HDC Webinar Series

The Health Care Cost Institute’sNational Transparency InitiativeDr. David Newman, Health Care Cost Institute

Introduced by Dwayne Spradlin, CEO, Health Data Consortium

Health Data Consortium Webinar

David Newman,

Executive Director, HCCI

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About HCCI

HCCI is a non-profit, independent, non-partisan research institute dedicated to creating the United States’ most comprehensive source of information on health care activity and promoting research on the drivers of health care costs and utilization.

– Public mission - improving US health system by creating comprehensive data infrastructure and analytics

– Research - We currently hold claims, with allowed amounts, for more than 50 million Americans, from 2007 onward which we make available for academic, non-commercial research

Organization

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GoverningBoard

ExternalAdvisor(s)

Researchers PayersAetna

HumanaKaiser PermanenteUnitedHealthcare

Scientific ResearchCommittee (SRC)

Data Integrity Committee (DIC)

Health CareCost Institute

Non-Profit

Governing Board

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Stephanie J. Carlton, R.N., M.B.A. is currently an expert consultant at McKinsey & Company

Almeta Cooper, J.D., Associate Vice President for Health Sciences and Executive Director for HHS Advocacy, Regulatory and Quality Improvement Programs at the Wexner Medical Center at the Ohio State University

Dr. Leemore Dafny, PhD., Herman Smith Research Professor in Hospital and Health Services, and a Professor of Management and Strategy, Kellogg School of Management, Northwestern University

David Dranove, Ph.D., Walter McNerney Professor of Health Industry Management, Northwestern University

Jonathan Gruber, Ph.D., Professor of Economics, Massachusetts Institute of Technology

Stephen Parente, Ph.D., Chair, Professor of Health Finance and Insurance, University of Minnesota

Theodore A. Prospect, F.S.A., M.A.A.A., Chief Actuary, UnitedHealth Center for Health Reform and Modernization

Dale Yamamoto, F.S.A., M.A.A.A, F.C.A., Independent Actuary

Current HCCI Data

• As of April 2014, HCCI holds data on 50 million people per year (2007-2013)– Initial supporters: Aetna, Humana, Kaiser Permanente and

UnitedHealthcare; new participants: Assurant Health

– Administrative Claims; employer-sponsored insurance, individual insurance; Medicare Advantage (Part C)

– Data for every state and the District of Columbia

– Updated annually (2012 data available now); 2013 data were processed in July and available in fall

– HIPAA-compliant, de-identified.

• Hold Vermont data for generally public reporting purposes; other APCD data

Future HCCI Data

• By end of 2014– Medicare (2009-onwards) through Qualified Entity

Program • Part A (100%)

• Part B (100%)

• Part D (~40%)

• In 2015 – Tricare

– State APCDs

• Other commercial data – additional insurers

• SGR fix – Medicaid and CHIP

HCCI Reports and Issue Briefs

All free and on the web

Health Affairs

Independent Research

Academic Research Partnerships

HCCI has signed letters of intent with leading research, actuarial, and government organizations for non-commercial, non-proprietary, faculty, association and government research studies and PhD dissertations.

Academic Partners

Dartmouth Yale

Penn Michigan

Minnesota MD Anderson

Northwestern One more to be announced

Medpac Congressional Budget Office

Academy of Actuaries Society of Actuaries

A Few More Points before . . .

• HCCI does not engage in any commercial proprietary research

• The data contributors do not gain access to the combined dataset

• HCCI does not perform commercial proprietary research for the data contributors

• Everything is in the public domain and free

• We believe we are building out an essential part of the health services research infrastructure – join the effort

HCCI Transparency Tool

HCCI motivation:• Consistent with our public mission• We already had the data• By working with insurers we have the

resources to pursue

Our original interest arose around Cycle III Grant program

We can do it well – we can do it nationally. As a nonprofit, our focus will be to deliver a best valuetool

Goals of the Transparency Initiative

1. Create a common consumer experience that is the private sector equivalent to www.medicare.gov

2. Provide consumers with cost and quality information, regardless of insurance status. It will be free to consumers

3. Give consumers a credible, accurate data source through an independent nonprofit

4. Improve markets by providing accurate information to consumers

Other Benefits of the Transparency Initiative

• Achieve economies of scale in creating a single source for educating consumers that also has the deep data to inform that education

• Serve Medicaid and Medicare managed care

• Drive standards on quality and cost. More reliable reported values through the use of bigger data. [New partners around integrated delivery and new payment models.

Introducing the go-to source for independent cost and quality data

A free public-facing website:• No registration• No password• No user identifier

• We will report data in as much specificity as the ‘thickness’ allows (Nation, Region, State, MSA, zip code)

• We will report average prices paid for care, treatment and procedures by procedure and episode along with descriptive statistics

• We will provide quality information and related consumer education. This information will become more robust over time as we develop industry standards and enhance site functionality.

We are designing an effective consumer experience, easy to understand and navigate. Initial release by Dec. 31, 2014

Consumer functionality

• Baseline site will present average cost data that serves as a ‘reference price’ for consumers.

• Information will be presented in a way that explains likely experience in a care pathway– including total cost, the additive components, and quality measures, where available.

• Costs will be geography-based

• Enhancements include severity, gender, and age search to better refine cost, standardized quality information and expanded comparative ability across search dimensions.

• Members of participating payers will have access to password-protected cost and quality information to include copays, deductible, network and insurer-specific quality information.

Baseline public site (Dec 2014)

Enhancements

Member password

functionality (2015)

Who the product serves

• The tool’s primary audience will be consumers seeking health care cost information for themselves or others.

• Secondarily, the tool will provide information to interested media outlets, policy makers, providers, academics and industry experts for research or communications purposes.

• The tool will be available to anyone with a web browser and internet access.

• HCCI is talking with several states about using the site as a price/quality portal for state employees and a quality portal for Medicaid.

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Creating value through collaboration

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• HCCI’s approach to transparency is unique:• Access to unparalleled data set• Ability to bring together diverse stakeholders to gain

consensus• Serving a public, non-commercial mission

• A common industry-wide website delivers value:• For consumers: Recognize and remember one source for

reliable cost and quality information (regardless of insurance status or insurer)

• For providers: Industry-wide quality measures calculated by independent organization

• For insurers: More reliable quality point estimates, and shared investment in infrastructure

A Few More Points again . . .

• While each insurer is free to continue to maintain their own website, it is HCCI’s hope that their efforts become redundant

• When logged in, an insured can access only their insurers’ information

• Insurers will not be able to use this tool to compare their commercial arrangements

• This is not a plan compare tool for employers nor is it a tool for shopping for insurance

• Some initial discussion about having this also be a provider portal for updating networks so information is current