stratarx john freedman md mba october 16, 2012
DESCRIPTION
All Payer Claims Datasets: Big Data is Coming to Public Health Officials, Providers and Patients Near You. StrataRx John Freedman MD MBA October 16, 2012. Health Care Transformation - Before. Focus on the individual patient in front of you Physician autonomy is paramount - PowerPoint PPT PresentationTRANSCRIPT
![Page 1: StrataRx John Freedman MD MBA October 16, 2012](https://reader036.vdocuments.us/reader036/viewer/2022062322/56814fa5550346895dbd6280/html5/thumbnails/1.jpg)
Copyright ©2011 Freedman Healthcare, LLC
All Payer Claims Datasets:Big Data is Coming to Public Health
Officials, Providers and Patients Near You
StrataRxJohn Freedman MD MBA
October 16, 2012
![Page 2: StrataRx John Freedman MD MBA October 16, 2012](https://reader036.vdocuments.us/reader036/viewer/2022062322/56814fa5550346895dbd6280/html5/thumbnails/2.jpg)
Health Care Transformation - Before
• Focus on the individual patient in front of you
• Physician autonomy is paramount
• All else being equal, more is better
• Physicians make the decisions
• Money has no place in the conversation
• Valued tools:– Patient chart– Physician knowledge and experience– Well-equipped facilities
![Page 3: StrataRx John Freedman MD MBA October 16, 2012](https://reader036.vdocuments.us/reader036/viewer/2022062322/56814fa5550346895dbd6280/html5/thumbnails/3.jpg)
Health Care Transformation - After
• Population health management
• Patient autonomy is paramount
• All else being equal, less is better
• Physicians guide patients to their decisions
• Money has a limited place in the conversation
• Valued tools:– Electronic health data– Learning systems– Physician analytic and interpersonal skills – Well-equipped facilities
![Page 4: StrataRx John Freedman MD MBA October 16, 2012](https://reader036.vdocuments.us/reader036/viewer/2022062322/56814fa5550346895dbd6280/html5/thumbnails/4.jpg)
Steps in the Transformation
• IT infrastructure
• Payment reform
• Transparency
• Workforce education & training
• Evidence-based medicine
• Access, analysis and distribution of health information
![Page 5: StrataRx John Freedman MD MBA October 16, 2012](https://reader036.vdocuments.us/reader036/viewer/2022062322/56814fa5550346895dbd6280/html5/thumbnails/5.jpg)
All Payer Claims Dataset
• An aggregation of data files – including eligibility records plus medical and pharmacy claims – compiled from multiple health benefits payers
• First statewide APCD created in Maine in 2003
5
![Page 6: StrataRx John Freedman MD MBA October 16, 2012](https://reader036.vdocuments.us/reader036/viewer/2022062322/56814fa5550346895dbd6280/html5/thumbnails/6.jpg)
What Do Claims Tell Us?
• What was done?
• When?
• For whom?
• By whom?
• Then what happened?
• What did it actually cost?
![Page 7: StrataRx John Freedman MD MBA October 16, 2012](https://reader036.vdocuments.us/reader036/viewer/2022062322/56814fa5550346895dbd6280/html5/thumbnails/7.jpg)
Why an APCD?• Rich information for health policy
– How does spending differ by location? Patient mix?– What are the trends in disease prevalence?– What are the trends in treatment choices?– How do disease, treatments, outcomes, etc. vary from
region to region? By gender? By type of insurance coverage? By provider?
– Which providers are better/worse in quality and cost?
• Support for performance improvement– Transparent reporting of provider and payer results– Data set can be used by providers to drive their QI efforts
7
![Page 8: StrataRx John Freedman MD MBA October 16, 2012](https://reader036.vdocuments.us/reader036/viewer/2022062322/56814fa5550346895dbd6280/html5/thumbnails/8.jpg)
Why an APCD (Cont’d)
• Support for informed consumer choice– Where should I be treated?– What will it cost?
