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MAKING USE OF ALL-PAYER CLAIMS DATABASES FOR HEALTH CARE
REFORM EVALUATIONJennifer Ricards, MS
Minnesota Health Services Research (HSR) Conference, March 3, 2015
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
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
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
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
APCD establishedAPCD legislation passed, but not yet fully established
State has established data release structures and processes to allow researchers and stakeholders access to the data
?
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
State Case Studies
Monitor Statewide Spending
Evaluate Transformation EffortsIncrease Care
Quality
Promote Price Transparency
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
Source: http://www.mass.gov/anf/docs/hpc/2013-cost-trends-report-final.pdf
Price Transparency
• 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
Price Transparency: 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
Evaluate Transformation 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
Evaluate Transformation 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
What’s Next for APCDs?
• “Administrative Simplification”
• Data Linkages
• ACO Measurement
• Payment Reform Evaluation
ResourcesAnalytic Approaches to Health Reform White 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’s APCD• 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/
Resources (cont.)
National Association of Health Data Organizations• https://www.nahdo.org/
Vermont’s APCD• http://gmcboard.vermont.gov/vhcures
THANK YOU!
Jennifer Ricards, MSSenior Research FellowState Health Access Data Assistance Center (SHADAC)University of MinnesotaEmail: [email protected]: 612-625-4835
