data sharing and value based payment strategies to improve health care … · 2018-09-10 · data...
TRANSCRIPT
Data Sharing and Value Based Payment Strategies to Improve Health Care and Reduce Costs
Andy Vasquez
HHSC Deputy Associate Commissioner, Quality & Program Improvement,
Medicaid & CHIP Services
Senate Finance Committee
September 11, 2018 1
Senate Bill 1, 85 R, 2017, Article IX, Section 10.06
“HHSC shall coordinate with DSHS, ERS, TDCJ, and TRS to
develop recommendations and a comprehensive plan for
an integrated health care information system…to collect
and analyze data on utilization, cost, reimbursement rates,
and quality in order to identify improvements for efficiency
and quality that can be implemented within each
healthcare system.”
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Four programs serving 5.5 million Texans, at a cost of $50 billion* in Fiscal Year 2017
* $50 billion includes all sources of funding, including federal Medicaid matching funds
Program Funding:$50 billion impact
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HHSC ERS TDCJ TRS
Sources of Funding
General Revenue (GR), General Revenue-Dedicated (GR-D),and federal funds
GR, GR-D; Employer surcharge of 1% payroll;Employees and retirees pay 50% of dependent contribution
GR TRS ActiveCare: State pays $75/month; School districts pay $150/month or more; Employees pay the rest
TRSCare: State contributes 1.25%; districts contribute 0.75%; actives contribute 0.65% of payroll. Retirees contribute fixed monthly premium
FY17 Funding(in millions)
$42,612 $3,386 $601.9 $3,484
Program Demographics: 5.5 million Texans covered
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HHSC ERS TDCJ TRS
PopulationServed
Primarilywomen and children with limited income and resources
State and higher education employees, retirees, and dependents(except UT and A&M)
Incarceratedoffenders, primarily men between the ages of 20 and 64
Employees, retirees, and dependents of participating public education entities
Number of Participants
4,039,590 534,053 145,409 760,744
Average Age
21 years 44 years 39 years TRS ActiveCare: 34 yearsTRSCare: 68 years
Gender 54% female 54% female 8% female TRS ActiveCare: 63% femaleTRSCare: 66% female
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General Findings
• The agencies have similar cost drivers and cost containment strategies
• Providing quality care while controlling costs is a shared goal
• An integrated system for sharing data could be helpful when collaborating on strategies for improved quality
• The agencies analyzed three options for the report
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Option 1: Standardized reports by each health program
Pros Cons Timeframe
• A series of scheduled paper reports could be achieved within existing resources
• Agencies have different capacities for generating compatible data sets
• Without age- or risk-adjustment, data would not be suitable for comparison
• Agencies do not have a shared visualization tool with sufficient security to protect health information and display shared results
• 3-4 months
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Option 2: Analysis conducted by a Texas academic institution
Pros Cons Timeframe
• Could be achieved with a memorandum of understanding with UT Health Science Center at Houston Data Center, which currently has access to 91% of the Texas market’s claims data
• Each agency would receive an individualized, age- and risk-adjusted benchmark analysis
• Reporting in interactive dashboards
• Potential for collaboration with other academic institutions, on a case-by-case basis
• $5M cost in first year, with ongoing approximate cost of $4.5M per year to maintain
• 6-8 months
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Option 3: Analysis conducted by third-party vendor
Pros Cons Timeframe
• There would likely be a number of vendors interested in bidding on such a contract
• Would require a new procurement process and a coordinated request for proposal among the agencies
• More costly than executing an memorandum of understanding with an academic institution
• Minimum of 2 years
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Recommendations
• The agencies have distinct challenges based on who they serve, how they are funded, and how they deliver care
• Sophisticated and consistent reporting methods must account for demographic and health acuity differences among populations
• Attempting to make valid comparisons among programs without risk- and age-adjusted data will not produce reliable insight needed to inform decision makers
• A data analytics tool would be a valuable addition to the existing collaboration among health programs; however, it will require additional resources
Considerations
Cost of the project
• $5 million would be required to implement UT Health
Data Center project; however, a federal match may be
available for HHSC’s portion of the cost, potentially
reducing the total cost by approximately $2 million
Value-based purchasing
• Data sharing project would provide a solid foundation
for the coordination around value-based purchasing
best practices required by Article IX, Section 10.07
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Cross-agency Collaboration on Value Based Payment Strategies
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Senate Bill 1, 85 R, 2017, Article IX, Section 10.07
Senate Bill 1, 85 R, 2017, Article IX, Section 10.07
“HHSC, ERS, and TRS shall collaborate on the
development and implementation of potential
value-based payment strategies, including
opportunities for episode-based bundling and
pay for quality initiatives. To the extent possible,
these agencies shall work towards similar
outcome measures.”
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Workgroup Milestones
• Elect chairperson and adopt Workgroup Charter
• Hold regularly scheduled meetings throughout the fiscal year and engage in strategic planning sessions
• Identify focus areas for collaborative value-based and quality improvement initiatives
• Use routine meetings as an incubator for ideas and an opportunity to share problems and solutions
• Develop strategies to address focus areas across agencies
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