1
APCD Advisory Group Meeting
Access Health CT
August 10 2017
2
Todayrsquos AgendaAPCD Advisory Group Meeting
Call To Order and Introductions (5 minutes)
Public Comments (10 minutes)
Approval of Minutes (10 minutes)
Updates amp Project Status Overview (15 minutes)
APCD Data Release Update (30 minutes)
CT APCD Data - Preliminary Analysis Examples amp Showcase (30 minutes)
Next Steps (5 minutes)
Future Meetings amp Adjournment (5 minutes)
3
Public Comments
(2 Minutes per Commenter)
4
Approval of Minutes
May 11 2017 Advisory Group Meeting
5
APCD Updates amp Project
Status Overview
6
Minnesota - Analysis of Low-Value Health Services inthe Minnesota All Payer Claims Database1
Virginia - VHI Five Most Common Avoidable ER Visits2
State APCD Activity
HealthCostcom latest publicly available transparency website released3
Cost Transparency Websites
SAMHSA - Confidentiality of Alcohol and Drug Abuse Patient Records 42 CFR Part 2
National Policy Update
Recent National DevelopmentsAPCD Updates and Project Status
1) httpwwwhealthstatemnushealthreformallpayerlvsissuebriefpdf2) httpwwwalexandrianewsorg201707virginias-five-most-common-avoidable-er-visits3) httpswwwhealthcostcomconsumer4) httpswwwcgactgov2017actpa2017PA-00154-R00SB-00546-PAhtm
PA 17-154 ndash An Act Concerning Participating Provider Directories4
State Policy Update
7
01Task
02Task
03Task
Ensure data quality issues are identified documented communicated and resolved
Data Quality
Promote data usage as a form of data QA
Preliminary Reporting
Continue building breadth of payer database amp complete enclave load
Data ETL
Identify leading consumer information and price transparency tools available
Consumer Tool Evaluation05Task
Finalize strategy to ensure site accomplishes PA 13-247 and PA 15-146 intent
Establish Strategy06Task
Ensure APCD staff can generate self-service extracts at little cost with minimal lead time
Extract Development04Task
Target Initiatives Since Last MeetingAPCD Development and Strategy Update
Distinguish Critical Paths Across and Within Strategic Priorities and Maintain Focus on ldquoMust Havesrdquo and ldquoQuick Winsrdquo
8
Accomplishments Since Last MeetingAPCD Updates and Project Status
Data Collection Status2016 Commercial data normalization and load into enclave to be completed by May 15th
Data Release Architecture CompletePreliminary data dictionary released Data release extract tool development nearly complete
Medicare Data ApprovedApplication for CMS Medicare data approved Data received and integration in progress
Data Release Training and CoordinationData Release Committee re-engaged and 1st release review scheduled August16th
Preliminary Analysis and End User FeedbackPopulation segmentation and profiling underway value added tables amp software in various phases of implementation (knowledge bases risk scoring software etc)
First Data Release Application1st completed data release application received
9
Data Collection Status UpdateAPCD Updates and Project Status
Eligibility Medical Pharmacy ProviderStatusNotesStart Date End Date Start Date End Date Start Date End Date Start Date End Date
AetnaAetna Health Insurance HMO FI 012012 062017 012012 062017 012012 062017 012012 062017 Submitter is current with file submissions to OnpointAetna Health Insurance HMO on ACAS FI 012012 062017 012012 062017 012012 062017 NA NA Submitter is current with file submissions to OnpointAetna Life Insurance Company Aetna Student Health 012012 062017 012012 062017 NA NA 012012 062017 Submitter is current with file submissions to OnpointAetna Life Insurance Company HMO Medicare 012012 062017 012012 062017 012012 062017 NA NA Submitter is current with file submissions to OnpointAetna Life Insurance Company Traditional 012012 062017 012012 062017 012012 062017 012012 062017 Submitter is current with file submissions to Onpoint
Anthem012012 012017 012012 012017 012012 012017 012012 012017 Submitter to resume data submissions in October 2017
Caremark LLC012012 062017 NA NA 012012 062017 NA NA Submitter is current with file submissions to Onpoint
CignaCigna Health and Life Insurance Company Inc - West 012012 062017 012012 062017 012012 062017 012012 062017 Submitter is current with file submissions to OnpointCigna Health and Life Insurance Company Inc - East 012012 062017 012012 062017 012012 062017 012012 062017 Submitter is current with file submissions to Onpoint
ConnectiCareConnectiCare 012012 052017 012012 052017 012012 052017 012012 052017 Submitter has not yet supplied June 2017 file submissionsConnectiCare Inc - Medicare Advantage 012012 052017 012012 052017 012012 012017 012012 052017 Submitter has not yet supplied June 2017 file submissions
Express Scripts- - NA NA - - NA NA Submitter supplied January 2012 test files on 872017
First Health Life and Health Insurance Company012012 062017 NA NA 012012 062017 NA NA Submitter is current with file submissions to Onpoint
Harvard Pilgrim012012 062017 012012 062017 012012 062017 012012 062017 Submitter is current with file submissions to Onpoint
HealthyCT012014 122014 012014 122014 012014 122014 012014 122014 Submitter no longer active with the CT APCD
United Health GroupeviCore (UHC - Oxford) NA NA 012015 042017 - - 012012 042017 Submitter has not yet supplied May - June 2017 file submissionsOptumHealth Care Solutions Inc (Optum) NA NA 012012 062017 NA NA 012012 062017 Submitter is current with file submissions to OnpointOrthoNet NA NA 012012 062017 NA NA NA NA Submitter is current with file submissions to OnpointOxford Health Plans 012012 062017 012012 052017 012012 062017 012012 062017 Submitter has not yet supplied June 2017 medical claims fileUHC - Golden Rule 012012 062017 012012 062017 012012 062017 012012 062017 Submitter is current with file submissions to OnpointUnitedHealthcare Insurance - Medicare 012012 062017 012012 062017 012012 062017 012012 062017 Submitter is current with file submissions to OnpointUnitedHealthcare Insurance Company 012012 062017 012012 062017 012012 062017 012012 062017 Submitter is current with file submissions to Onpoint
WellCare Health Plans Inc012012 062017 012012 062017 012012 122015 012012 062017 Submitter is current with file submissions to Onpoint
Medicaid- - - - - - - -
Medicare- - - - - - - - Data received 82017
Submission D
elay lt 3 Months or Integration In Progress
Submission O
n Schedule
Submission N
ot Scheduled or ge 3 Months D
elayed
10
APCD Data Release
Update
11
Develop and implement core requirements to achieve DRcapabilities
Administration Data release application dictionary ampsupport materialsSoftwareTools Extract creation and delivery toolSupport Admin support and documentation
Phase 1 Develop DR Process Tools and CapabilitiesEngage potential requestors to ensurecapabilities opportunities and services arerecognized
Phase 2 Promotion and Delivery
Data Release (DR) RecapAPCD Data Release Update
Legislative Charge (PA 13-247) The exchange shall helliphellip and (B) make data in the all-payer claims database available to any state agency insurer employer health care provider consumer of health care services or researcher for the purpose of allowing such person or entity to review such data as it relates to health care utilization costs or quality of health care services
12
End to End application process can take between 17 to 40days depending on time of month an application issubmitted All requests must follow the data releaseprocess outlined by Privacy Policy amp Procedures
Data Release ApplicationRequestor general information project summary research details data selection and securityintegrity
Data Release CommitteeReview application alignment with objectives re-identification risk safeguard adequacy and research design
Data Use Agreement Fees amp ExtractUser agrees to fee schedule DUA requirements Standard extract creation within 5 business days (after 1st release)
S M T W T F S
1 2 3 4 5
6 7 8 9 10 11 12
13 14 15 16 17 18 19
20 21 22 23 24 25 26
27 28 29 39 31
DR Process amp Turn-Around TimeAPCD Data Release Update
13
DR TableField Classification MatrixAPCD Data Release Update
Table Name
Field Classifications
Administrative
Enrollee Coverage
InformationEnrollee
DemographicsClaim
