Health Data Transparency: Utah’s All Payer Claims Database
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The document outlines the mission and strategic priorities of the Utah Department of Health, emphasizing the establishment of the Utah All Payer Claims Database (APCD) to enhance healthcare data transparency and improve Medicaid services. It provides a timeline of the APCD's implementation phases from 2008 to 2023 and highlights key achievements in data quality and analytic capacity. Future plans include expanding public access to cost data and improving overall healthcare service quality.
Health Data Transparency: Utah’s All Payer Claims Database
- 1. HEALTHIEST PEOPLE | OPTIMIZE MEDICAID | A GREAT ORGANIZATION Health Data Transparency: Utah’s All Payer Claims Database Norm Thurston & Sterling Petersen Office of Health Care Statistics, UDOH June 19, 2019
- 2. HEALTHIEST PEOPLE | OPTIMIZE MEDICAID | A GREAT ORGANIZATION Utah’s All Payer Claims Database HEALTHIEST PEOPLE | OPTIMIZE MEDICAID | A GREAT ORGANIZATION The Utah Department of Health’s mission is to protect the public’s health through preventing avoidable illness, injury, disability, and premature death; assuring access to affordable, quality health care; and promoting healthy lifestyles. MISSION & VISION Our vision is for Utah to be a place where all people can enjoy the best health possible, where all can live and thrive in healthy and safe communities.
- 3. HEALTHIEST PEOPLE | OPTIMIZE MEDICAID | A GREAT ORGANIZATION Utah’s All Payer Claims Database HEALTHIEST PEOPLE | OPTIMIZE MEDICAID | A GREAT ORGANIZATION STRATEGIC PRIORITIES Healthiest People – The people of Utah will be among the healthiest in the country. Optimize Medicaid – Utah Medicaid will be a respected innovator in employing health care delivery and payment reforms that improve the health of Medicaid members and keep expenditure growth at a sustainable level. A Great Organization – The UDOH will be recognized as a leader in government and public health for its excellent performance. The organization will continue to grow its ability to attract, retain, and value the best professionals and public servants.
- 4. HEALTHIEST PEOPLE | OPTIMIZE MEDICAID | A GREAT ORGANIZATION Utah’s All Payer Claims DatabaseUtah’s All Payer Claims Database The Office of Health Care Statistics collects, analyzes, and disseminates healthcare data related to cost and quality HEALTHIEST PEOPLE | OPTIMIZE MEDICAID | A GREAT ORGANIZATION The Utah Health Data Committee oversees policy and implementation of the APCD. 15 members represent payers, providers, public health, patients, and businesses. Subcommittees pull in dozens of stakeholders to give input on transparency, data standards, data use and release, and process improvement. Today – • Brief overview of the history and progress in establishing the Utah All Payer Claims Database • Implementation plans for 2019 legislation
- 5. HEALTHIEST PEOPLE | OPTIMIZE MEDICAID | A GREAT ORGANIZATION Utah’s All Payer Claims Database Utah APCD Timeline Phase 1 2008-2012 Spectre Enterprises/CareAdvantage Phase 2 2013-2018 Treo Solutions/3M HIS Phase 3 2018-2023 Milliman MedInsight 2007 2008 2012 2018
- 6. HEALTHIEST PEOPLE | OPTIMIZE MEDICAID | A GREAT ORGANIZATION Utah’s All Payer Claims Database Phase 1 (2008-2012) Spectre Enterprises/CareAdvantage • Utah becomes one of first 3 APCD states • Limited vendor capacity • Limited technical knowledge in the market • Focused on setting up infrastructure – Data format – Data submission – Database structure • Vendor issues – One vendor went bankrupt – One contract terminated for performance issues Learning: Setting up an APCD is complicated in terms of both data quality and analytic capacity
- 7. HEALTHIEST PEOPLE | OPTIMIZE MEDICAID | A GREAT ORGANIZATION Utah’s All Payer Claims Database Phase 2 (2013-2018) Treo Solutions/3M HIS • Focused heavily on data quality: • The Wakely Report (UID looking at risk adjustment) • Completeness • Compliance with standards • Referential integrity • 2013 new watermark for useful data • Analytic capacity not fully realized (custom build only) Learning: Quality APCD data can be collected successfully. Next vendor needs more mature analytic capacity.
- 8. HEALTHIEST PEOPLE | OPTIMIZE MEDICAID | A GREAT ORGANIZATION Utah’s All Payer Claims Database Phase 3 (2018-2023) Milliman MedInsight • Substantially deeper knowledge of healthcare data and analytics • New system supports data quality monitoring • Promise of significantly improved analytic capacity Status in first 12 months (July 2018-June 2019): • Data transitioned to new system • Successful data intake and processing systems • Built-in analytic capacity is functional
- 9. HEALTHIEST PEOPLE | OPTIMIZE MEDICAID | A GREAT ORGANIZATION Utah’s All Payer Claims Database Since 2013 Impressive Usefulness of Data • Clinic comparison of quality measures (11 total measures will be reported on July 1) – 4th Year • U of U Institutional license – Medical, health services, & public health research • Health plans looking to improve services • Facilities wanting to improve service quality • Informing public health activities, such as reporting on the opioid crisis • Publishing aggregate data on OpenData – Data on price & quality of care in Utah
- 10. HEALTHIEST PEOPLE | OPTIMIZE MEDICAID | A GREAT ORGANIZATION Utah’s All Payer Claims Database Risk Adjusted Episodes of Care The Total Cost of Care Project • National effort to compare cost and resource use across the country • 4 years of reporting • 153 Utah clinic reports for CY2016, Project 192 for CY2017 • Documents significant intrastate variation – Above-average clinics: $36.5M per year in added costs for 55,956 patients
- 11. HEALTHIEST PEOPLE | OPTIMIZE MEDICAID | A GREAT ORGANIZATION Utah’s All Payer Claims Database
- 12. HEALTHIEST PEOPLE | OPTIMIZE MEDICAID | A GREAT ORGANIZATION Utah’s All Payer Claims Database
- 13. HEALTHIEST PEOPLE | OPTIMIZE MEDICAID | A GREAT ORGANIZATION Utah’s All Payer Claims Database Expectations and Limitations • We are just scratching the surface of what the APCD can be used for – Linked data across six years (2013-2018) and growing – Quarterly releases are on the horizon – Data quality continues to improve – Filling in the gaps (Medicare data, self-funded plans) • Real world limitation for consumerism – There is a mismatch between how care is billed and what a patient perceives or understands
- 14. HEALTHIEST PEOPLE | OPTIMIZE MEDICAID | A GREAT ORGANIZATION Utah’s All Payer Claims Database 2019 Legislation Implementation Plans • 50 most commonly performed medical procedures – Median paid amounts – Consult with Transparency Advisory Group • Make cost data available to the public – Expand current data through OpenData • Made data available to the State Auditor for HB 178 (Transparency Website Amendments)
- 15. HEALTHIEST PEOPLE | OPTIMIZE MEDICAID | A GREAT ORGANIZATION Utah’s All Payer Claims DatabaseContact Us stats.health.utah.gov Norm Thurston Director, Office of Health Care Statistics nthurston@utah.gov, 801-538-7052 Sterling Petersen Analytics Lead, Office of Health Care Statistics sterlingpetersen@utah.gov, 801-538-7058