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All-Payer Claims Database – Current Status and Future Capabilities October 24, 2013. Objective. Develop a strategy for establishing All-Payer Claims Database (“APCD”)
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All-Payer Claims Database – Current Status and Future CapabilitiesOctober 24, 2013
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
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 11-58 • Public Act 12-166 implemented governor’s recommendations to build APCD • Subsequently, Public Act 13-247 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
Projected Timeline for APCD’s Data Submissions Data Submission Timeline
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
Data Management Healthcare Analytics - Techniques and Capabilities • Epidemiology • Econometrics • 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 • QuantileRegression • 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
APCD’s Capabilities Enabling Enhanced Care Models • Analytic Capabilities • Predictive Analytics • Opportunity Assessment • Risk Stratification and Care Gaps • Provider Performance • Gain/risk Sharing and Bundled Payment Models • Clinical Groupers • Data management Capabilities • Cleanse, standardize and integrate: • Clinical • Administrative • Census and Lifestyle • Member Engagement • EMR Data • Apply Benchmark Data Population Health Management (e.g., advanced risk analytics) Provider Performance Management (e.g., gain-share, P4P) Clinical Cost Management (e.g., clinical interventions) Enhanced Care • 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 Payment Management (e.g., bundled payment)