InformationDiagnosis
Information
Procedure Coding amp
DetailFinancial
InformationProvider
InformationPayer
InformationSafe Harbor
Variable Grand TotalEligibility 2 11 1 1 1 1 4 21
Eligibility Supplemental 2 13 9 4 28
Medical 2 3 13 2 7 8 4 1 6 46
Medical Claim Header 2 5 7
Medical Supplemental 4 6 3 11 1 6 31
Medical Claim Diagnosis 1 3 1 5
Medical Claim Icd Procedure 2 14 5 4 1 26
Pharmacy 3 3 11 2 9 2 1 3 34
Pharmacy Supplemental 2 8 4 1 15
Provider 3 2 1 6Grand Total 23 30 10 55 10 15 41 10 5 20 219
Data Release Dictionary Located httpagencyaccesshealthctcommeetings1485450397264-a8f3a430-837b
14
ProviderFacility Directory
512k Unique National Provider Identifiers
Pharmacy Claims
All claimsencounters paid by submitting carrier
Data includes info on Administrative Enrollee Coverage Claim Detail Diagnosis Codes Procedure Codes Financials Payers Providers Safe Harbor (12)
1273M Claims $125B
Medical Claims
All claimsencounters paid by submitting carrier
Data includes info on Administrative Enrollee Coverage Claim Detail Diagnosis Codes Procedure Codes Financials Payers Providers Safe Harbor (12)
747M Claims $304B
Enrollees
CY 2012 ndash Present (n- 1 month)
Data includes info on Administrative Enrollee Coverage Enrollee Demographics Financials Payers Providers Safe Harbor (2)Fully insuredNon-ERISA plans (~900k Lives)
Whatrsquos Available Through DRAPCD Data Release Update
Billing rendering prescribing pharmacy primary care provider IDs (varying completion rate)
Data includes info on Unblended and composite provider IDs and NPIs
15
ERISALives covered under self-
insured ERISA plans
Part 2 SUD claimsSUD claims provided by
Part 2 providers
Denied ClaimsFully denied claims not
collected
Test Result ValuesLab imaging biometrics
and physician derived data
Third Party Data Risk scoring social
determinants knowledge base etc
Dental ClaimsDental claims not required
for submission
Ancillary FinancialsPlan premiums capitation payments performance
payments administrative fees
Whatrsquos Not Available Through DRAPCD Data Release Update
HIPAA Safe Harbor Variables18 HIPAA identifiers
16
18 HIPAA identifiers removed from dataset
Identifiers removed as set forth in 45 CFR 164514
De-identification
De-Identified Data ReleaseAPCD Data Release Update
Age caps applied (over 89 less than 1) amp geography reduced to 3 digit zip
All dates related to service and payments masked
First three digits of zip codes only if the geographic area covered by all zip codes beginning with those three digits has a population greater than 20000 or the zip codes for those areas are changed to 000 in the data set
Supplementary safeguards imposed to reduce unique characteristics
17
Partnerships LicensingAccessibilityValue Add DataProcess
Improvement
Identify third party data that can supplement and enrich within release requirements
Third Party DataIdentify areas of process
improvement and automation
ScalabilityEstablish enclave capability
upon needdemand
Extract v EnclaveIdentify areas of opportunity for ongoing multiple use by
institutions
Engagement
Potential Future ImprovementsAPCD Data Release Update
18
AUGUST
16SEPTEMBER
7SEPTEMBER
15SEPTEMBER
22Committee review and
vote on first data request application
from UConn
DATA RELEASE COMMITTEE MEETING
To be canceled if no additional applications
submitted
DATA RELEASE COMMITTEE MEETING
Review and confirmation of de-
identification methods and implementation
EXTRACT AUDIT
Extract delivered and support channel
opened
DATA RELEASE
Data release activities within the next two months include
Open Action ItemsAPCD Data Release Update
Project Descriptions
bull State Innovation Modelndash Online dashboard of ~30 pace and performance measures
bull Used to monitor performance of SIM bull 12 measures use APCD databull Includes yearly targets for overall Connecticut
ndash Online Scorecard Online dashboard of FQHC and Advanced Network performancebull First health care performance scorecard in CTbull Provides transparency in provider performancebull Utilizes claims based measures from common scorecard and CAHPS surveys
bull Suicide Risk Identificationndash Improves identification of patients at risk of suicide
bull Utilizes APCD claims data EHR data from 5 health care providers and mortality databull Creation of phenotypic algorithm
19
APCD Based Dashboard Measures
Health Care DeliveryPercent of adults with regular source of careChildren well-child visits for at-risk popMammograms for women gt50 last 2 yearsOptimal diabetes care- 2+ annual A1c testsED use- asthma as primary dx (per 10k)
Percent of adults with HTN taking HTN medsFollow-Up after Discharge from the Emergency Department for Mental Health or Alcohol or other Drug
Follow-Up after Hospitalization for Mental Illness
Antidepressant Medication ManagementInitiation and Engagement of Alcohol and Other Drug Dependence Treatment
Health Care Costs
Cost of inpatient care PMPY
Cost of outpatient care PMPY
httpwwwpublichealthuconnedusim_dashhtmlohriNav=7C
Scorecard MeasuresReporting Only
Coordination of Care30 day readmission
PCPs that meet Meaningful Use
Prevention
Non-recommended Cervical Cancer Screening in Adolescent Female
Well-child visits in the third fourth fifth and sixth years of life (Medicaid only)
Frequency of Ongoing Prenatal Care (FPC)
Oral Evaluation Dental Services (Medicaid only)
Acute and Chronic Care
Cardiac strss img Testing in asymptomatic low risk patients
Behavioral HealthAdult major depressive disorder (MDD) Coordination of care of patients with specific co-morbid conditions
Anti-Depressant Medication Management
Initiation and Engagement of Alcohol and Other Drug Dependence Treatment
Follow up after hospitalization for mental illness 7 amp 30 days
21
Provisional Core Measure SetCare CoordinationPlan all-cause readmissionAnnual monitoring for persistent medications (roll-up)PreventionBreast cancer screeningCervical cancer screeningChlamydia screening in womenAdolescent female immunizations HPV
Weight assessment and counseling for nutrition and physical activity for childrenadolescents
Well-child visits in the first 15 months of lifeAdolescent well-care visitsBehavioral health screening (pediatric Medicaid only custom measure)
Acute amp Chronic Care
Medication management for people w asthma
DM HbA1c Testing
DM Diabetes medical attention for nephropathy
Use of imaging studies for low back pain
Avoidance of antibiotic treatment in adults with acute bronchitis
Appr treatment for children with upper respiratory infection
Behavioral Health
Follow-up care for children prescribed ADHD medicationMetabolic Monitoring for Children and Adolescents on Antipsychotics (pediatric Medicaid only custom measure)
Suicide Risk Identification
22
23
CT APCD Data -
Preliminary Analysis
Examples amp Showcase
Title XxSubtitle Xx
Presenter TitleDate
24Proprietary and Confidential 24
Connecticut APCDPreliminary Analysis Examples amp Showcase
CT APCD Advisory Group Meeting August 10 2017
25
bull Data source CY2016 commercial data from the CT APCDbull Focus commercial population-based reportingbull Considerations risk adjustment for age gender and health statusbull Areas of exploration
ndash Multiple views of the CT APCD population total members health exchange members members with diabetes
ndash Expenditures utilization and effective and preventive care ratesndash Analysis by multiple geographic units county Hospital Service
Area (HSA) and Health Reference Group (HRG) bull Conclusion Recap and lessons learned
Presentation Overview
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
26
bull Member Any person covered in a submitterrsquos eligibility databull Average Members Member months divided by 12 (months)bull Expenditures Allowed amount bull Capping Capped outliers in the data at the 99th percentilebull Clinical Risk Groups Individualsrsquo categorized health statusbull County Administrative focus areasbull Hospital Service Area Local hospital marketsbull Health Reference Group Community types bull Rates Expenditures by average membersbull Risk Adjustment Adjusting for differences between member
populations by considering membersrsquo age gender and health status
Key Terms
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
