Utah Partnership for Value: Update on Total Cost of Care Reports in Utah

Transcription

1 Utah Partnership for Value: Update on Total Cost of Care Reports in Utah June 18 th, 2018 HealthInsight Utah and Utah Department of Health Office of Healthcare Statistics

2 Zoom Instructions Audio/mute Please use audio by phone or computer, not both You will start muted and will need to unmute to speak Chat is welcome You are welcome to use your camera This session will be recorded

3 Getting to Know Zoom Video on / off Chat please enter name and organization when you join meeting Mute / Unmute (*6 on phone)

4 Sarah Woolsey, Medical Director, HealthInsight Your Presenters Rita Hanover, Senior Analyst, HealthInsight Brantley Scott, Data Quality Project Manager Office of Health Care Statistics, Technical Advisor National TCoC Project

5 Objectives Understand the National Total Cost of Care Measure (TCoC) and project significance Understand Utah s 2015 TCoC Reports Understand potential value of TCoC reports for Utah practices Discuss the opportunity of public reporting of cost and quality

6 In order to ascertain the effectiveness of the current health care system, we need more transparent information around costs and their drivers. Once we know that, people, providers, and purchasers can begin to make truly informed decisions that enable better care and lower cost. Elizabeth Mitchell, recent past President and CEO of the Network for Regional Healthcare Improvement (NRHI) The Concept: Why Total Cost of Care?

7 Exponential Growth

8 Cumulative Increases in Health Insurance Premiums, Workers Contributions to Premiums, Inflation and Workers Earnings ( ) 300% 250% Health Insurance Premiums Workers' Contribution to Premiums Workers' Earnings Overall Inflation 242% 200% 167% 213% 150% 160% 100% 50% 0% 98% 92% 60% 45% 24% 35% 44% 21% SOURCE: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, Bureau of Labor Statistics, Consumer Price Index, U.S. City Average of Annual Inflation (April to April), ; Bureau of Labor Statistics, Seasonally Adjusted Data from the Current Employment Statistics Survey, (April to April).

9 Factors Accounting for Growth in Personal Health Care Expenditures, Selected Calendar Years ( ) Micah Hartman, et al. National Health Care Spending In 2016: Spending And Enrollment Growth Slow After Initial Coverage Expansions. Health Affairs 37(1):

10 Where to Start?

11 Our Project

12 Utah and Total Cost of Care 2016-Spring 2017 Funded by Robert Wood Johnson Foundation(RWJF) and Network for Regional Health Improvement (NRHI) Collaboration organizations in CO, MD, ME, MN, MO and OR Utah produced 123 clinical reports using 2014 data and disseminated to primary care practices for review Spring 2017-present Two National Total Cost of Care Benchmark Reports on five states published Utah produced and disseminated 92 clinical reports using 2015 data

13 Importance of Utah Physician Engagement for Total Cost of Care Impact Physician leadership and engagement is essential to addressing health care costs Physicians control or influence most utilization decisions As accountability for cost and health outcomes grows, physicians are best positioned to responsibly manage costs aligned with patient values Without actionable data it is unreasonable to expect physicians to change current practices

14 Total Cost of Care Measure Components

15 About the TCoC Measure Total per capita costs (or resources used) for a panel of patients attributed to a primary care clinic Includes all care delivered to all attributed patients Professional, Outpatient, Inpatient and Pharmacy Includes all allowed amounts All payments made by the patient and the insurer Risk-adjusted to account for the illness burden of each provider s patients Based on diagnoses, age and gender using Johns Hopkins Adjusted Clinical Groups (ACG) risk adjusters Based on the patented algorithm of HealthPartners, Inc. (Bloomington, MN) Measures have been in use for over 10 years and adopted nationally; there are over 90 licensees in 29 states

16 Health Partners TCoC Overview Resource Use Price Total Cost Measures the frequency and intensity of services used Affected by fee schedules, referral patterns, place of service Overall cost effectiveness of managing patient health Designed to highlight cost-saving opportunities and to identify potential instances of overuse or inefficiency in health care delivery

17 Exclusions Those with less than 9 months of medical eligibility Student, capitated, and any non fully insured plan Dental claims Patients under the age of one or over the age of 65 Costs over $100k per patient Medicaid, Medicare data

18 Attribution Process 1. Patient attributed to a primary care provider (PCP) E&M visits: - Total visits - Most recent 2. Providers are attributed to PCP groups HealthInsight/OHCS Master Provider List

19 Master Provider List Elements used to facilitate provider-to-group attribution: National Provider ID (NPI) SK&A National Plan and Provider Enumeration System (NPPES) List provided by clinics List provided by plans Verification by phone

20 National View of Total Cost of Care

21 Use of the TCoC Measure: National Progress Geography Oregon Colorado St. Louis Minnesota Maine Utah Maryland Massachusetts Ohio Houston Washington Wisconsin Coming on line 2018: Michigan, Nevada, Greater Detroit, New Mexico, Philadelphia, California, Virginia Active TCoC Reporting Sites Development Sites

22 Network for Regional Health Improvement National Benchmark Reports From Claims to Clarity: Deriving Actionable Healthcare Cost Benchmarks from Aggregated Commercial Claims Data (2017) Healthcare Affordability: Untangling Cost Drivers (2018)

