NH ACCOUNTABLE CARE LEARNING NETWORK: ANALYTIC REPORT USER GUIDE June 2018

Transcription

1 NH ACCOUNTABLE CARE LEARNING NETWORK: ANALYTIC REPORT USER GUIDE June 2018 Contents OVERVIEW... 2 Introduction... 2 User Guide Purpose... 2 REPORT ASSUMPTIONS & DEFINITIONS... 3 Data Sources:... 4 USING THE ANALYTIC REPORT... 6 Report Access... 6 Report Access Levels... 7 Launch Page: Payer Type Selection... 8 Control Center: Report Selection... 9 Report Structure Report Measures Cost Measures Table of Cost Measure Reports Utilization Measures Table of Utilization Measure Reports Quality Measures Table of Quality Measure Reports Tips & Shortcuts RELATED DOCUMENTS RELEASE NOTES... 21

2 2 OVERVIEW Introduction The NH Citizens Health Initiative and the Center for Health Analytics at the Institute for Health Policy and Practice, in collaboration with the Accountable Care Learning Network (ACLN) participant organizations, have developed and published a set of analytic reports to compare performance on measures of quality, utilization and cost across health systems and regions. This work was initially funded with support from the Robert Wood Johnson Foundation. The ACLN reporting includes two report types: The claims-based reports, based on data from the NH Comprehensive Health Information System (NH CHIS), have both site-level access for participating organizations and a public-level access for all interested stakeholders. The report suite includes data for Commercial, Medicaid, and Medicare populations. The Electronic Health Record (EHR) quality report is based on self-reported data from participating organizations. The aggregated median rates report provides a benchmark for comparison around key quality measures. Access to the EHR reporting tool is limited to participating partners. The goal of these reports is to provide analysis for the participants in the Accountable Care Learning Network, and the public, to understand the cost, utilization, and outcome patterns within their populations, as well as in the context of regional and statewide populations. User Guide Purpose The purpose of this guide is to provide an overview of the claims-based ACLN Analytic Report suite, including instructions for access and use, as well as descriptions of the analyses included in the suite. It is intended for use by the ACLN participant organizations as described in the following section, and by the public.

3 3 REPORT ASSUMPTIONS & DEFINITIONS Details for the attribution methodology and data can be found in the New Hampshire Accountable Care Learning Network: Analytic Reporting Methodology. Key aspects of the methodology are highlighted here. Member Selection Criteria for Analysis: Data Sources Age Coverage Commercial Age < 65 Includes members with policies that originate in NH; members can reside in NH or other states. Medicaid* Age < 65 Members covered by NH Medicaid. Medicare* All ages Members who reside in NH at the end of a reporting period. Only members with parts A&B coverage, not participating in an HMO, and without any state Medicaid support. * Medicaid and Medicare data is limited to only members in NH at the time of data request. During a given 12 month measurement period (e.g. current period), a member is included in the analysis if the member was active for at least 9 months of the given 12 month measurement period (does not apply to members less than one year old). Attribution: Attribution is used to define a population of members who receive care in a participant organization, or of a certain type. The analytic report suite includes two categories of attribution: primary care providers (PCPs) and behavioral health providers (BHs). Reporting based on PCP attribution provides an understanding of the health status, cost, and utilization profile of the population that has a primary care relationship. The BH attributed reports provides an understanding of the health status, cost, and utilization profile of the population of members who have an attributed behavioral health provider. These two categories are not mutually exclusive; members can be included in both PCP and BH report suites. For Accountable Care Learning Network organizations, the organization provides a list of providers that are associated with the organization, and claims are reviewed to attribute members who receive care with those providers to the organization. ACLN participant organization reports reflect the claims experience for the members attributed to that organization, based on the attribution of the members to the organization s list of providers. BH: Behavioral Health see Analytic and Attribution Methodology for list of taxonomies defined as BH. PCP: Primary Care Provider see Analytic and Attribution Methodology for list of taxonomies defined as PCP. PMPM: Per Member, Per Month is a measure of cost. This is the total yearly medical costs associated with the population divided by the number of members, then divided by 12 months. MM: Member Months each member month is defined as 1 member enrolled during 1 month. For example, an individual who is part of a plan for a full year will generate 12 member months and a family of 4 enrolled for a period of 6 months will generate 24 member months.