27
Population-Based Reporting
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
bull Reporting units county modified Hospital Service Area (HSA) and Health Reference Group (HRG)
bull Risk adjustment age gender and health status (3M CRGs)
28
CT APCD Population Overview
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Measure Count
Unique Members 875129
Total Member Months 9122482
Average Members 760207
Total Expenditures $40 Billion
Total Expenditures Per Member Per Year (PMPY) $5255
Total Expenditures Per Member Per Month (PMPM) $438
Total expenditures are capped at the 99th percentile
29
Expenditures PMPY by Age amp Gender
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$0
$1000
$2000
$3000
$4000
$5000
$6000
$7000
$8000
$9000
0-18 Female 0-18 Male 18-34 Female 18-34 Male 35-44 Female 35-44 Male 45-54 Female 45-54 Male 55-64 Female 55-64 Male
30
Expenditures PMPY by CRGs
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$-
$5000
$10000
$15000
$20000
$25000
$30000
$35000
$40000
Healthy Acute or Minor Chronic Moderate Chronic Significant Chronic Cancer or Catastrophic
$0
31
CT Health Exchange Population Overview
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
MeasureExchange Members
Non-Exchange Members
Average Members 86941 673266
Percentage of Members 55-64 Years of Age 31 20
Percentage of Members with Chronic Condition(s) 23 19
Expenditures PMPY $5378 $5239
Expenditures PMPY Risk Adjusted $4780 $5316 Expenditures PMPY for Members with Diabetes Risk-Adjusted $17561 $19291
32
CT Exchange vs Non-Exchange Rates
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Rate per 1000 Rate per 1000 (Risk Adj)
Measure Exchange Members
Non-Exchange Members
Exchange Members
Non-Exchange Members
Inpatient Acute Visits 390 328 339 335Medical 210 144 181 147Surgical 140 116 115 119Maternity 41 69 41 69
Outpatient Emergency Visits 1941 1924 1944 1923MRIs 920 803 810 817CT Scans 1108 824 938 844Primary Care Office Visits 15216 18755 16068 18628Psychiatric Visits 9864 9783 9783 11092Chiropractic Visits 3403 7808 3088 7913
Utilization measures are capped at the 99th percentile
33
Expenditure PMPY Diabetes Population
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$-
$5000
$10000
$15000
$20000
$25000
$30000
No Diabetes (n=730838) Diabetes amp no comorbidity (n=16419) Diabetes with comorbidity (n=12950)$0
No Diabetes (n = 730838)
Diabetes No Comorbidity(n = 16419)
Diabetes Comorbidity(n = 12950)
34
Vermont Blueprint for HealthDiabetes HbA1c Control amp Outcomes
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Measure HbA1c in Control HbA1c Not in Control
Members 5619 786
Average annual expenditures per capita
$15726 ($15219 $16233)
$17328 ($16110 $18546)
Inpatient hospitalizations per 1000 members
1897 (1782 2011)
2531 (2177 2886)
Inpatient days per 1000 members
8685 (8440 8930)
11561 (10804 12318)
Outpatient ED visits per 1000 members
6275 (6067 6483)
8011 (7381 8642)
Risk-adjusted rates and 95 confidence intervals 99th percentile outliers excluded HbA1c not in control gt9
35
Expenditures PMPY by County
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
County Average Members Expenditures PMPYExpenditures PMPY
(Risk Adjusted)Fairfield 223295 $5182 $5539 New London 44741 $5913 $5342 New Haven 161763 $5494 $5335 Middlesex 38531 $5359 $5184 Litchfield 43224 $5136 $5118 Tolland 36304 $5047 $5019 Hartford 191415 $4998 $4958 Windham 20934 $5539 $4950
Total 760207 $5255 $5255
36
Expenditures PMPY by HSA Risk Adjusted
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$0
$1000
$2000
$3000
$4000
$5000
$6000
$7000
37
EffectivePreventive Care
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
HEDIS MeasureCT APCD
CommercialNCQA
National HMONCQA
National PPOAvoidance of Antibiotic Treatment in Adults with Acute Bronchitis 268 276 258Anti-Depressant Medication Management 764 664 666Well-Child Visits 798 762 723Breast Cancer Screening 671 732 696
NCQA National HMO and NCQA National PPO benchmark metrics calculated for CY2015 Several other HEDIS measures can be run using the CT APCD data set and compared against the NCQA National HMO and PPO benchmarks Examples include Comprehensive Diabetes Care ndash HbA1C Testing Comprehensive Diabetes Care ndash Medical Attention for Nephrology Comprehensive Diabetes Care ndash Eye Exam Performed Adolescent Well-Care Visits Appropriate Treatment for Children with Upper Respiratory Infection etc
38
Breast Cancer Screening
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
60
62
64
66
68
70
72
Urban Centers (n=3369) Manufacturing Centers (n=10974) Diverse Suburbs (n=12206) Mill Towns (n=16281) Rural Towns (n=16789) Wealthy Suburbs (n=12266)
39
Vermont Blueprintrsquos Hub amp Spoke Model
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
bull Vermontrsquos ldquoHealth Homerdquo program designed to treat Vermonters with chronic opioid addiction
bull Hubs ndash designated providers ndash Provide coordinated care to patients through MAT services
ndash Coordinate referral to ongoing care
bull Spokes ndash teams of healthcare professionalsndash Blueprint Advanced Practice Medical Homes
ndash Federally-Qualified Health Centers
ndash Outpatient substance abuse and primary care providers
40copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Medication Assisted Treatment
bull Vermont Blueprint baseline study comparing medication-assisted treatment (MAT) population versus non-MAT population
bull Study published in the Journal of Substance Abuse Treatment (August 2016)
41
bull The CT APCD is a comparable resource to other statewide APCDs ndash A powerful tool that will only continue to grow with usendash Encompasses a robust set of information including
expenditures procedure codes diagnosis coding drug codes and enhanced value-adds (eg claim type master membermaster provider IDsNPIs MS-DRGs etc)
bull Future considerations to enhance the CT APCDndash Add Medicare and Medicaid claims datandash Continue to strengthen the completeness and validity of data
elements of importance to downstream analytic use cases (eg member race and ethnicity codes) in data collection
Lessons Learned
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
43
Next Steps
44
01Task
02Task
Ensure data quality issues are identified documented communicated and resolved
Data Quality
Continue building breadth of payer database amp complete enclave load
Data ETL
Finalize strategy to ensure site accomplishes PA 13-247 and PA 15-146 intent
Establish Strategy
05Task
Identify leading consumer information and price transparency tools available
Consumer Tool Evaluation04Task
Tasks Until Next Meeting (11917)APCD Development and Strategy Update
Distinguish Critical Paths Across and Within Strategic Priorities and Maintain Focus on ldquoMust Havesrdquo and ldquoQuick Winsrdquo
Ensure APCD staff can generate self-service extracts at little cost with minimal lead time
Deliver First DR Extract03Task
45
Future MeetingsAPCD Development and Strategy Update
November
9Legislative Office
Building Room 1D 300 Capitol Avenue
Hartford
All Payer Claims Database Advisory GroupMeeting
900ndash1100 AM
2
Todayrsquos AgendaAPCD Advisory Group Meeting
Call To Order and Introductions (5 minutes)
Public Comments (10 minutes)
Approval of Minutes (10 minutes)
Updates amp Project Status Overview (15 minutes)
APCD Data Release Update (30 minutes)
CT APCD Data - Preliminary Analysis Examples amp Showcase (30 minutes)
Next Steps (5 minutes)
Future Meetings amp Adjournment (5 minutes)
3
Public Comments
(2 Minutes per Commenter)
4
Approval of Minutes
May 11 2017 Advisory Group Meeting
5
APCD Updates amp Project
Status Overview
6
Minnesota - Analysis of Low-Value Health Services inthe Minnesota All Payer Claims Database1
Virginia - VHI Five Most Common Avoidable ER Visits2
State APCD Activity
HealthCostcom latest publicly available transparency website released3
Cost Transparency Websites
SAMHSA - Confidentiality of Alcohol and Drug Abuse Patient Records 42 CFR Part 2
National Policy Update
Recent National DevelopmentsAPCD Updates and Project Status
1) httpwwwhealthstatemnushealthreformallpayerlvsissuebriefpdf2) httpwwwalexandrianewsorg201707virginias-five-most-common-avoidable-er-visits3) httpswwwhealthcostcomconsumer4) httpswwwcgactgov2017actpa2017PA-00154-R00SB-00546-PAhtm
