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Medical Provider Subcommittee of
the Utah Transparency Advisory
Group
Sarah Woolsey, MD, FAAFP
Medical Director, HealthInsight Utah
March 26 &27, 2015
Welcome and Introductions
Objectives for this call
• Provide Background and Opportunity
– National trends and examples
– Utah data transparency work
• Engage the right providers
• Review anticipated work
– Recruit volunteers for initial attribution steps
• Alert interested parties to meeting time
polls coming up
• Answer questions
OPPORTUNITY
Maine Practice Reports
Wisconsin Reports
Sources of State-wide Data
• All Payer Claims Databases (APCDs)
– Payor and pharmacy benefit manager originated
claims
• Practice level submissions of data
• Ideal Future state for communities
– Clinical and and claim-based data (Health
Information Exchange ideal)
2014 Status of APCDs in US
Uses For APCD Data
• Monitor and evaluate health care spending and
cost trends over time
• Identify high cost spending by condition and
geographic area and evaluate drivers of spending
• Produce price transparency reports that identify
average price for specific procedures, health
conditions, geographic areas and/or payers
• Develop and monitor quality using measures that
rely on claims data
• Develop and monitor payment reform initiatives
State Health Access Data Assistance Center (SHADAC),
Making Use of All-Payer Claims Databases for Health Care Reform Evaluation
July 2014
Background on Utah
Transparency Work
• 2008-Utah Health Data Committee voted for creation of an
APCD
– Funding provided via House Bill 133, Health Care Reform
(2008)
• 2011 first claims submitted (2007-2009)
• 2011 HB 128 passed
– UDOH Office of Healthcare Statistics designated to utilize
APCD
– Clinic-level reporting for clinics with 5 or more providers
(MD, DO, APRN)
– Small area-level reporting for smaller clinics
– Denominator of at least 15 patients per measure
http://le.utah.gov/~2011/htmdoc/hbillhtm/hb 128.htm
Background on Utah
Transparency Work (cont’d)
• 2013 claims vendor folded
• 2013 small area report produced from
existing data
• 2014 3M became vendor
• 2014 statute modified to 106.5 current
language
Note: Utah has well-developed hospital and Emergency
Department databases, and ambulatory surgery databases
Current Statute “106.5”
• Data are to be reported at the clinic level for clinics with
five or more providers
• Clinics with fewer providers will have their data
aggregated with other small practices by geographic
area
• Providers are defined as physicians and nurse
practitioners, at least one of whom must be engaged in
primary care
• Care provided by physician assistants may be attributed
to their billing provider
• Price and Quality data reports to be published yearly, 3
quality areas identified yearly
• Data will not be used if not able to be validated
Current APCD Submitters
•
•
•
•
19 commercial payers
Medicaid Fee for Service
3 of the Medicaid ACOs
3 pharmacy benefit managers
– CVS, Express Scripts and VRx
Note: Data will be 2013-14, then after June,
2015 starts to come in, 6 mo cycles
History of the Transparency
Advisory Group (TAG)
• Formerly the Reporting Task Force (RTF)
• Established in 2008 by Utah Partnership for Value
(UPV), HealthInsight value-interested group
• Part of the strategy to “build stakeholder
empowerment through transparency and actionability
of healthcare data with focus and attention on
consumers”
Purpose: Make useful cost and quality data available
to Utah patients and providers
Composition
• Health Data Committee leadership-Chair
Alan Ormsby, AARP Utah
• Utah Department of Health (UDOH) Office
of Healthcare Statistics leadership and staff
• HealthInsight Utah
• Community
– providers
– payers
– consumers/employers
TAG Long-Term Objectives
• Use transparency to improve quality and cost of care
• Partner with Utah organizations to publish a series of reports
with nationally created measures and local data that are:
– Actionable and understandable to consumers
– Reliable source for redesigning incentives
– Accepted as reasonably valid and reliable by the provider
community and include resources for improving measures
• Act as an advisory body for Health Data Committee (HDC)
and other organizations
• Educate membership and community to elevate use of data for
transparency in UT
(TAG Charter 2013)
TAG Products to Date
• Developed and sent health data
transparency priorities paper to Health
Data Committee (August 2014)
• http://utahhealthscape.org/
• http://ibis.health.utah.gov/indicator/view/L
owBacPaiImaPro.MRI.SA_UTMap.html
• First Quality Transparency measures sent
to data vendor
APCD Quality Measures for 2015
•
•
•
•
•
Breast cancer screenings (50-75y)
Well-child visits in first 15 months (NQF 1392)
Diabetes measure: HbA1c testing (NQF 0057)
Chlamydia Screening (NQF 0033)
Avoidance of antibiotics for adults with acute
bronchitis (NQF 0058)
Note: Asthma care utilization and low back pain imaging are
of interest, and the state will look at models for working with
this data
MEDICAL PROVIDER
SUBCOMMITTEE
Goals
• Accurate and actionable cost and quality
information is provided to providers and public
• The health provider community has an
opportunity to support the accuracy of the
information provided
• The provider community supports alignment of
processes as appropriate for transparency work
in Utah (such as data collection methods,
attribution methods, a core set of measures)
• Bring ideas for data use cases
Target participants
• Physicians with interest
• Provider leaders from large clinics, health
systems
• Health Plan Medical Directors or Quality
Analysts
Actions Requested
• Regular attendance and virtual comment on
versions of APCD and other transparency data
• Sharing to constituents as needed
• Volunteering to validate parcels of data as we test
attribution of patients to providers and providers
to clinics
• Participation to review organizational data for
accuracy prior to release
• Assist to develop solid processes for provider
benefit from transparency
Actions Requested (cont’d)
• Attendees are willing to
– Familiarize with topic
– Critically assess for improvement
– Suggest uses and processes for the data that
will improve health for Utah
Anticipated Activities
• Meeting frequency- at most monthly
• Committee work anticipated in 2015
–
–
–
–
Provider/Clinic attribution
Provider/Patient attribution
Discussion of Total Cost of Care Measures
Processes for confidential sharing of quality
data
– Topics for future data queries of benefit to
clinicians
WIIFM
• Ensure your data is appropriate
• See some of the first cuts as we work
through the process
• Set a foundation for our community
• Learn about transparency
• Understand aggregate data, compare
yourself to your community
Provider Attribution Volunteers
Needed
• Any location and size
– Distant locations will need to be willing to install the Adobe
Connect plugin that allows our remote desktop sharing and file
transfer
• Custom reporting system that can generate
– an entire patient roster (first, middle and last name and DOB)
– registry lists for diabetes patients or some other way to generate
diabetes diagnosis information for the entire population (can be
meaningful use if the report has a denominator patient list )
• Best timing for custom reports run –during the day or after
hours.
• Excel or Open Office Calc on the desktop of the computer
for sharing behind the firewall
Meeting Preference polls
• Day of the week
• Time
• Look for a poll to follow to select an
acceptable meeting time
Examples from CO, MN
http://www.mnhealthscores.org
https://www.comedprice.org/#/home
https://www.comedprice.org/#/client
Dr. Tyson on Data
Any time scientists disagree, it's because we have
insufficient data. Then we can agree on what
kind of data to get; we get the data; and the data
solves the problem. Either I'm right, or you're
right, or we're both wrong. And we move on.
That kind of conflict resolution does not exist in
politics or religion.
-Neil deGrasse Tyson, American astrophysicist,
director of the Hayden Planetarium
Questions
Thank you
Sarah Woolsey, MD, FAAFP
Medical Director, HealthInsight Utah
(801)694-9466
[email protected]
www.healthinsight.org