4 4 Rate per 1,000: total number of encounters/total member months annualized, per 1,000. ACP: Accountable Care Learning Network The ACLN total population sums all the members attributed to the providers, PCP or BH, identified by all organizations participating in the NH Accountable Care Learning Network. Non-ACP: Non-ACLN members are those members who are attributed to a provider, PCP or BH, but whose provider was not identified by an organization participating in the NH Accountable Care Learning Network. Not Attributed: Members who did not attribute to a PCP or BH provider based on the attribution methodology. For additional information on the attribution methodology and data, please see the New Hampshire Accountable Care Learning Network: Analytic Reporting Methodology. Data Sources: Data for these reports is from the New Hampshire Comprehensive Healthcare Information System (NH CHIS), New Hampshire s All-Payer Claims Database. With UNH IRB approval, IHPP analyzed data from a NH CHIS Limited Use Data set provided by the NH Department of Health and Human Services. Medicare and Medicaid data are also made available with agreements with the NH Department of Health and Human Services. Commercial: The report suite is limited to the top eight Commercial insurers: Aetna, Anthem, Cigna, Harvard Pilgrim Health Care, Tufts Insurance Company, Health Plans, Inc., Matthew Thornton Health Plans, and United Healthcare Services. These carriers generally include more than 90% of the commercial claims in NHCHIS. The reports are based on the top insurers to limit data quality issues that may not have been addressed during the data collection process. NOTE: In March 2016, the Supreme Court ruled that Liberty Mutual, as a self-insured employer, can choose not to submit their health claims data to Vermont's all-payer claims database. This decision resulted in many commercial carriers opting not to submit the self-insured business to the NH CHIS. Therefore, please use caution in interpreting analysis/measures derived from data after March 2016, because there are fewer employer plans submitting data after March Medicaid: The report suite data is limited to those covered by Medicaid Managed Care; Medicaid fee-for-service services for these members are excluded from analysis. Medicare: The report suite includes members with both Part A and Part B coverage. This ensures that the analysis is based on members for which complete data is available. Members who have only partial coverage (only Part A or only Part B) and those who are dually eligible for Medicare and Medicaid are excluded from analysis. Medicare Advantage is not included. Data Suppression: As of the June 2018 release of the Report Suite, all member count measures are removed in order to remain in compliance with the Centers for Medicare & Medicaid Services (CMS) data use agreement policies.

5 5 Additional suppression of measures for member counts between 1 and 10 (1 and 20 for a rate) complies with data use agreements and accounts for volatility of the data given the small sample size.

6 6 USING THE ANALYTIC REPORT Report Access The NH Accountable Care Learning Network Report Suite can be accessed at using the ACCESS CLAIMS REPORTS button (see below).

7 7 Report Access Levels There are two levels of access to the NH Accountable Care Learning Network Reports: one for public use and one for NH ACLN participant organizations. Each NH ACLN participating organization has determined a single primary user account holder and has been assigned an Organization ID and Organization Key. Each organization will use their organization-specific log-in ID and key to access the site-level reports. All participating organizations have the same level of access and are able to view data for all participating sites (as described in the terms of the Accountable Care Learning Network Sponsorship Agreement). ACLN participant sites have access to both the public and ACLN participant site versions of the analytic reports. The table below explains which the access levels are available by user type. Report Access Level Accessible to Public Accessible to ACLN Participating Sites NH State Non-ACLN 1 for PCP/BH attributed members X X NH ACLN Total 2 for PCP/BH attributed members X X NH State PCP/BH not-attributed 3 members X X NH ACLN by Organization/Site for PCP/BH attributed members X 1 Non-ACLN members are those members who are attributed to a provider, PCP or BH, but whose provider was not identified as an organization participating in the NH Accountable Care Learning Network. 2 The ACLN Total Population sums all the members attributed to the providers, PCP or BH, identified by all organizations participating in the NH Accountable Care Learning Network. 3 The PCP and BH Not-Attributed population includes members who did not attribute to a PCP or BH provider based on the attribution methodology, New Hampshire Accountable Care Learning Network: Analytic Reporting Methodology.