PA 17-154 ndash An Act Concerning Participating Provider Directories4
State Policy Update
7
01Task
02Task
03Task
Ensure data quality issues are identified documented communicated and resolved
Data Quality
Promote data usage as a form of data QA
Preliminary Reporting
Continue building breadth of payer database amp complete enclave load
Data ETL
Identify leading consumer information and price transparency tools available
Consumer Tool Evaluation05Task
Finalize strategy to ensure site accomplishes PA 13-247 and PA 15-146 intent
Establish Strategy06Task
Ensure APCD staff can generate self-service extracts at little cost with minimal lead time
Extract Development04Task
Target Initiatives Since Last MeetingAPCD Development and Strategy Update
Distinguish Critical Paths Across and Within Strategic Priorities and Maintain Focus on ldquoMust Havesrdquo and ldquoQuick Winsrdquo
8
Accomplishments Since Last MeetingAPCD Updates and Project Status
Data Collection Status2016 Commercial data normalization and load into enclave to be completed by May 15th
Data Release Architecture CompletePreliminary data dictionary released Data release extract tool development nearly complete
Medicare Data ApprovedApplication for CMS Medicare data approved Data received and integration in progress
Data Release Training and CoordinationData Release Committee re-engaged and 1st release review scheduled August16th
Preliminary Analysis and End User FeedbackPopulation segmentation and profiling underway value added tables amp software in various phases of implementation (knowledge bases risk scoring software etc)
First Data Release Application1st completed data release application received
9
Data Collection Status UpdateAPCD Updates and Project Status
Eligibility Medical Pharmacy ProviderStatusNotesStart Date End Date Start Date End Date Start Date End Date Start Date End Date
AetnaAetna Health Insurance HMO FI 012012 062017 012012 062017 012012 062017 012012 062017 Submitter is current with file submissions to OnpointAetna Health Insurance HMO on ACAS FI 012012 062017 012012 062017 012012 062017 NA NA Submitter is current with file submissions to OnpointAetna Life Insurance Company Aetna Student Health 012012 062017 012012 062017 NA NA 012012 062017 Submitter is current with file submissions to OnpointAetna Life Insurance Company HMO Medicare 012012 062017 012012 062017 012012 062017 NA NA Submitter is current with file submissions to OnpointAetna Life Insurance Company Traditional 012012 062017 012012 062017 012012 062017 012012 062017 Submitter is current with file submissions to Onpoint
Anthem012012 012017 012012 012017 012012 012017 012012 012017 Submitter to resume data submissions in October 2017
Caremark LLC012012 062017 NA NA 012012 062017 NA NA Submitter is current with file submissions to Onpoint
CignaCigna Health and Life Insurance Company Inc - West 012012 062017 012012 062017 012012 062017 012012 062017 Submitter is current with file submissions to OnpointCigna Health and Life Insurance Company Inc - East 012012 062017 012012 062017 012012 062017 012012 062017 Submitter is current with file submissions to Onpoint
ConnectiCareConnectiCare 012012 052017 012012 052017 012012 052017 012012 052017 Submitter has not yet supplied June 2017 file submissionsConnectiCare Inc - Medicare Advantage 012012 052017 012012 052017 012012 012017 012012 052017 Submitter has not yet supplied June 2017 file submissions
Express Scripts- - NA NA - - NA NA Submitter supplied January 2012 test files on 872017
First Health Life and Health Insurance Company012012 062017 NA NA 012012 062017 NA NA Submitter is current with file submissions to Onpoint
Harvard Pilgrim012012 062017 012012 062017 012012 062017 012012 062017 Submitter is current with file submissions to Onpoint
HealthyCT012014 122014 012014 122014 012014 122014 012014 122014 Submitter no longer active with the CT APCD
United Health GroupeviCore (UHC - Oxford) NA NA 012015 042017 - - 012012 042017 Submitter has not yet supplied May - June 2017 file submissionsOptumHealth Care Solutions Inc (Optum) NA NA 012012 062017 NA NA 012012 062017 Submitter is current with file submissions to OnpointOrthoNet NA NA 012012 062017 NA NA NA NA Submitter is current with file submissions to OnpointOxford Health Plans 012012 062017 012012 052017 012012 062017 012012 062017 Submitter has not yet supplied June 2017 medical claims fileUHC - Golden Rule 012012 062017 012012 062017 012012 062017 012012 062017 Submitter is current with file submissions to OnpointUnitedHealthcare Insurance - Medicare 012012 062017 012012 062017 012012 062017 012012 062017 Submitter is current with file submissions to OnpointUnitedHealthcare Insurance Company 012012 062017 012012 062017 012012 062017 012012 062017 Submitter is current with file submissions to Onpoint
WellCare Health Plans Inc012012 062017 012012 062017 012012 122015 012012 062017 Submitter is current with file submissions to Onpoint
Medicaid- - - - - - - -
Medicare- - - - - - - - Data received 82017
Submission D
elay lt 3 Months or Integration In Progress
Submission O
n Schedule
Submission N
ot Scheduled or ge 3 Months D
elayed
10
APCD Data Release
Update
11
Develop and implement core requirements to achieve DRcapabilities
Administration Data release application dictionary ampsupport materialsSoftwareTools Extract creation and delivery toolSupport Admin support and documentation
Phase 1 Develop DR Process Tools and CapabilitiesEngage potential requestors to ensurecapabilities opportunities and services arerecognized
Phase 2 Promotion and Delivery
Data Release (DR) RecapAPCD Data Release Update
Legislative Charge (PA 13-247) The exchange shall helliphellip and (B) make data in the all-payer claims database available to any state agency insurer employer health care provider consumer of health care services or researcher for the purpose of allowing such person or entity to review such data as it relates to health care utilization costs or quality of health care services
12
End to End application process can take between 17 to 40days depending on time of month an application issubmitted All requests must follow the data releaseprocess outlined by Privacy Policy amp Procedures
Data Release ApplicationRequestor general information project summary research details data selection and securityintegrity
Data Release CommitteeReview application alignment with objectives re-identification risk safeguard adequacy and research design
Data Use Agreement Fees amp ExtractUser agrees to fee schedule DUA requirements Standard extract creation within 5 business days (after 1st release)
S M T W T F S
1 2 3 4 5
6 7 8 9 10 11 12
13 14 15 16 17 18 19
20 21 22 23 24 25 26
27 28 29 39 31
DR Process amp Turn-Around TimeAPCD Data Release Update
13
DR TableField Classification MatrixAPCD Data Release Update
Table Name
Field Classifications
Administrative
Enrollee Coverage
InformationEnrollee
DemographicsClaim
InformationDiagnosis
Information
Procedure Coding amp
DetailFinancial
InformationProvider
InformationPayer
InformationSafe Harbor
Variable Grand TotalEligibility 2 11 1 1 1 1 4 21
Eligibility Supplemental 2 13 9 4 28
Medical 2 3 13 2 7 8 4 1 6 46
Medical Claim Header 2 5 7
Medical Supplemental 4 6 3 11 1 6 31
Medical Claim Diagnosis 1 3 1 5
Medical Claim Icd Procedure 2 14 5 4 1 26
Pharmacy 3 3 11 2 9 2 1 3 34
Pharmacy Supplemental 2 8 4 1 15
Provider 3 2 1 6Grand Total 23 30 10 55 10 15 41 10 5 20 219
Data Release Dictionary Located httpagencyaccesshealthctcommeetings1485450397264-a8f3a430-837b
14
ProviderFacility Directory
512k Unique National Provider Identifiers
Pharmacy Claims
All claimsencounters paid by submitting carrier
Data includes info on Administrative Enrollee Coverage Claim Detail Diagnosis Codes Procedure Codes Financials Payers Providers Safe Harbor (12)
1273M Claims $125B
Medical Claims
All claimsencounters paid by submitting carrier
Data includes info on Administrative Enrollee Coverage Claim Detail Diagnosis Codes Procedure Codes Financials Payers Providers Safe Harbor (12)
747M Claims $304B
Enrollees
