Data StrategyJoel Cantor, Rutgers Center for State Health Policy

Ken Gross, Camden Coalition of Healthcare Providers

October 5, 2012

Session Overview

• Overview of required data & purposes

• CMS reporting requirements

• Plans for benchmarking

• Care management process

– Demo: TrackVia

• Next steps

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Required Data & Purposes

Purpose

Hospital Encounter

Data

Care Mgn’tProcess

Data

Patient Outcome

Data

Staffing and Budget

Info

Patient identificationand triage/risk assm’t

X

Care management X X X

Benchmarking X ?

CMS quarterly reports

X X X X

CMS evaluation X ? X ?

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CMS Quarterly Reporting Requirements [1/3]

Process & Outcome Measures

Standard measures:

- Required for all 107 awardees- Begins in January 2013- Requirements being compiled by RAND; to be released at the end of 2012

Project-specific patient-level measures:

- Hospital inpatient / ED use & costs- Hospital Dx (primary and secondary)- Chronic conditions, social co-morbidities- Staff-assessed health status- Satisfaction- Care management encounters (types and length of interactions) & referrals- Demographic

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CMS Quarterly Reporting Requirements[2/3]

Organizational & Operational Measures

Quality improvement e.g., - CQI process- Data used and review process- Specific efforts during reporting period

Participants (patients) - Counts by age, gender, race/ethnicity, payer- % deviation from projection- # encounters by type and delivery mode

Data capability checklist(i.e., assuring CMS that these variables are collected)

- Patient identifiers (SSN, or combination of name, DOB, home address)

- Provider tax IDs- Service types and dates- Practitioner NPIs- Payer IDs (Medicare, Medicaid, other)

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CMS Quarterly Reporting Requirements[3/3]

Organizational & Operational Measures (Continued)

Staffing, paid e.g., - FTEs funded by HCIA (by type, new/existing)- Clinical FTEs (by licensure and prescribing

authority)- % deviation of actual FTEs from projection

Staffing, volunteers - # individual volunteers- # volunteer hours- Functions

Staff training - Training program duration (hours)- Audience type- # individuals

Budget - Actual expenditures: Itemized by personnel, fringe, travel, equipment, supplies, contractual, construction, indirect, total

- Forecasted expenditures: % deviation

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CMS Evaluation Requirements

• Little information has been provided to us yet

• Anticipate that identified patient data will be required

• Interviews and site visits possible

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Benchmarking

• Document how care management “bends the hospital cost curve”• Costs of high-utilization patients may “regress to the mean”, so

simple trend data will not tell credible story• Benchmarking will compare care management patients to matched

non-intervention patients (by demographics, utilization history, diagnoses/comorbidities, payer)– Comparison data from state all-payer billing databases (NJ, CA, FL)– Outcome metrics: total resource use, readmissions, return to ED– Statistical risk adjustment

• Will require de-identified hospital billing records (or similar data) for enrolled patients– Before, during, and after enrollment– Will work with each clinical partner to see what is feasible– Refinements possible if linked to care management process data

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Care Management Process

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TrackVia Demonstration

Next Steps

• Data Committee

– Representative(s) from each partner

– Committee call (first call within 2-3 weeks)

• CMS reporting on personnel & budget

– Focus of next project director call

• CMS reporting on patient-level measures

– Details forthcoming soon

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Site Breakout Questions

• How has this session changed your operational plan?

• How should the Camden tools (including Track Via) be incorporated into your workflow?

• What assistance do you need to move forward?

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