• Powerful data for researchers– Policy research and clinical research
8
![Page 9: StrataRx John Freedman MD MBA October 16, 2012](https://reader036.vdocuments.us/reader036/viewer/2022062322/56814fa5550346895dbd6280/html5/thumbnails/9.jpg)
National Map of State APCDs
Source: APCD Council www.apcdcouncil.org 10/10/20129
![Page 10: StrataRx John Freedman MD MBA October 16, 2012](https://reader036.vdocuments.us/reader036/viewer/2022062322/56814fa5550346895dbd6280/html5/thumbnails/10.jpg)
Examples
• Leading causes of illness and hospitalization
• Rates of accidents, infections and cancer
• Geographic differences in incidence of diseases, such as diabetes or heart disease
• Ethnic, gender or socioeconomic variations in illness
• Most expensive diagnoses and procedures
• Role of prevention on illness and costs
10
![Page 11: StrataRx John Freedman MD MBA October 16, 2012](https://reader036.vdocuments.us/reader036/viewer/2022062322/56814fa5550346895dbd6280/html5/thumbnails/11.jpg)
11
![Page 12: StrataRx John Freedman MD MBA October 16, 2012](https://reader036.vdocuments.us/reader036/viewer/2022062322/56814fa5550346895dbd6280/html5/thumbnails/12.jpg)
Antidepressant Use in Utah
Utah Atlas of Health Care, Sept. 2010
![Page 13: StrataRx John Freedman MD MBA October 16, 2012](https://reader036.vdocuments.us/reader036/viewer/2022062322/56814fa5550346895dbd6280/html5/thumbnails/13.jpg)
Distribution of Antidepressant Use
Utah Atlas of Health Care, Sept. 2010
![Page 14: StrataRx John Freedman MD MBA October 16, 2012](https://reader036.vdocuments.us/reader036/viewer/2022062322/56814fa5550346895dbd6280/html5/thumbnails/14.jpg)
Source: VT Healthcare Claims Uniform Reporting & Evaluation System
![Page 15: StrataRx John Freedman MD MBA October 16, 2012](https://reader036.vdocuments.us/reader036/viewer/2022062322/56814fa5550346895dbd6280/html5/thumbnails/15.jpg)
30-Day Readmission Rates
Source: VT Healthcare Claims Uniform Reporting & Evaluation System
![Page 16: StrataRx John Freedman MD MBA October 16, 2012](https://reader036.vdocuments.us/reader036/viewer/2022062322/56814fa5550346895dbd6280/html5/thumbnails/16.jpg)
16
NHHealthCost.org
![Page 17: StrataRx John Freedman MD MBA October 16, 2012](https://reader036.vdocuments.us/reader036/viewer/2022062322/56814fa5550346895dbd6280/html5/thumbnails/17.jpg)
17
![Page 18: StrataRx John Freedman MD MBA October 16, 2012](https://reader036.vdocuments.us/reader036/viewer/2022062322/56814fa5550346895dbd6280/html5/thumbnails/18.jpg)
18
![Page 19: StrataRx John Freedman MD MBA October 16, 2012](https://reader036.vdocuments.us/reader036/viewer/2022062322/56814fa5550346895dbd6280/html5/thumbnails/19.jpg)
APCD Data Sources
• Commercial (private) carriers
• Medicaid
• Medicare
• Uninsured
• Dental
• Pharmacy
19
![Page 20: StrataRx John Freedman MD MBA October 16, 2012](https://reader036.vdocuments.us/reader036/viewer/2022062322/56814fa5550346895dbd6280/html5/thumbnails/20.jpg)
Privacy
• Patients– HIPAA as minimum
• Providers– Reputation – Proprietary information
• Payer protections– Reputation– Proprietary information
20
![Page 21: StrataRx John Freedman MD MBA October 16, 2012](https://reader036.vdocuments.us/reader036/viewer/2022062322/56814fa5550346895dbd6280/html5/thumbnails/21.jpg)
Links to Other Data and Initiatives
• Quality – CMS, state reports, regional collaboratives
• Vital statistics – to assess mortality rates
• Hospital Discharge Datasets – for additional data detail and measures
• Health Information Exchanges – integrate claims and clinical (EMR) data
• Health Insurance Exchanges
21
![Page 22: StrataRx John Freedman MD MBA October 16, 2012](https://reader036.vdocuments.us/reader036/viewer/2022062322/56814fa5550346895dbd6280/html5/thumbnails/22.jpg)
National Collaboration
• APCD Council (state and national data users), America’s Health Insurance Plans, and national data standards organizations (ANSI X12, NCPDP)
• Supported by the Commonwealth Fund and AHRQ
• “Harmonization” to reduce work involved
• Allow data sharing across states
• Long term goal of creating a national standard
22
![Page 23: StrataRx John Freedman MD MBA October 16, 2012](https://reader036.vdocuments.us/reader036/viewer/2022062322/56814fa5550346895dbd6280/html5/thumbnails/23.jpg)
Limitations of APCDs
• Based on claims data– Not real-time– Completeness and accuracy– Alternative payment arrangements
• Cost– Implementation and ongoing operating expenses– Still lacks a clear business model
• Access– Variable limits on access to data
• Comparability between states– Harmonization will improve comparability
23
![Page 24: StrataRx John Freedman MD MBA October 16, 2012](https://reader036.vdocuments.us/reader036/viewer/2022062322/56814fa5550346895dbd6280/html5/thumbnails/24.jpg)
Trends and Future Directions
• Power and complexity are about to explode
• Better understanding what we do and the effects that it has will make a bigger difference to health than more data about specific individuals
24