CY 2012 ndash Present (n- 1 month)
Data includes info on Administrative Enrollee Coverage Enrollee Demographics Financials Payers Providers Safe Harbor (2)Fully insuredNon-ERISA plans (~900k Lives)
Whatrsquos Available Through DRAPCD Data Release Update
Billing rendering prescribing pharmacy primary care provider IDs (varying completion rate)
Data includes info on Unblended and composite provider IDs and NPIs
15
ERISALives covered under self-
insured ERISA plans
Part 2 SUD claimsSUD claims provided by
Part 2 providers
Denied ClaimsFully denied claims not
collected
Test Result ValuesLab imaging biometrics
and physician derived data
Third Party Data Risk scoring social
determinants knowledge base etc
Dental ClaimsDental claims not required
for submission
Ancillary FinancialsPlan premiums capitation payments performance
payments administrative fees
Whatrsquos Not Available Through DRAPCD Data Release Update
HIPAA Safe Harbor Variables18 HIPAA identifiers
16
18 HIPAA identifiers removed from dataset
Identifiers removed as set forth in 45 CFR 164514
De-identification
De-Identified Data ReleaseAPCD Data Release Update
Age caps applied (over 89 less than 1) amp geography reduced to 3 digit zip
All dates related to service and payments masked
First three digits of zip codes only if the geographic area covered by all zip codes beginning with those three digits has a population greater than 20000 or the zip codes for those areas are changed to 000 in the data set
Supplementary safeguards imposed to reduce unique characteristics
17
Partnerships LicensingAccessibilityValue Add DataProcess
Improvement
Identify third party data that can supplement and enrich within release requirements
Third Party DataIdentify areas of process
improvement and automation
ScalabilityEstablish enclave capability
upon needdemand
Extract v EnclaveIdentify areas of opportunity for ongoing multiple use by
institutions
Engagement
Potential Future ImprovementsAPCD Data Release Update
18
AUGUST
16SEPTEMBER
7SEPTEMBER
15SEPTEMBER
22Committee review and
vote on first data request application
from UConn
DATA RELEASE COMMITTEE MEETING
To be canceled if no additional applications
submitted
DATA RELEASE COMMITTEE MEETING
Review and confirmation of de-
identification methods and implementation
EXTRACT AUDIT
Extract delivered and support channel
opened
DATA RELEASE
Data release activities within the next two months include
Open Action ItemsAPCD Data Release Update
Project Descriptions
bull State Innovation Modelndash Online dashboard of ~30 pace and performance measures
bull Used to monitor performance of SIM bull 12 measures use APCD databull Includes yearly targets for overall Connecticut
ndash Online Scorecard Online dashboard of FQHC and Advanced Network performancebull First health care performance scorecard in CTbull Provides transparency in provider performancebull Utilizes claims based measures from common scorecard and CAHPS surveys
bull Suicide Risk Identificationndash Improves identification of patients at risk of suicide
bull Utilizes APCD claims data EHR data from 5 health care providers and mortality databull Creation of phenotypic algorithm
19
APCD Based Dashboard Measures
Health Care DeliveryPercent of adults with regular source of careChildren well-child visits for at-risk popMammograms for women gt50 last 2 yearsOptimal diabetes care- 2+ annual A1c testsED use- asthma as primary dx (per 10k)
Percent of adults with HTN taking HTN medsFollow-Up after Discharge from the Emergency Department for Mental Health or Alcohol or other Drug
Follow-Up after Hospitalization for Mental Illness
Antidepressant Medication ManagementInitiation and Engagement of Alcohol and Other Drug Dependence Treatment
Health Care Costs
Cost of inpatient care PMPY
Cost of outpatient care PMPY
httpwwwpublichealthuconnedusim_dashhtmlohriNav=7C
Scorecard MeasuresReporting Only
Coordination of Care30 day readmission
PCPs that meet Meaningful Use
Prevention
Non-recommended Cervical Cancer Screening in Adolescent Female
Well-child visits in the third fourth fifth and sixth years of life (Medicaid only)
Frequency of Ongoing Prenatal Care (FPC)
Oral Evaluation Dental Services (Medicaid only)
Acute and Chronic Care
Cardiac strss img Testing in asymptomatic low risk patients
Behavioral HealthAdult major depressive disorder (MDD) Coordination of care of patients with specific co-morbid conditions
Anti-Depressant Medication Management
Initiation and Engagement of Alcohol and Other Drug Dependence Treatment
Follow up after hospitalization for mental illness 7 amp 30 days
21
Provisional Core Measure SetCare CoordinationPlan all-cause readmissionAnnual monitoring for persistent medications (roll-up)PreventionBreast cancer screeningCervical cancer screeningChlamydia screening in womenAdolescent female immunizations HPV
Weight assessment and counseling for nutrition and physical activity for childrenadolescents
Well-child visits in the first 15 months of lifeAdolescent well-care visitsBehavioral health screening (pediatric Medicaid only custom measure)
Acute amp Chronic Care
Medication management for people w asthma
DM HbA1c Testing
DM Diabetes medical attention for nephropathy
Use of imaging studies for low back pain
Avoidance of antibiotic treatment in adults with acute bronchitis
Appr treatment for children with upper respiratory infection
Behavioral Health
Follow-up care for children prescribed ADHD medicationMetabolic Monitoring for Children and Adolescents on Antipsychotics (pediatric Medicaid only custom measure)
Suicide Risk Identification
22
23
CT APCD Data -
Preliminary Analysis
Examples amp Showcase
Title XxSubtitle Xx
Presenter TitleDate
24Proprietary and Confidential 24
Connecticut APCDPreliminary Analysis Examples amp Showcase
CT APCD Advisory Group Meeting August 10 2017
25
bull Data source CY2016 commercial data from the CT APCDbull Focus commercial population-based reportingbull Considerations risk adjustment for age gender and health statusbull Areas of exploration
ndash Multiple views of the CT APCD population total members health exchange members members with diabetes
ndash Expenditures utilization and effective and preventive care ratesndash Analysis by multiple geographic units county Hospital Service
Area (HSA) and Health Reference Group (HRG) bull Conclusion Recap and lessons learned
Presentation Overview
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
26
bull Member Any person covered in a submitterrsquos eligibility databull Average Members Member months divided by 12 (months)bull Expenditures Allowed amount bull Capping Capped outliers in the data at the 99th percentilebull Clinical Risk Groups Individualsrsquo categorized health statusbull County Administrative focus areasbull Hospital Service Area Local hospital marketsbull Health Reference Group Community types bull Rates Expenditures by average membersbull Risk Adjustment Adjusting for differences between member
populations by considering membersrsquo age gender and health status
Key Terms
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
27
Population-Based Reporting
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
bull Reporting units county modified Hospital Service Area (HSA) and Health Reference Group (HRG)
bull Risk adjustment age gender and health status (3M CRGs)
28
CT APCD Population Overview
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Measure Count
Unique Members 875129
Total Member Months 9122482
Average Members 760207
Total Expenditures $40 Billion
Total Expenditures Per Member Per Year (PMPY) $5255
Total Expenditures Per Member Per Month (PMPM) $438
Total expenditures are capped at the 99th percentile
29
Expenditures PMPY by Age amp Gender
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$0
$1000
$2000
$3000
$4000
$5000
$6000
$7000
$8000
$9000
0-18 Female 0-18 Male 18-34 Female 18-34 Male 35-44 Female 35-44 Male 45-54 Female 45-54 Male 55-64 Female 55-64 Male
30
Expenditures PMPY by CRGs
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$-
$5000
$10000
$15000
$20000
$25000
$30000
$35000
$40000
Healthy Acute or Minor Chronic Moderate Chronic Significant Chronic Cancer or Catastrophic
$0
31
