Making use of All-Payer Claims Databases for Health Care Reform Evaluation
- 1. MAKING USE OF ALL-PAYER CLAIMS DATABASES FOR HEALTH CARE REFORM EVALUATION Jennifer Ricards, MS Minnesota Health Services Research (HSR) Conference, March 3, 2015
- 2. Acknowledgements • Funded by the Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation • Co-author: Lynn Blewett, PhD • Other contributors: Amy Potthoff-Anderson, BA; Kelsey Avery, MPH; and Mary Cobb, MPH; Karen Turner, BA
- 3. Objectives • Provide an update on state all-payer claims database (APCD) uses • Describe analytic uses and capabilities for state health care reform efforts: • Monitor health care costs trends over time • Identify drivers of high spending • Foster price transparency • Track key quality measures • Develop and monitor payment reform initiatives
- 4. Methods • Secondary data collection • Peer-reviewed studies • Formal reports • Documentation • Web-content • Primary data collection • Phone and email communications with state staff • Semi-structured interviews • January through June 2014
- 5. What are State Operated APCDs? • Repositories of health care claims from multiple payers for the purposes of analyzing and monitoring state-level cost and quality of health care • Significant resources are devoted to planning, implementing, and maintaining state-operated APCDs
- 7. APCD established APCD legislation passed, but not yet fully established
- 8. State has established data release structures and processes to allow researchers and stakeholders access to the data ?
- 9. Minnesota’s APCD • Represents 85% of the state's population • Claims dating back to 2008 • Truly “all payer” • Medicare (fee-for-service and advantage) • Medicaid (fee-for-service and managed care) • Commercial • Self-insured
- 10. State Case Studies Monitor Statewide Spending Evaluate Transformation EffortsIncrease Care Quality Promote Price Transparency
- 11. Statewide Spending: Massachusetts Develop “High Cost” Patient Profiles Analysis of Patient Characteristics Source: http://www.mass.gov/anf/docs/hpc/2013-cost-trends-report-final.pdf
- 13. PriceTransparency • Price transparency refers to the degree to which health care cost information is readily available to consumers • Both federal and state officials are looking to increased price transparency as a means of reducing health care costs • When coupled with information on care quality, consumers can use price information to make informed decisions about their care
- 14. PriceTransparency: Colorado Source: http://www.comedpriceshowcase.org/ Can click through by topic to explore ways in which the APCD data are being used; e.g.: • Pricing of emergency room services • Combining medical claims data with EMR data for Medicaid
- 20. EvaluateTransformation Efforts • Impact of reform on health care costs, utilization, and quality • To what extent reforms have impacted processes vs. patient outcomes; and the differences in impacts of reforms across population subgroups
- 21. EvaluateTransformation Efforts:Vermont • Vermont Health Care Uniform Reporting and Evaluation System (VHCURES) • VHCURES data are used to evaluate Blueprint for Health initiative • Identify participating patients • Define the comparison group • Assess patient utilization, cost, and quality metrics
- 24. What’s Next for APCDs? • “Administrative Simplification” • Data Linkages • ACO Measurement • Payment Reform Evaluation
- 25. Resources Analytic Approaches to Health ReformWhite Papers (SHADAC) • http://www.shadac.org/content/analytic-approaches-monitoring-and-evaluating- health-reform-topic-papers APCD Council • http://www.apcdcouncil.org/ APCD Development Manual • http://apcdcouncil.org/all-payer-claims-database-development-manual Colorado’sAPCD • http://www.civhc.org/All-Payer-Claims-Database.aspx/ Minnesota’s APCD • http://www.health.state.mn.us/healthreform/allpayer/ Massachusetts’ ACPD • http://chiamass.gov/ma-apcd/
- 26. Resources (cont.) National Association of Health Data Organizations • https://www.nahdo.org/ Vermont’s APCD • http://gmcboard.vermont.gov/vhcures
- 27. THANKYOU! Jennifer Ricards, MS Senior Research Fellow State Health Access Data Assistance Center (SHADAC) University of Minnesota Email: ricar010@umn.edu Phone: 612-625-4835