23 Healthcare Affordability: Untangling Cost Drivers (2018) Untangling Cost Drivers

24

25 2015 Total Cost of Care Report Overview for Utah

26 Utah 2015 Report Data Contribution 2.5 million commercial insured members; over 15,000 inpatient claims, 300,000 outpatient claims, 2 million professional claims Select Health Cigna U of U DMBA UHC Regence Aetna Altius APCD contributors: 20 product lines Quality Assurance Process: Data validation included stability, consistency, evaluation of distributions by type of service, orphan claims, standardized MS- DRGs, evaluation of diagnosis code fields 92 Primary Care Practices (58 Adult and 34 Pediatric Reports) 351,083 eligible members; 228,401 attributed to a PCP; 191,750 patients attributed to a PCP with >50 members

27 Initial Learning from Two Years of Utah TCoC Reports Improved completion of APCD claims submissions Improved attribution to clinics High correlations between 2014 and 2015 indices at the clinic level Risk Scores (r = 0.86) $PMPM (r = 0.83)

28 Year Over Year Changes % Change Patient Panel Avg Age %Male %Female Inpatient Adm/ ER Visit/ Risk Adj. IP PMPM $71.54* $ Risk Adj. OP PMPM $ $ Risk Adj. Prof PMPM $ $ Risk Adj. Rx PMPM $96.00 $ Risk Adj. Overall PMPM $ $ Total members eligible 635, , Total attributed 212, , *Denotes corrected value

29 Discussion/Questions

30 2015 TCoC Report Review

31 Example Report

32 Example Report

33 Example Report

34 Example Report

35 More Information Pages 4-6 How to Use this Report Important Definitions Additional Information (aggregate of data sources)

36 Limitations of This Report Incomplete representation of payers Extensive quality assurance impacted claims used No care quality component Planned going forward 2015 claims data represented Data lag unavoidable Commercial claims only this year, no Medicare and Medicaid representation NQF measure only designed for commercial claims, but being adapted

37 Discussion/Questions

38 Using the Report Where are there themes if you see outlier metrics? Is there a category to address? Is there a setting of care to address? Is there a transition to address? How does this compare to other reports from payers? CMS reports?

39 Competencies for Success in Emerging Environment echnology and Analytics HIT and analytics for population care and care coordination Infrastructure to monitor, manage, and report quality and cost Track, receive, distribute payments and savings Management Governance and leadership with culture of teamwork and improvement Ability to manage financial risk, contract negotiation; assess options Provider relationships management Processes (clinical and business) Expertise in engaging and activating patients Patient education tools Experience in process redesign and quality improvement and effectively connecting to community resources Infrastructure, protocols and agreement for collaborative care

40 Why is Cost Transparency Important?

41 Community Level Minnesota Community Measurement has published cost data since Report includes Total Cost of Care Able to track statewide cost of care trends Looks at drivers of cost in the state and variation Publishes lists of clinics and their position to the state average for PMPM and Total Cost Index Focus on ER utilization as a driver of TCoC

42 MNCM Total Cost Report

43 ER Utilization Highest correlation to TCoC in MN

44 ER Utilization Case Study: Ortonville, MN Ortonville Area Health Services, 20 bed critical access hospital and the attached Northside Medical Clinic Six physicians, four mid-level providers One EMR for clinic and hospital with remote access Systems to maintain low ER use ER appropriate-use fliers distributed in clinic Posters on doors to ER Openings for same-day appointments at office On-call physician sees patients both in clinic and ER (no scheduled appointments) Saturday 8:30 a.m. noon clinic for urgent care One telephone number for the organization: business hours/nurses station

45 Next Steps Production of 2016 TCoC reports (Summer 2018) Review of private TCoC report (late Summer 2018) Community-wide review of quality measures and potential composite result (late Summer 2018) Community-wide discussion on public reporting of TCoC/Quality Composite Reports (Fall 2018)

46 Quality Component Development Important to a true value report Current All Payer Claims Data is potential source data available Measures for Adults: Comprehensive Diabetes Care: Hemoglobin A1c (HbA1c) Testing, Breast Cancer Screening, Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis, Lower Back Pain and Medication (75%) for clinics with five or more physicians. Measures for Pediatrics: Management for People with Asthma ( 5 years and up)

47 Mock Template for Public Reporting

48 Discussion/Questions

49 Thank You Rita Hanover, Senior Analyst HealthInsight Brantley Scott, Data Quality Project Manager Office of Health Care Statistics Utah Department of Health, Technical Advisor to National TCoC Project Sarah Woolsey, Medical Director HealthInsight

50 How to Use This Report 1. Consider places where your clinic s Total Cost Index (TCI), Price Index and Resource Use Index (RUI) differ from the state average (1.0). 2. Look for places where your clinic report has a substantially higher Price Index than RUI 3. Look for places where your clinic report has a substantially higher RUI than Price Index 4. Based on the CMS QRUR report or other payer reports, are there service areas where you see higher cost consistently?

51 How to Use This Report (cont d) 5. Look at emergency department use and inpatient admission index. If your retrospective clinic risk score is low but use of these facilities is higher than average, consider ways to minimize non-indicated use of these facilities 6. If you are looking at reports for different facilities within the same physician group, where do you see variation? What might be the causes of variation?