Virginia Chamber of Commerce4th Annual Virginia Health Care Conference

Michael T. Lundberg, Executive Director

June 5, 2014

VHI Represents all Health Care Stakeholders

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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

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.

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

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

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

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

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

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

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

PCP Dashboard

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