8 8 Launch Page: Payer Type Selection All reports are based on medical claims. The report names indicate the claims (medical) and payer type (commercial, Medicaid, or Medicare); there are three reports within the ACLN report tool: ACP-MED-COM (Accountable Care Learning Network Medical Commercial) ACP-MED-MCD (Accountable Care Learning Network Medical Medicaid) ACP-MED-MCR (Accountable Care Learning Network Medical Medicare)

9 9 Control Center: Report Selection Once payer type is selected, users can select the access level and attribution type via the Control Center options. Default report settings are for Public users to view PCP-attributed reports. ACLN participating organizations must enter *MASTER* in the Organization ID field and the Organization Key which will be ed to the data contact in each partner organization. Once entered, *MASTER* will be available as an option in the Select Suite View dropdown list. Selecting *MASTER* will open access to sitelevel reports. Note: Please Clear Filter if you do not see *MASTER* from the Select Suite View after entering Organization ID and Organization Key. Users may select PCP or BH attribution in the Select Attribution View drop-down.

10 10 Report Structure A. The Report Type displayed on the top left corner will indicate which report is currently open. B. Each report suite contains multiple sections (or tabs) displaying two different views of each measure: 1) Population view, which displays the measure data table and graph for a single population 2) Comparison view, which allows users to visualize three side-by-side populations C. Under each section (or tab) users may select: 1) The Organization. Public users may select: ACP, non-acp, not attributed. ACLN users may also select from list of current ACLN organizations. 2) Group (For ACLN organization users only): ACLN users may select specific sites based on ACLN organization selection in previous section 3) Measurement period: Users may select the current or previous measurement period. 4) Note: when no selections are made the default is to display all selection. In other words, if no measurement period is selected all periods are displayed. D. Please note that in both the Population view and in the Comparison view, each chart s scale changes dynamically based on the values of the report; i.e. the three populations in the Comparison view may have three different ranges in the vertical (y) axis. E. Hover over any bar in the chart to display the actual value. A B C D E

11 Report Measures Cost Measures The Medical Cost (allowed) indicates the amount paid by both the payer (e.g. Medicaid, Medicare, Commercial carrier) and the patient (e.g., coinsurance, copays, and/or deductibles). This provides a holistic view of a population s medical cost. Medical cost reporting does not include pharmacy costs. Notes: OPTUMInsight s Symmetry Episode Treatment Groups (ETGs ) was used to identify the following nine representative chronic conditions in the report: Diabetes, Chronic Obstructive Pulmonary Disease (COPD), Heart Failure (HF), Ischemic Vascular Disease (IVD), Asthma, Hypertension, Mood Disorder Depression, Mood Disorder Bipolar, and Anxiety Disorder/Phobia). Please see OPTUMInsight for additional information on ETGs. The OptumInsight Episode Risk Groups (ERGs ) is used to report risk scores risk-adjusted costs. The ERG model was developed primarily for the Commercial population and has not been extensively used in the 65 and older age group. The ACLN reports apply the risk adjustment for all payer types. Table of Cost Measure Reports Report Title Overview by Geography Report Description The Overview by Geography section reports the total medical cost (allowed) and the PMPM cost for members living within the selected Integrated Delivery Network (IDN). The member geographic region is based on the member s zip code in the claims data. Notes: The majority of members who are included in the data reside in New Hampshire; however, a small percentage of the population resides outside of New Hampshire. Overview by Payer NHCHIS data includes members whose policies are issued in New Hampshire and therefore may include members who reside outside of the state. For example, members residing in a different state but who have coverage with a policy from a New Hampshire-based employer would be included in the analysis. The Overview by Payer section reports the total medical cost (allowed) and the PMPM cost for the top eight Commercial payers in New Hampshire, based on size of market share, are reported in the Commercial report suites.

