Why is this measure important? Smaller otherwise undetectable cancers if treated early result in better overall success rates.
According to data in the APCD, slightly lower than half of eligible Utah women get screened for breast cancer.
Well-Child Visits • This measure tracks the percentage of members who turned 15 months old during the measurement year and had at least 5 well-child visits. • Who is eligible? Any member that turns 15 months old during the measurement year is eligible for the measure. • Why is this measure important? These visits provide information about the growth and development of the child, as well as being a key time and place for communication between the physician and caregiver.
According to data in the APCD, half of eligible Utah children receive 5 or more well-child visits.
Summary List of HB 128 Measures for 2011 Diabetes Measures
Other Measures
HbA1c LDL-C Nephropathy Breast Cancer Well-Child Visits: Screenings 5 or More Measure Screenings Screenings Screenings 59% 46% 30% 43% 50% APCD Average State HEDIS Average
83%
73%
70%
60%
19%
Data Summary • There are a few reminders about the data when comparisons are made:
HEDIS and APCD data are from different sources • Both sets of data contain different payers • Both HEDIS and the APCD use different methods to abstract the data, and slight variations in analyzing the data •
Next Steps Once the original state aggregate data has been published, clinic
level data is next to be explored. Further analysis will be completed to better understand the differences between the APCD and other existing data resources. Clinic level analysis will begin with further validation of the existing five measures These five measures will also be supplemented with additional measures annually to provide further information about the quality of care Utah clinics are providing. OHCS will continue working with its data partners, including HealthInsight, which was instrumental in choosing the measures and providing input into the data collection.