claims datawebinar102312

Camden Coalition of

Healthcare Providers

Hospital Claims Data 101

Webinar

Kennen S. Gross, PhD, MPH

Director, Research & Evaluation

Camden Coalition of Healthcare Providers

Camden Coalition of

Healthcare Providers

www.camdenhealth.org

"What we have before us are some

breathtaking opportunities disguised as

insolvable problems."

-John Gardner

Secretary of Health, Education and Welfare 1965-1968

Questions to be addressed

• What are hospital claims data?

• Why do we need it?

• What hospitals do I need it from?

• How do you get claims data?

• Once you get claims data what do you do

with it?

What are hospital claims data?

• Collected by hospitals for billing purposes

• Patient information

• Diagnosis information

• Billing information

• Lag in the completeness of data

• Does not include claims for pcp

visits, specialist visits, pharmacy

What are hospital claims data?

Emergency Room

ED ClaimPatient name

Address

Date

Diagnosis codes

Insurance

Charity care

Charges

Receipts

Patient

A

Inpatient Stay

IP ClaimPatient name

Address

Date Admitted

Date Discharge

Diagnosis codes

Insurance

Charity care

Charges

Receipts

Patient

B

Emergency Room

IP ClaimPatient name

Address

Date Admitted

Date Discharge

Diagnosis codes

Insurance

Charity care

Charges

Receipts

Patient

B

Inpatient Stay

Understand

the problem

Develop

interventions

to target the

problem

Evaluate the

impact of

the solutions


Identify and

engage

patients

needing

intervention

Why do we need hospital claims data?

7www.camdenhealth.org


If its going to be, its up to me!



Existing population health databases are not sufficient



Claims data from payers is not feasible

From which hospital(s)?

• What patients are you targeting with your

intervention?

• Where do those patients live?

• At what hospitals do those patients receive

care?

• One hospital


From which hospital(s)?Camden Example

How do you get claims data?

Business Intelligence Issues

Legal Issues

Data Access IssuesSTART WITH WHY


Quality Assurance

Process ImprovementResearch Project

Business Associates

Agreements (BAAs)

Institutional Review

Boards

•

•

•

•

•

•

What do you do with claims data?

• Store the data

• Clean the data

• Reorganize the data

• Link the data

• Calculate variables

• Map the data

• Activate the data

• Share the activated data

Store the data

Clean the data

•

•

•

•

•

Link the data

Map the data

CCHP Solution:

Camden Health Database

Yearly Clams Data

Data Use Agreements

IRB Agreement

Data processing/cleaning

Probabilistic matching

Geocoding

Camden Residents All-Payer Claims Longitudinal Dataset

Demographics

Inpatient and Emergency visits

Diagnosis codes

Charges/receipts

Insurance


Understand

the

problem

Hospital Costs – Camden Residents, 2011

Total hospital revenue

$108 million

$1,396 per capita

Total inpatient revenue

$79 million

$1,021 per capita

Total Emergency Department revenue

$29 million

$375 per capita

Understand

the

problem

Camden Hospital Utilization, 2011


Understand

the

problem

Camden Hospital Inpatient and Emergency Revenue, 2011


Understand

the

problem

Camden Cost Curve, 2011


Understand

the

problem

ED visits, 2011

Inpatient visits, 2011

0 1 2 3 to 4 5+

044,728 (85%) patients

5,210 Inpatient visits

63,489 ED visits

$28,000,000 (50%) IP payment

$25,800,000 (59%) ED payment985 (2%) patients

1,856 IP visits

4,129 ED visits

$10,000,000 (17%) IP

payment

$1,700,000 (4%) ED

payments

503 (1%) patients

2,026 Inpatient Visits

4,144 ED Visits

$10,900,000 (20%) in IP payment

$1,700,000 (4%)in ED payment

1

2 to 3

4 to 5

4,961(9%) patients

28,447 ED visits

$11,500,000 (27%) in

ED payment

1,563 (3%) patients

1,239 IP visits

6,962 ED visits

$6,700,000 (18%) in IP

payment

$2,800,000 (6%) in ED

payment

6 to 7

8 to 9

10 +


Camden Hospital Utilization Typology

Understand

the

problem

“Ambulatory Care Sensitive Conditions” and

are often amenable to outpatient

management

Camden ED use by diagnosis, 2011


Understand

the

problem

“Ambulatory Care Sensitive Conditions” and

are often amenable to outpatient

management

Camden Inpatient use by Diagnosis, 2011


Understand

the

problem

Camden High Utilizers, 2011


Understand

the

problem


Camden Spatial Analysis of Hospital Costs

Identify and

engage

patients

needing

intervention

Understand

the

problem

Hospital Visits - Camden Residents, 2005- 2011

Understand

the

problem

0

2

4

6

8

10

12

14

1/3/2011 2/3/2011 3/3/2011 4/3/2011 5/3/2011 6/3/2011 7/3/2011 8/3/2011 9/3/2011 10/3/2011 11/3/2011 12/3/2011

Len

gth

of

Sta

y

ED IP


Patient utilization profile

C

Evaluate the

impact of

the

solutions

0

2

4

6

8

10

12

Len

gth

of

Stay

ED IPC

1 year pre-enrollment

Charges = $745,018; Receipts: $95,358;

Inpatient days: 55; ED visits: 1

Post-enrollment

Charges = $0; Receipts= $0

Inpatient days: 0; ED visit=0


Evaluate the

impact of

the

solutions

Data access is a necessary but not sufficient

step towards innovative delivery reforms.

Data Quality is essential

Measurement is essential

Statistical Literacy is essential

Effective Dissemination in essential

Maintaining partnerships is essential

Thank you for your time

Questions/comments please contact me at

[email protected]


claims datawebinar102312

Documents