12 12 Overview by Month Overview by Age & Gender The Overview by Month section reports any fluctuations by month, which may be due to seasonality. Monthly reports also allow the user to check for major unexpected variations month-to-month. The Per Member Per Month (PMPM) costs are also reported. The Overview by Age & Gender section reports total medical cost (allowed), the PMPM cost and the risk scores by major demographic groups. Risk scores are calculated for each age and gender group. Risk adjustment accounts for the differences in a population s risk. Two types of risk are shown. Risk scores are based on the age and gender mix of the population (Demographic or Demo risk) and the disease profile of the population (Retrospective or Retro risk). Risk adjustment allows for meaningful comparisons to be made between regions and practices by accounting for differences in the risk profile of patients. The reference risk score is Risk scores greater than indicates higher risk and risk scores less than indicate lower risk. Notes: The Medicare population in the age group may be underrepresented due to the nine-month continuous enrollment requirement. That is, some newly enrolled Medicare beneficiaries may not have coverage for the full 9-month eligibility period. Cost by Chronic Indication Level Cost by Chronic Condition/ Comorbidity Status The PMPM presented in the bar chart is representative of the overall age category (subtotal of male and female). PMPM for age category by gender is broken out in the data table. The Cost by Chronic Indication Level section reports total medical cost (allowed) and the PMPM cost for members with one or more chronic condition. Costs are reported for all members, members with one or more chronic condition(s), with no chronic condition, 1 chronic condition, and with 2 or more chronic conditions. The Cost by Chronic Condition/Comorbidity Status section reports the total medical cost and the PMPM cost associated with members who have one or more chronic conditions. The measure does not represent only those medical costs for that specific chronic condition(s), but all medical costs for the population with that condition. Note: The PMPM presented in the bar chart is representative of all members for the reported chronic condition. PMPMs for the subpopulations of members with and without comorbidities are reported in the data table, but not in the bar chart.

13 13 Overview by MPC The Overview by MPC section reports on volume and cost for each Major Practice Category (MPC) which represents a body system and/or a particular physician specialty. Each Episode Treatment Group (ETG) corresponds to one MPC. There are 22 total MPCs in OPTUMInsight s Symmetry Episode Treatment Groups. The report includes the number of members with claims in each of the MPCs and the medical costs associated with each MPC. The PMPM calculations are as follows: PMPM condition costs for members with condition = Costs for condition/member months for members with condition PMPM condition costs for total population = Costs for condition/member months for total population (all eligible) PMPM all costs for members with condition = Total cost for members with condition/member months for members with condition Overview by ETG Note: The categories displayed for each population selected in the Overview by MPC Comparison view is dynamic. The displayed categories are based on the top 10 PMPM condition costs for members with condition for the selected population and the displayed categories may vary for each population selected. The Overview by ETG section reports the top Episode Treatment Groups (ETGs). The measure includes the number of members and the costs associated with each ETG. The PMPM calculations are similar to the MPC calculations described above. TCRRV Note: The categories displayed for each population selected in the Overview by ETG Comparison view is dynamic. The displayed categories are based on the top 10 PMPM condition costs for members with condition for the selected population and the displayed categories may vary for each population selected. The TCRRV section reports the total medical health care costs for a selected population. The measure includes the number of member months included in the selected period, the PMPM in the selected period, the Total Care Relative Resource Values (TCRRV) PMPM for the selected period. Calculations and definitions for this report include: TCRRV assess the frequency and intensity of use of services across the medical care continuum. Total Cost Index = (PMPM Medical Cost)/(PMPM Total Medical Cost) Resource Use Index = (PMPM TCRRV Cost)/(PMPM Total TCRRV Cost) Price Index = (Total Cost Index)/(Resource Use Index)

14 14 Note: For each member in the population, a risk score is calculated, using a claims-based risk adjustment grouper. A member's risk score is multiplied by the member's member months to create a member's total risk score.

