Michael T. Lundberg, Executive Director

2  VHI is an independent, nonprofit, 501(c)(3) health information organization established in 1993  Formed to administer Virginia Health Care Data Reporting Initiatives to benefit Virginians

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Big Data Does Not Know Everything Yet? Philadelphia Inquirer :a member's decision to skip the gym could trigger an auto tweet from the inactive gym shoes to the health insurance network, leading to an increase in premiums.

Example: Retail Marketing of Video Games Historically: a fast response to actual demand for services was an advantage Today: Game Changing with Big Data by: Predicting & Preparing for Future Trends Predicting Areas of Highest Demand Setting Prices Targeting Most Likely Customers Making Contact In the Right Location Personalize Offer Identify other Potential Purchases

Define your Needs and Make a Plan

8 APCD - All Payer Claims Database JCHC Legislation passed in 2012 Voluntary Bill passed in 2012 CHAPTER 693 ● Administered by VDH contracting with VHI ●Initial 30 month funding by H.I.C. - 40%, Hospital Association - 40%, VHI - 20% ● Health plans and related entities may submit APCD Data ● Act specifies types of information to be collected and reported ● RFP developed, bids evaluated, Milliman selected as Data Subcontractor ● 1 st data received November, 2013 ● 1 st Reports, Spring/Summer, 2014 ● Full implementation contingent upon Data Submitters APCDs are increasing in numbers across the nation

APCDs in Action Wisconsin Health Information Organization Extracted from the Robert Wood Johnson Foundation leaving fee for service behind behind.html?cid=xsh_rwjf_em behind.html?cid=xsh_rwjf_em How WHIO used their APCD to Reduce Variation WHIO uncovered wide variation in health spending on total knee replacements Standardized costs ranging from $55,000 to $17,000 A single, or bundled, payment was negotiated between the payer and provider for all “relevant services” Providers assume some risk should there be complications, errors or other problems, ensuring a quality component and not just to reduce costs

Virginia’s APCD will include rates of unnecessary ER visits for employers and others Reducing unnecessary ER visits 25% would save an estimated $29.3 to $43.1 million dollars

Accessing Virginia’s APCD Subscription Services Designed for Flexibility Online advanced analytics for novice to expert Broad tool chest of dashboards, pre-formatted reports and custom design for employer, payer, provider, policymaker needs MedInsight Analytics Efficient access for advanced users Allows mirroring of existing employer report formats and special needs Direct Access to De-identified Tables Creating own database for offline access Greatest flexibility for power users De-identified Data Extracts

Taming Big Data in Virginia MedInsight® Analytic Platform  Population and benefit driven including:  Age  Gender  Geography  Benefit design  Benchmark detail:  DRG  Procedures  Drugs  Episodes  Chronic conditions  Based on Milliman Health Research Database of 45M members MethodologiesBenchmarks Health Cost Guidelines Evidence Based Measures Milliman Advanced Risk Adjustors Chronic Conditions Hierarchical Groups (Disease Identification) Global RVUs (Standardized Proxy Reimbursement) Provider Affiliation into Group Practices NYU Avoidable Emergency Dept. visits Episode Grouping - Truven MEGs

Milliman's MedInsight® Analytic Platform is a data warehousing, analytics, and performance reporting tool. Aggregates medical and pharmacy claims, as well as eligibility and provider data from multiple sources. Data can be accessed through dashboards, standard reports, a drill down ad-hoc reporting tool, and SQL back end tables. *Courtesy of Milliman MedInsight MedInsight® Analytic Platform

Virginia’s APCD - Your Opportunity for Better Value in Health Care Sign up for updates and data availability at Established through law, implemented by stakeholdersLarge APCD State Leveraging Economies of ScaleAdvanced Predictive AnalyticsNationally Recognized Evidence Based Quality and Utilization Measures Comprehensive Benchmarking - compare geographic regions, providers, benefit design, industries Tailored to needs of businesses, health plans, providers, public health