CT Health Exchange Population Overview
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
MeasureExchange Members
Non-Exchange Members
Average Members 86941 673266
Percentage of Members 55-64 Years of Age 31 20
Percentage of Members with Chronic Condition(s) 23 19
Expenditures PMPY $5378 $5239
Expenditures PMPY Risk Adjusted $4780 $5316 Expenditures PMPY for Members with Diabetes Risk-Adjusted $17561 $19291
32
CT Exchange vs Non-Exchange Rates
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Rate per 1000 Rate per 1000 (Risk Adj)
Measure Exchange Members
Non-Exchange Members
Exchange Members
Non-Exchange Members
Inpatient Acute Visits 390 328 339 335Medical 210 144 181 147Surgical 140 116 115 119Maternity 41 69 41 69
Outpatient Emergency Visits 1941 1924 1944 1923MRIs 920 803 810 817CT Scans 1108 824 938 844Primary Care Office Visits 15216 18755 16068 18628Psychiatric Visits 9864 9783 9783 11092Chiropractic Visits 3403 7808 3088 7913
Utilization measures are capped at the 99th percentile
33
Expenditure PMPY Diabetes Population
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$-
$5000
$10000
$15000
$20000
$25000
$30000
No Diabetes (n=730838) Diabetes amp no comorbidity (n=16419) Diabetes with comorbidity (n=12950)$0
No Diabetes (n = 730838)
Diabetes No Comorbidity(n = 16419)
Diabetes Comorbidity(n = 12950)
34
Vermont Blueprint for HealthDiabetes HbA1c Control amp Outcomes
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Measure HbA1c in Control HbA1c Not in Control
Members 5619 786
Average annual expenditures per capita
$15726 ($15219 $16233)
$17328 ($16110 $18546)
Inpatient hospitalizations per 1000 members
1897 (1782 2011)
2531 (2177 2886)
Inpatient days per 1000 members
8685 (8440 8930)
11561 (10804 12318)
Outpatient ED visits per 1000 members
6275 (6067 6483)
8011 (7381 8642)
Risk-adjusted rates and 95 confidence intervals 99th percentile outliers excluded HbA1c not in control gt9
35
Expenditures PMPY by County
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
County Average Members Expenditures PMPYExpenditures PMPY
(Risk Adjusted)Fairfield 223295 $5182 $5539 New London 44741 $5913 $5342 New Haven 161763 $5494 $5335 Middlesex 38531 $5359 $5184 Litchfield 43224 $5136 $5118 Tolland 36304 $5047 $5019 Hartford 191415 $4998 $4958 Windham 20934 $5539 $4950
Total 760207 $5255 $5255
36
Expenditures PMPY by HSA Risk Adjusted
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$0
$1000
$2000
$3000
$4000
$5000
$6000
$7000
37
EffectivePreventive Care
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
HEDIS MeasureCT APCD
CommercialNCQA
National HMONCQA
National PPOAvoidance of Antibiotic Treatment in Adults with Acute Bronchitis 268 276 258Anti-Depressant Medication Management 764 664 666Well-Child Visits 798 762 723Breast Cancer Screening 671 732 696
NCQA National HMO and NCQA National PPO benchmark metrics calculated for CY2015 Several other HEDIS measures can be run using the CT APCD data set and compared against the NCQA National HMO and PPO benchmarks Examples include Comprehensive Diabetes Care ndash HbA1C Testing Comprehensive Diabetes Care ndash Medical Attention for Nephrology Comprehensive Diabetes Care ndash Eye Exam Performed Adolescent Well-Care Visits Appropriate Treatment for Children with Upper Respiratory Infection etc
38
Breast Cancer Screening
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
60
62
64
66
68
70
72
Urban Centers (n=3369) Manufacturing Centers (n=10974) Diverse Suburbs (n=12206) Mill Towns (n=16281) Rural Towns (n=16789) Wealthy Suburbs (n=12266)
39
Vermont Blueprintrsquos Hub amp Spoke Model
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
bull Vermontrsquos ldquoHealth Homerdquo program designed to treat Vermonters with chronic opioid addiction
bull Hubs ndash designated providers ndash Provide coordinated care to patients through MAT services
ndash Coordinate referral to ongoing care
bull Spokes ndash teams of healthcare professionalsndash Blueprint Advanced Practice Medical Homes
ndash Federally-Qualified Health Centers
ndash Outpatient substance abuse and primary care providers
40copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Medication Assisted Treatment
bull Vermont Blueprint baseline study comparing medication-assisted treatment (MAT) population versus non-MAT population
bull Study published in the Journal of Substance Abuse Treatment (August 2016)
41
bull The CT APCD is a comparable resource to other statewide APCDs ndash A powerful tool that will only continue to grow with usendash Encompasses a robust set of information including
expenditures procedure codes diagnosis coding drug codes and enhanced value-adds (eg claim type master membermaster provider IDsNPIs MS-DRGs etc)
bull Future considerations to enhance the CT APCDndash Add Medicare and Medicaid claims datandash Continue to strengthen the completeness and validity of data
elements of importance to downstream analytic use cases (eg member race and ethnicity codes) in data collection
Lessons Learned
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
43
Next Steps
44
01Task
02Task
Ensure data quality issues are identified documented communicated and resolved
Data Quality
Continue building breadth of payer database amp complete enclave load
Data ETL
Finalize strategy to ensure site accomplishes PA 13-247 and PA 15-146 intent
Establish Strategy
05Task
Identify leading consumer information and price transparency tools available
Consumer Tool Evaluation04Task
Tasks Until Next Meeting (11917)APCD Development and Strategy Update
Distinguish Critical Paths Across and Within Strategic Priorities and Maintain Focus on ldquoMust Havesrdquo and ldquoQuick Winsrdquo
Ensure APCD staff can generate self-service extracts at little cost with minimal lead time
Deliver First DR Extract03Task
45
Future MeetingsAPCD Development and Strategy Update
November
9Legislative Office
Building Room 1D 300 Capitol Avenue
Hartford
All Payer Claims Database Advisory GroupMeeting
900ndash1100 AM
3
Public Comments
(2 Minutes per Commenter)
4
Approval of Minutes
May 11 2017 Advisory Group Meeting
5
APCD Updates amp Project
Status Overview
6
Minnesota - Analysis of Low-Value Health Services inthe Minnesota All Payer Claims Database1
Virginia - VHI Five Most Common Avoidable ER Visits2
State APCD Activity
HealthCostcom latest publicly available transparency website released3
Cost Transparency Websites
SAMHSA - Confidentiality of Alcohol and Drug Abuse Patient Records 42 CFR Part 2
National Policy Update
Recent National DevelopmentsAPCD Updates and Project Status
1) httpwwwhealthstatemnushealthreformallpayerlvsissuebriefpdf2) httpwwwalexandrianewsorg201707virginias-five-most-common-avoidable-er-visits3) httpswwwhealthcostcomconsumer4) httpswwwcgactgov2017actpa2017PA-00154-R00SB-00546-PAhtm
PA 17-154 ndash An Act Concerning Participating Provider Directories4
State Policy Update
7
01Task
02Task
03Task
Ensure data quality issues are identified documented communicated and resolved
Data Quality
Promote data usage as a form of data QA
Preliminary Reporting
Continue building breadth of payer database amp complete enclave load
Data ETL
Identify leading consumer information and price transparency tools available
Consumer Tool Evaluation05Task
Finalize strategy to ensure site accomplishes PA 13-247 and PA 15-146 intent
Establish Strategy06Task
Ensure APCD staff can generate self-service extracts at little cost with minimal lead time
Extract Development04Task
Target Initiatives Since Last MeetingAPCD Development and Strategy Update
Distinguish Critical Paths Across and Within Strategic Priorities and Maintain Focus on ldquoMust Havesrdquo and ldquoQuick Winsrdquo
8
Accomplishments Since Last MeetingAPCD Updates and Project Status
Data Collection Status2016 Commercial data normalization and load into enclave to be completed by May 15th
Data Release Architecture CompletePreliminary data dictionary released Data release extract tool development nearly complete
Medicare Data ApprovedApplication for CMS Medicare data approved Data received and integration in progress
Data Release Training and CoordinationData Release Committee re-engaged and 1st release review scheduled August16th
