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Virginia Chamber of Commerce4th Annual Virginia Health Care Conference
Michael T. Lundberg, Executive Director
June 5, 2014
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VHI Represents all Health Care Stakeholders
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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VHI Publishes Business and Consumer Guides, Reports and Information at www.vhi.org
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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.
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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
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Define your Needs and Make a Plan
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APCD - All Payer Claims DatabaseJCHC Legislation passed in 2012
Voluntary Bill passed in 2012CHAPTER 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
● 1st data received November, 2013
● 1st Reports, Spring/Summer, 2014
● Full implementation contingent upon Data Submitters
APCDs are increasing in numbers across the nation
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APCDs in Action
Wisconsin Health Information Organization
Extracted from the Robert Wood Johnson Foundation leaving fee for service behind http://www.rwjf.org/en/research-publications/find-rwjf-research/2014/05/leaving-fee-for-service-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
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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
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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
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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
Methodologies Benchmarks
• 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
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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
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PCP Dashboard
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Virginia’s APCD - Your Opportunity for
Better Value in Health Care
Sign up for updates and data availability at www.vhi.org/apcd
• Established through law, implemented by stakeholders
• Large APCD State Leveraging Economies of Scale
• Advanced Predictive Analytics
• Nationally 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