Gobeille v. Liberty Mutual and the Colorado APCD NHPF Forum Session: Show Me the Data

Transcription

1 Gobeille v. Liberty Mutual and the Colorado APCD NHPF Forum Session: Show Me the Data Jonathan Mathieu, PhD VP for Research and Compliance February 5,

2 Who is CIVHC? Independent, non-profit, non-partisan organization Recommendation of Colorado Blue Ribbon Commission on Health Care Reform Goals: Achieve Triple Aim + 1 for Colorado Better health, better care, lower costs and Greater transparency and access to data Areas of Focus: Colorado All Payer Claims Database Payment Reform episode/bundle analytics Delivery System Redesign care transitions, palliative care, integration of physical and behavioral health

3 Colorado APCD Origins 2008: Recommendation of Colorado Blue Ribbon Commission for Health Care Reform 2010: Colorado Statute (HB ) Creates Broadly Representative APCD Advisory Committee 2011: Colorado APCD Rule Promulgated by Dep t. of Health Care Policy and Financing (HCPF) 2012: Operations and Data Collection Begin: 7 largest commercial plans and Medicaid Historical data files from 2009 through 2011 Monthly data submissions ongoing basis November 2012: Public Reporting Website LIVE!

4 Colorado APCD Key Features Mandate for Public Reporting of: Performance data on quality, health outcomes, health disparities, cost, utilization and pricing in a manner accessible for consumers, public and private purchasers, providers and policymakers Non-Public Data Release Permitted if: Consistent with the statutory purpose of the APCD, Contributes to efforts to improve public health and care delivered to Colorado residents, and Complies with the requirements of HIPAA, etc. No General Fund Appropriations Sustainability Model

5 Approach to Self-Funded Plans Self-funded Plans were not Included in the APCD Definition of Payer - Initially Administrative Rule Change in 2015: Added Self-funded Plans to Definition of Payer Self-funded Plans are Required to Submit Unless: TPA/ASO has fewer than 1,000 CO covered lives Employer has fewer than 100 CO covered lives ASOs/TPAs/Plans must Submit: Beginning with complete 2015 claims data State and Local Gov ts, School Districts, Public Utilities Employer Opt-out for ERISA plans

6 Policy Implications We Cannot Understand what is not Measured Where does variation exist, to what extent? Is the observed variation justified/appropriate? What are the causes of variation, what can be done? APCDs are a Valuable and Unique Data Source Inform debate based on a comprehensive view of utilization, spending, disease prevalence, etc. Leverage local knowledge and relationships to bring about meaningful and lasting change Need Self-funded plan data for a Complete Picture Essential for Design of Effective Policies/Reform

7 Colorado APCD Use Cases Public Reporting on Interactive Reports Map and Tabular Views Compared to Expected Values reflects risk adjustment IP, OP, ER, Professional, Ancillary, Rx and % Generic Readmissions per 1,000 population, by admission type/service line and potentially preventable Observation Stays, Illness Burden, Provider Density Prevalence/costs of Asthma, Diabetes, HTN, Depression Quality Indicators Stratified by age group and gender Geographic groupings by county, 3-digit zip and Health Statistics Regions (HSR) All Reports and Underlying Data Available for Download

8 Variation in Medicare FFS Knee Replacement Component Costs

9 Colorado APCD Use Cases Non-Public Data Release to Support Research, Public Health and Health Care Operations Highlights at Examples: Access to care/services by geographic region Cost/utilization of services, e.g., vision care, women s and reproductive health, dental ER/ED use, access to Hepatitis C treatment, HTN medication adherence Rates Analysis in commercial and exchange markets Return on Investment Analysis, e.g., Palliative care, Home delivery of prescription meals Registry Validation CIIS maintained by CDPHE

10 Total Cost of Care Lead by Network for Regional Healthcare Improvement (NRHI) Funded by the Robert Wood Johnson Foundation Phase I Participants: Colorado, Maine, Minnesota, Midwest Health Initiative, Oregon Purpose: Implement the NQF-endorsed, HealthPartners TCoC and RU measure set across multiple regions Identify drivers of regional healthcare costs and develop strategies to reduce spending at the community level Report detailed results to PCP Practice Groups and Publicly Facilitates understanding of specific opportunities to improve care and lower costs Helps to identify high-value providers

11 Final Thoughts We cannot understand what we do not measure We cannot address/fix what we don t understand APCDs: Are a powerful resource for understanding variation in utilization, spending, chronic disease prevalence, etc. Can support a wide variety of use cases and help to inform policy Have the greatest utility when comprehensive and reflect all payer types Self-funded claims data is a very important component

12 Contact Information Jonathan Mathieu, PhD, VP for Research & Compliance and Chief Economist Stay Connected! Join our list (from the or home page) Follow CIVHC on social Facebook.com/CIVHC LinkedIn (linkedin.com/company/ )