Preliminary Analysis and End User FeedbackPopulation segmentation and profiling underway value added tables amp software in various phases of implementation (knowledge bases risk scoring software etc)
First Data Release Application1st completed data release application received
9
Data Collection Status UpdateAPCD Updates and Project Status
Eligibility Medical Pharmacy ProviderStatusNotesStart Date End Date Start Date End Date Start Date End Date Start Date End Date
AetnaAetna Health Insurance HMO FI 012012 062017 012012 062017 012012 062017 012012 062017 Submitter is current with file submissions to OnpointAetna Health Insurance HMO on ACAS FI 012012 062017 012012 062017 012012 062017 NA NA Submitter is current with file submissions to OnpointAetna Life Insurance Company Aetna Student Health 012012 062017 012012 062017 NA NA 012012 062017 Submitter is current with file submissions to OnpointAetna Life Insurance Company HMO Medicare 012012 062017 012012 062017 012012 062017 NA NA Submitter is current with file submissions to OnpointAetna Life Insurance Company Traditional 012012 062017 012012 062017 012012 062017 012012 062017 Submitter is current with file submissions to Onpoint
Anthem012012 012017 012012 012017 012012 012017 012012 012017 Submitter to resume data submissions in October 2017
Caremark LLC012012 062017 NA NA 012012 062017 NA NA Submitter is current with file submissions to Onpoint
CignaCigna Health and Life Insurance Company Inc - West 012012 062017 012012 062017 012012 062017 012012 062017 Submitter is current with file submissions to OnpointCigna Health and Life Insurance Company Inc - East 012012 062017 012012 062017 012012 062017 012012 062017 Submitter is current with file submissions to Onpoint
ConnectiCareConnectiCare 012012 052017 012012 052017 012012 052017 012012 052017 Submitter has not yet supplied June 2017 file submissionsConnectiCare Inc - Medicare Advantage 012012 052017 012012 052017 012012 012017 012012 052017 Submitter has not yet supplied June 2017 file submissions
Express Scripts- - NA NA - - NA NA Submitter supplied January 2012 test files on 872017
First Health Life and Health Insurance Company012012 062017 NA NA 012012 062017 NA NA Submitter is current with file submissions to Onpoint
Harvard Pilgrim012012 062017 012012 062017 012012 062017 012012 062017 Submitter is current with file submissions to Onpoint
HealthyCT012014 122014 012014 122014 012014 122014 012014 122014 Submitter no longer active with the CT APCD
United Health GroupeviCore (UHC - Oxford) NA NA 012015 042017 - - 012012 042017 Submitter has not yet supplied May - June 2017 file submissionsOptumHealth Care Solutions Inc (Optum) NA NA 012012 062017 NA NA 012012 062017 Submitter is current with file submissions to OnpointOrthoNet NA NA 012012 062017 NA NA NA NA Submitter is current with file submissions to OnpointOxford Health Plans 012012 062017 012012 052017 012012 062017 012012 062017 Submitter has not yet supplied June 2017 medical claims fileUHC - Golden Rule 012012 062017 012012 062017 012012 062017 012012 062017 Submitter is current with file submissions to OnpointUnitedHealthcare Insurance - Medicare 012012 062017 012012 062017 012012 062017 012012 062017 Submitter is current with file submissions to OnpointUnitedHealthcare Insurance Company 012012 062017 012012 062017 012012 062017 012012 062017 Submitter is current with file submissions to Onpoint
WellCare Health Plans Inc012012 062017 012012 062017 012012 122015 012012 062017 Submitter is current with file submissions to Onpoint
Medicaid- - - - - - - -
Medicare- - - - - - - - Data received 82017
Submission D
elay lt 3 Months or Integration In Progress
Submission O
n Schedule
Submission N
ot Scheduled or ge 3 Months D
elayed
10
APCD Data Release
Update
11
Develop and implement core requirements to achieve DRcapabilities
Administration Data release application dictionary ampsupport materialsSoftwareTools Extract creation and delivery toolSupport Admin support and documentation
Phase 1 Develop DR Process Tools and CapabilitiesEngage potential requestors to ensurecapabilities opportunities and services arerecognized
Phase 2 Promotion and Delivery
Data Release (DR) RecapAPCD Data Release Update
Legislative Charge (PA 13-247) The exchange shall helliphellip and (B) make data in the all-payer claims database available to any state agency insurer employer health care provider consumer of health care services or researcher for the purpose of allowing such person or entity to review such data as it relates to health care utilization costs or quality of health care services
12
End to End application process can take between 17 to 40days depending on time of month an application issubmitted All requests must follow the data releaseprocess outlined by Privacy Policy amp Procedures
Data Release ApplicationRequestor general information project summary research details data selection and securityintegrity
Data Release CommitteeReview application alignment with objectives re-identification risk safeguard adequacy and research design
Data Use Agreement Fees amp ExtractUser agrees to fee schedule DUA requirements Standard extract creation within 5 business days (after 1st release)
S M T W T F S
1 2 3 4 5
6 7 8 9 10 11 12
13 14 15 16 17 18 19
20 21 22 23 24 25 26
27 28 29 39 31
DR Process amp Turn-Around TimeAPCD Data Release Update
13
DR TableField Classification MatrixAPCD Data Release Update
Table Name
Field Classifications
Administrative
Enrollee Coverage
InformationEnrollee
DemographicsClaim
InformationDiagnosis
Information
Procedure Coding amp
DetailFinancial
InformationProvider
InformationPayer
InformationSafe Harbor
Variable Grand TotalEligibility 2 11 1 1 1 1 4 21
Eligibility Supplemental 2 13 9 4 28
Medical 2 3 13 2 7 8 4 1 6 46
Medical Claim Header 2 5 7
Medical Supplemental 4 6 3 11 1 6 31
Medical Claim Diagnosis 1 3 1 5
Medical Claim Icd Procedure 2 14 5 4 1 26
Pharmacy 3 3 11 2 9 2 1 3 34
Pharmacy Supplemental 2 8 4 1 15
Provider 3 2 1 6Grand Total 23 30 10 55 10 15 41 10 5 20 219
Data Release Dictionary Located httpagencyaccesshealthctcommeetings1485450397264-a8f3a430-837b
14
ProviderFacility Directory
512k Unique National Provider Identifiers
Pharmacy Claims
All claimsencounters paid by submitting carrier
Data includes info on Administrative Enrollee Coverage Claim Detail Diagnosis Codes Procedure Codes Financials Payers Providers Safe Harbor (12)
1273M Claims $125B
Medical Claims
All claimsencounters paid by submitting carrier
Data includes info on Administrative Enrollee Coverage Claim Detail Diagnosis Codes Procedure Codes Financials Payers Providers Safe Harbor (12)
747M Claims $304B
Enrollees
CY 2012 ndash Present (n- 1 month)
Data includes info on Administrative Enrollee Coverage Enrollee Demographics Financials Payers Providers Safe Harbor (2)Fully insuredNon-ERISA plans (~900k Lives)
Whatrsquos Available Through DRAPCD Data Release Update
Billing rendering prescribing pharmacy primary care provider IDs (varying completion rate)
Data includes info on Unblended and composite provider IDs and NPIs
15
ERISALives covered under self-
insured ERISA plans
Part 2 SUD claimsSUD claims provided by
Part 2 providers
Denied ClaimsFully denied claims not
collected
Test Result ValuesLab imaging biometrics
and physician derived data
Third Party Data Risk scoring social
determinants knowledge base etc
Dental ClaimsDental claims not required
for submission
Ancillary FinancialsPlan premiums capitation payments performance
payments administrative fees
Whatrsquos Not Available Through DRAPCD Data Release Update
HIPAA Safe Harbor Variables18 HIPAA identifiers
16
18 HIPAA identifiers removed from dataset
Identifiers removed as set forth in 45 CFR 164514
De-identification
De-Identified Data ReleaseAPCD Data Release Update
Age caps applied (over 89 less than 1) amp geography reduced to 3 digit zip
All dates related to service and payments masked
First three digits of zip codes only if the geographic area covered by all zip codes beginning with those three digits has a population greater than 20000 or the zip codes for those areas are changed to 000 in the data set
Supplementary safeguards imposed to reduce unique characteristics
