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All-Payer Claims Database – Current Status and Future Capabilities October 24, 2013 1.

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Presentation on theme: "All-Payer Claims Database – Current Status and Future Capabilities October 24, 2013 1."— Presentation transcript:

1 All-Payer Claims Database – Current Status and Future Capabilities October 24,

2 2 Objective Develop a strategy for establishing All-Payer Claims Database (“APCD”) The purpose of APCD is to create “… health care information relating to safety, quality, cost effectiveness, access and efficiency for all levels of health care in Connecticut” APCD will include data from commercial carriers, PBMs, CT State Employee Insurance, Medicaid and Medicare enrollees for the residents of CT The database will contain historical data (≥ 3 years) and then monthly additions starting from August, 2014 APCD primary database will be isolated and secured from the analytic/reporting database, differentiated by the process of deidentification Analytic and public use data will be derived from a secondary datamart Includes a high level overview of HIX information architecture

3 3 History of Connecticut’s APCD Initiative In 2012, Connecticut’s Office of Health Reform and Innovation developed a plan for a multi-payer data initiative as required by Public Act Public Act implemented governor’s recommendations to build APCD Subsequently, Public Act transferred APCD to Access Health CT Policy & Procedure (P&P) & Data Submission Guide (DSG) were developed in the summer of 2013 First draft of both documents were approved by the Board for placement for public review in Aug/Sep, 2013 We anticipate that the Board will approve the P&P and DSG on Nov. 21, 2013 The approval of the P&P and DSG documents is vital for other items to follow subsequently

4 4 Projected Timeline for APCD’s Data Submissions Data Submission Timeline Vote and Release of Policies and Procedures Circa 11/21/2013 Submission of Test Data (+150 days) Circa 4/20/2014 Submission of 36 Months of Historic Data (+60 Days) Circa 6/20/2014 Submission of YTD Data (+ 45 Days) Circa 8/05/2014 Closure of any gaps in data. Begin Monthly Data Submissions (+30 Days) Future Elements: Provision of Dental Data (TBD)

5 5 Other Decisions for Connecticut’s APCD Data Management – – should it be managed internally or assign it to a vendor? – Should analytics be assigned to external vendor or brought in-house? Denial Data – should it be part of the data submission requirement? Identify stakeholders – – Identify how various stakeholders can use the APCD data – We have yet to identify how the various state agencies can use this data Sustainability Plan – we have not yet developed a data use and data governance set of P&Ps, including user fees

6 6 Decision – Insourcing vs. Outsourcing

7 7 Overview of HIX Infrastructure Integration Opportunity

8 8 Statistical Techniques –Multiple Regression/GML –Limited Variable Regression Techniques - Logistic, Tobit, Heckman & Others –Forecasting/Prediction Modeling –Conjoint Analysis, Discriminant Analysis, Factor Analysis, Cluster Analysis –Data Reduction Techniques - Principal Component, Factor –Quantile Regression –Bootstrapping –Propensity Matching Analysis –Neural Network Analysis Clinical Insights –Clinical Groupers – ERG, CDPS, DxCG, CRG, CMS-HCC –Surgery episodes – ETG, Prometheus –Disease mapping – medical & pharmacy –Various risk models –Expertise in health services research –Deep bench-strength in advanced analytic research Healthcare Analytics - Techniques and Capabilities Solution Health Services Research Methodology Statistics/ Bio- statistics Clinical Groupers Epidemiology Econometrics Data Management

9 9 Data management Capabilities  Cleanse, standardize and integrate: ‒ Clinical ‒ Administrative ‒ Census and Lifestyle ‒ Member Engagement ‒ EMR Data  Apply Benchmark Data Analytic Capabilities  Predictive Analytics  Opportunity Assessment  Risk Stratification and Care Gaps  Provider Performance  Gain/risk Sharing and Bundled Payment Models  Clinical Groupers Information Transparency  Variations in specific services costs/utilization by counties  Variations in costs per episodes for select surgeries by sites and counties  Variations in preventative care by counties  Self-service platform Reporting Capabilities  Cost, Quality and Utilization Reports  CMS/Compliance Reports  Intervention Outcomes Reports  Provider Performance Reports  Payment Reconciliation APCD’s Capabilities Enabling Enhanced Care Models Population Health Management (e.g., advanced risk analytics) Provider Performance Management (e.g., gain-share, P4P) Payment Management (e.g., bundled payment) Clinical Cost Management (e.g., clinical interventions) Enhanced Care

10 10 APCD’s Analytics - Stakeholders Providers Comparative effectiveness research (w/inclusion of clinical data) Cost and Quality of care variations for hospitals and physicians Provider practice analyses with risk-share Allocation of benefits based on efficiency/quality of care, in ACO or PCMH models Initiate large-scale studies involving alternative reimbursements Payors – Health-plan, Medicaid, Medicare Medical trend Cost of Care Risk variations by population groups and geographic locations Risk analyses of newly enrolled members versus current insureds Various Medicare and Medicaid Analyses Others based on various state department-specific needs Members / Beneficiaries Cost Transparency Safety and quality of care Access to care Personalized healthcare purchase decision making tool Total episode cost of diseases and/or surgeries


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