15 15 Utilization Measures Costs include medical costs only (i.e., not pharmacy claims). Type of service assignments were based on AMA CPT code categories. Table of Utilization Measure Reports Report Title Report Description Medical Type (High Level) The Medical Type (High Level) section reports the distribution and total medical cost (allowed), the PMPM cost and the risk adjusted PMPM cost in specific service categories; duplicate claims have been compressed to a single claim record based on the member on a date of service. Medical Type (Low Level) Facility Inpatient Costs for facility use associated with inpatient stay Facility Outpatient Costs for facility use associated with outpatient visit Professional Costs for personnel services associated with a visit (i.e. physician, psychologist, lab technician anyone with professional designation) Ancillary Other costs associated with visit (i.e., supplies, drugs administered) The Medical Type (Low Level) section reports the total medical cost (allowed), the PMPM cost and rate of interactions with the system for the service type indicated; duplicate claims have been compressed to a single claim record based on the member on a date of service. Medical Service Type (Low Level) categories: Drugs Administered Drug costs are for drugs administered as part of medical claims, not pharmacy claims Emergency Both facility & professional costs in emergency room setting Evaluation & Management Consultation for new or established patients with the following key elements of service: history, examination and medical decision making Laboratory Clinical diagnostic laboratory tests including blood tests, urinalysis, etc. Medical Other professional medical diagnostic, therapeutic and preventative services Mental Health/Substance Abuse Cost and utilization for mental health or substance abuse services. NOTE: Mental health claims are known to be under-reported, so the data for the analysis are likely incomplete Radiology Both diagnostic and therapeutic services Surgical Inpatient/outpatient surgical services including major and minor procedures Facility Inpatient Costs for facility use associated with inpatient stay

16 16 Medical Interaction Level The Medical Interaction Level section reports the total medical cost (allowed), the PMPM cost and the rate per 1,000 members utilization categorized by the following visit types: Primary Care, Specialist, Inpatient, and Emergency Department. To select the visit type, click on the visit type in the button bar located at the top of the report. Medical Provider Type The Medical Provider Type section reports the total medical cost (allowed), the PMPM cost and the rate per 1,000 member s utilization for Office visits for the following service categories: Primary Care Other Professional Medical Specialty Facility Surgical Specialty ED Visits by ETG Note: The encounters will not capture the costs for the surgical event but any office visits associated with a surgical event. The ED Visits by ETG section reports emergency department utilization rates by ambulatory care-sensitive ETG. The section reports the % of member months by ETG, % of ED visits with the condition, counts by condition, and rates of ED visits for members with the condition and total members. To select the ambulatory care-sensitive condition flag type (Yes or No), click on the Y or N in the button bar located at the top of the report.

17 17 INP Stays by ETG The INP Stays by ETG section reports inpatient utilization rates by ETG. The section reports the % of member months with inpatient stays for a specific ETG, % of inpatient stays with the condition, counts by condition, and rates of inpatient stays for members with the condition and total members. To select the ambulatory care-sensitive condition flag type (Yes or No), click on the Y or N in the button bar located at the top of the report.

18 18 Quality Measures Quality Measures are reported as a percent of eligible population. The numerator is the number of members who received the service and the denominator is the number of members who are eligible for the service. Table of Quality Measure Reports Report Title Report Description Overview by Preventive Care The Overview by Preventive Care section reports the rate of the following 6 preventive care visits: Well-child visits for children 2 years and younger Breast cancer screening for females age years Cervical cancer screening for females age years Colorectal cancer screening (colonoscopy, fecal occult blood stool, or flexible sigmoidoscopy) for females and males aged years Imaging for Lower Back Pain for females and males aged 19-50

19 Tips & Shortcuts If using Internet Explorer, the F11 key expands the browser window to full screen. The report name is indicated at the top left corner of the screen. To view a different report, select Open under File or the File Open icon and then select the desired report. The hide banner button on the top right corner conceals the banner to increase the report viewing area. The help tab directs you to the SAS website and tutorials on how to use SAS Visual Analytics.

