Translating Health Data into Community Change

Transcription

1 Translating Health Data into Community Change Ricky C. Brathwaite, PhD Director, Health Economics 11th Caribbean Conference on Health Financing Bonaire, 2016

2 Topics The Need for Claims Analysis Select Data Findings Using the Findings to Promote Policy Development Lessons Learned from the Process Bermuda s Health Strategy Mission is to Provide Affordable and Sustainable Healthcare For All Bermuda Residents

3 Comparing Healthcare Investment Trends Per Capita Spend (PPP Adjusted) Bermuda Per Capita Health Expenditure OECD Average Per Capita Health Expenditure $8,000 $7,000 $6,000 $5,000 $4,000 $3,000 $2,000 $1,000 $

4 Linking Healthcare to the Economy

5 Spending Wisely? Bermuda Hospitals Board Overseas Care Prescription Drugs Ministry of Health Local Practitioners Other Administration 7% 7% 7% 7% 8% 8% 9% 10% 8% 8% 9% 9% 9% 9% 9% 8% 7% 7% 7% 6% 7% 6% 11% 6% Health Determinants 17% 15% 16% 15% 13% 14% 12% 11% 13% 6% 13% 7% 16% 6% 15% 14% 13% 14% 14% 8% 7% 6% 6% 6% 10% 18% 29% Behaviors Social Circumstances Environment Genetics 41% 43% 39% 42% 43% 44% 44% 43% 18% 5% 20% Medical Care Stress Source: McGovern et al. (2014) US Spends less than 9% on Prevention

6 Obtaining Value for Money 11.5% of Bermuda s Gross Domestic Product However Healthcare is a Key Contributor to Jobs Per Capita Healthcare Spend of Over $11,000 USD

7 Future Care $ Services covered SUPPLEMENTAL BENEFITS Private Insurers (& Approved Schemes) $450 $1,700 HIP $ HOSPITALIZATION AND HOSPITAL RELATED SERVICES Standard Health Benefit $ (& Mutual Reinsurance Fund) Adapted from WHO 2010 Population covered

8 $20, $41, $32, $53, $41, $62, $72, $93, $190, $211, Public Affordability INCOME REQUIREMENT FOR AFFORDABILITY Yearly Employed Yearly Not Employed Available? Bankruptcy Risk? Pension Coverage? Tradeoffs? SHB ONLY HIP FUTURE CARE SUPPLEMENTAL MID SUPPLEMENTAL HIGH An estimated 21% of households in Bermuda earn under $3,154 per person per month or $37,848 per year Bermuda 2014: $51,012 Relative Low Income Threshold

9 Quarterly Data Submission Person ID Insurance Product Sex Age Place of Service Service Provided (e.g., CPT) Diagnosis codes Date of service Overseas facility Charges, claims and paid amounts Service dates Processing status and date Payment date Provider name and provider type

10 Understanding the General Population Claims help us better understand the cost of care by age in a rapidly changing environment

11 Priority Setting in Chronic Disease Approximately 190 dialysis patients at costs of $200,000 per patient per year Cancer is the leading cause of death in Bermuda Diabetes ranks in the top 5 of leading causes of death in Bermuda and has a 13% prevalence (OECD average 8.9%) In the U.S., people with diagnosed diabetes, on average, have medical expenditures approximately 2.3 times higher than what expenditures would be in the absence of diabetes Heart Disease can lead to strokes and other disabling complications $12,000, $10,000, $8,000, $6,000, $4,000, $2,000, $- Claims for Diagnosed Diabetes were 5 times higher than Cancer Heart Diseases and Cerebrovascular Diseases have high death rates Only 8% of the $2.4M of Cancer treatment dollars were spent on island Cancer Treatment Heart Disease Diabetes Local Overseas Mental Health Disorders rank in the top 5

12 Improving Mental Health Policy Bipolar Disorder $ Depression $65.16 Schizophrenia $ $- $50.00 $ $ $ $ $ $ $ $ $ Schizophrenia Depression Bipolar Disorder Utilized regression analysis controlling for individual patient characteristics and place of service

13 Creating Innovative Programs

14 Referrals Referrals Monitoring Testing Rates DI Test Order Rates YoY Comparison 40,000 35,000 30,000 25,000 20,000 15,000 10,000 5,000 0 General Practitioners General Surgery Orthopaedics Paediatrics Other Specialists Non- Physician No. of visits April - October ,240 1,105 3,369 6,523 9,249 2,144 No. of visits October - March ,185 1,334 3,734 6,747 10,621 3,053 Mean Order Rates - April - October Mean Order Rates - October - March LAB Test Order Rates YoY Comparison 40,000 35,000 30,000 25,000 20,000 15,000 10,000 5,000 0 General Practitioners General Surgery Orthopaedics Paediatrics Other Specialists Non- Physician No. of visits April - October ,240 1,105 3,369 6,523 9,646 2,155 No. of visits October - March ,186 1,334 3,734 6,747 10,996 3,101 Mean Order Rates - April - October Mean Order Rates - October - March

15 Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Evaluating Public Information Campaigns Initial indicator of utilization decrease (March 2015) Public Protest (4 th June 2015) 100 0

16 Promoting Clinical Guidelines OECD Comparison Range (Ages 50 69) Decreased rate for early 40 s women Mammograms provided over the age of 70 (Limited evidence of benefit

17 $17, $20, $14, $19, $29, $30, $15, $20, $60, $50, $18, $24, $13, $9, $8, $6, $143, $61, $20, $3, $2, $81, $27, $4, $3, $191, $391, $410, $760, $1,097, $1,013, $1,148, Reducing Costs MAMMOGRAPHY EXPENDITURES Est G G G

18 More Analysis, More Requests Compared costs between local providers and overseas providers Defined current services provided in continuum of care for cancer patients by location and provider Analyzed the types of pediatric services being delivered Began assessment of the impact of road traffic accidents Calculated the incidence of diabetes related blindness Approximated insurer loss ratios to prepare for policy discussions Described claims experience profile of the most vulnerable and economically challenged Determined average claims processing time to ensure compliance with legislation Used data to evaluate corporate wellness program Set fees for basic health benefits using the Relative Value Units methodology Complete annual national health accounts

19 Lessons Learned Good Data requires buy-in from all stakeholders Claims data does not answer the Why? question Local data helps in easing local change Timely claims data requires effective relationships with insurers or other claims processors

20 Health Financing Reform

21 Streamline Financing and Encourage Innovation and Research

22 Data Driven Stakeholder Collaboration

23 Data Driven Objectives for FY2017 Create a low cost adequate benefit product Create more competition through price and quality regulation Assess impact of financially vested referrals Determine system capacity for health technologies and conduct health technology reviews Establish the infrastructure to share data and best practices with other jurisdictions

24 Thank You