20 20 To open a different report, please close the current report from either the report name at the top left corner or using the option under the File menu. To go to the ACLN Analytic Reports home page, click on the Home icon at the top left corner. The export functionality of the report is still in development and is not fully functional, but can be found on the Print (preproduction) button. The columns in tables and axes in charts can be sorted. Right-click on the column or measure of interest and select Sort > Ascending or Sort > Descending

21 RELATED DOCUMENTS New Hampshire Accountable Care Learning Network: Analytic Reporting Methodology RELEASE NOTES Version Release Date Reports Included Notes June PUB_COM_PCP PUB_COM_BH ORG_COM_PCP ORG_COM_BH 2014 September PUB_MCD_PCP PUB_MCD_BH ORG_MCD_PCP ORG_MCD_BH 2015 April PUB_MCR_PCP PUB_MCR_BH ORG_MCR_PCP ORG_MCR_BH 2015 July PUB_COM_PCP PUB_COM_BH ORG_COM_PCP ORG_COM_BH PUB_MCD_PCP PUB_MCD_BH ORG_MCD_PCP ORG_MCD_BH PUB_MCR_PCP PUB_MCR_BH ORG_MCR_PCP ORG_MCR_BH 2015 November PUB_COM_PCP PUB_COM_BH ORG_COM_PCP ORG_COM_BH PUB_MCD_PCP PUB_MCD_BH ORG_MCD_PCP ORG_MCD_BH PUB_MCR_PCP PUB_MCR_BH ORG_MCR_PCP ORG_MCR_BH 2016 May PUB_COM_PCP PUB_COM_BH ORG_COM_PCP Includes measurement periods CY2010 CY2011 Attribution list provided 2012 Includes measurement periods 10/2010 9/2012 Attribution list provided 2012 Includes measurement periods CY2011 CY2012 Attribution list provided 2012 Includes measurement periods CY2012 CY2013 Attribution list provided 2014 Includes measurement periods 10/2010 9/2012 Attribution list provided 2014 Includes measurement periods CY2012 CY2013 Attribution list provided 2014 Includes measurement periods CY2012 CY2013 Attribution list provided 2014 New reports added: Overview by Preventive Care, Overview by MPC and Overview by ETG Includes measurement periods 10/2010 9/2012 Attribution list provided 2014 New reports added: Overview by Preventive Care, Overview by MPC and Overview by ETG Includes measurement periods CY2012 CY2013 Attribution list provided 2014 New reports added: Overview by Preventive Care, Overview by MPC and Overview by ETG Includes measurement periods CY2013 CY2014 Attribution list provided 2016 Table of Contents page added

22 22 ORG_COM_BH PUB_MCR_PCP PUB_MCR_BH ORG_MCR_PCP ORG_MCR_BH 2016 September PUB_COM_PCP PUB_COM_BH ORG_COM_PCP ORG_COM_BH PUB_MCR_PCP PUB_MCR_BH ORG_MCR_PCP ORG_MCR_BH Additional organizations added to ORG reports PUB_COM_BH reports now provide ACP and non-acp totals Includes measurement periods CY2013 CY2014 Attribution list provided 2016 Table of Contents page added Additional organizations added to ORG reports PUB_MCR_BH reports now provide ACP and non-acp totals Attribution list provided 2016 updates for additional organization identifiers Attribution list provided 2016 updates for additional organization identifiers March All Reports Control Center added ACP-MED-COM Includes measurement periods 7/2013 6/2015 ACP-MED-MCD Includes measurement period 7/2014 6/2015 Reports are limited to Medicaid Managed Care members; excludes Fee-For-Service population. ACP-MED-MCR Includes measurement periods 7/2013 6/ July ACP-MED-COM All member counts suppressed Public Health Region changed to Geography ACP-MED-MCD All member counts suppressed Public Health Region changed to Geography ACP-MED-MCR All member counts suppressed Public Health Region changed to Geography June ACP-MED-COM Includes measurement period 1/ /2016 ACP-MED-MCR Includes measurement period 1/2015 6/2016 ACP-MED-MCD Includes measurement period 1/ /2016