17
Partnerships LicensingAccessibilityValue Add DataProcess
Improvement
Identify third party data that can supplement and enrich within release requirements
Third Party DataIdentify areas of process
improvement and automation
ScalabilityEstablish enclave capability
upon needdemand
Extract v EnclaveIdentify areas of opportunity for ongoing multiple use by
institutions
Engagement
Potential Future ImprovementsAPCD Data Release Update
18
AUGUST
16SEPTEMBER
7SEPTEMBER
15SEPTEMBER
22Committee review and
vote on first data request application
from UConn
DATA RELEASE COMMITTEE MEETING
To be canceled if no additional applications
submitted
DATA RELEASE COMMITTEE MEETING
Review and confirmation of de-
identification methods and implementation
EXTRACT AUDIT
Extract delivered and support channel
opened
DATA RELEASE
Data release activities within the next two months include
Open Action ItemsAPCD Data Release Update
Project Descriptions
bull State Innovation Modelndash Online dashboard of ~30 pace and performance measures
bull Used to monitor performance of SIM bull 12 measures use APCD databull Includes yearly targets for overall Connecticut
ndash Online Scorecard Online dashboard of FQHC and Advanced Network performancebull First health care performance scorecard in CTbull Provides transparency in provider performancebull Utilizes claims based measures from common scorecard and CAHPS surveys
bull Suicide Risk Identificationndash Improves identification of patients at risk of suicide
bull Utilizes APCD claims data EHR data from 5 health care providers and mortality databull Creation of phenotypic algorithm
19
APCD Based Dashboard Measures
Health Care DeliveryPercent of adults with regular source of careChildren well-child visits for at-risk popMammograms for women gt50 last 2 yearsOptimal diabetes care- 2+ annual A1c testsED use- asthma as primary dx (per 10k)
Percent of adults with HTN taking HTN medsFollow-Up after Discharge from the Emergency Department for Mental Health or Alcohol or other Drug
Follow-Up after Hospitalization for Mental Illness
Antidepressant Medication ManagementInitiation and Engagement of Alcohol and Other Drug Dependence Treatment
Health Care Costs
Cost of inpatient care PMPY
Cost of outpatient care PMPY
httpwwwpublichealthuconnedusim_dashhtmlohriNav=7C
Scorecard MeasuresReporting Only
Coordination of Care30 day readmission
PCPs that meet Meaningful Use
Prevention
Non-recommended Cervical Cancer Screening in Adolescent Female
Well-child visits in the third fourth fifth and sixth years of life (Medicaid only)
Frequency of Ongoing Prenatal Care (FPC)
Oral Evaluation Dental Services (Medicaid only)
Acute and Chronic Care
Cardiac strss img Testing in asymptomatic low risk patients
Behavioral HealthAdult major depressive disorder (MDD) Coordination of care of patients with specific co-morbid conditions
Anti-Depressant Medication Management
Initiation and Engagement of Alcohol and Other Drug Dependence Treatment
Follow up after hospitalization for mental illness 7 amp 30 days
21
Provisional Core Measure SetCare CoordinationPlan all-cause readmissionAnnual monitoring for persistent medications (roll-up)PreventionBreast cancer screeningCervical cancer screeningChlamydia screening in womenAdolescent female immunizations HPV
Weight assessment and counseling for nutrition and physical activity for childrenadolescents
Well-child visits in the first 15 months of lifeAdolescent well-care visitsBehavioral health screening (pediatric Medicaid only custom measure)
Acute amp Chronic Care
Medication management for people w asthma
DM HbA1c Testing
DM Diabetes medical attention for nephropathy
Use of imaging studies for low back pain
Avoidance of antibiotic treatment in adults with acute bronchitis
Appr treatment for children with upper respiratory infection
Behavioral Health
Follow-up care for children prescribed ADHD medicationMetabolic Monitoring for Children and Adolescents on Antipsychotics (pediatric Medicaid only custom measure)
Suicide Risk Identification
22
23
CT APCD Data -
Preliminary Analysis
Examples amp Showcase
Title XxSubtitle Xx
Presenter TitleDate
24Proprietary and Confidential 24
Connecticut APCDPreliminary Analysis Examples amp Showcase
CT APCD Advisory Group Meeting August 10 2017
25
bull Data source CY2016 commercial data from the CT APCDbull Focus commercial population-based reportingbull Considerations risk adjustment for age gender and health statusbull Areas of exploration
ndash Multiple views of the CT APCD population total members health exchange members members with diabetes
ndash Expenditures utilization and effective and preventive care ratesndash Analysis by multiple geographic units county Hospital Service
Area (HSA) and Health Reference Group (HRG) bull Conclusion Recap and lessons learned
Presentation Overview
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
26
bull Member Any person covered in a submitterrsquos eligibility databull Average Members Member months divided by 12 (months)bull Expenditures Allowed amount bull Capping Capped outliers in the data at the 99th percentilebull Clinical Risk Groups Individualsrsquo categorized health statusbull County Administrative focus areasbull Hospital Service Area Local hospital marketsbull Health Reference Group Community types bull Rates Expenditures by average membersbull Risk Adjustment Adjusting for differences between member
populations by considering membersrsquo age gender and health status
Key Terms
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
27
Population-Based Reporting
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
bull Reporting units county modified Hospital Service Area (HSA) and Health Reference Group (HRG)
bull Risk adjustment age gender and health status (3M CRGs)
28
CT APCD Population Overview
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Measure Count
Unique Members 875129
Total Member Months 9122482
Average Members 760207
Total Expenditures $40 Billion
Total Expenditures Per Member Per Year (PMPY) $5255
Total Expenditures Per Member Per Month (PMPM) $438
Total expenditures are capped at the 99th percentile
29
Expenditures PMPY by Age amp Gender
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$0
$1000
$2000
$3000
$4000
$5000
$6000
$7000
$8000
$9000
0-18 Female 0-18 Male 18-34 Female 18-34 Male 35-44 Female 35-44 Male 45-54 Female 45-54 Male 55-64 Female 55-64 Male
30
Expenditures PMPY by CRGs
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$-
$5000
$10000
$15000
$20000
$25000
$30000
$35000
$40000
Healthy Acute or Minor Chronic Moderate Chronic Significant Chronic Cancer or Catastrophic
$0
31
CT Health Exchange Population Overview
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
MeasureExchange Members
Non-Exchange Members
Average Members 86941 673266
Percentage of Members 55-64 Years of Age 31 20
Percentage of Members with Chronic Condition(s) 23 19
Expenditures PMPY $5378 $5239
Expenditures PMPY Risk Adjusted $4780 $5316 Expenditures PMPY for Members with Diabetes Risk-Adjusted $17561 $19291
32
CT Exchange vs Non-Exchange Rates
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Rate per 1000 Rate per 1000 (Risk Adj)
Measure Exchange Members
Non-Exchange Members
Exchange Members
Non-Exchange Members
Inpatient Acute Visits 390 328 339 335Medical 210 144 181 147Surgical 140 116 115 119Maternity 41 69 41 69
Outpatient Emergency Visits 1941 1924 1944 1923MRIs 920 803 810 817CT Scans 1108 824 938 844Primary Care Office Visits 15216 18755 16068 18628Psychiatric Visits 9864 9783 9783 11092Chiropractic Visits 3403 7808 3088 7913
Utilization measures are capped at the 99th percentile
33
Expenditure PMPY Diabetes Population
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$-
$5000
$10000
$15000
$20000
$25000
$30000
No Diabetes (n=730838) Diabetes amp no comorbidity (n=16419) Diabetes with comorbidity (n=12950)$0
No Diabetes (n = 730838)
Diabetes No Comorbidity(n = 16419)
Diabetes Comorbidity(n = 12950)
34
Vermont Blueprint for HealthDiabetes HbA1c Control amp Outcomes
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Measure HbA1c in Control HbA1c Not in Control
Members 5619 786
Average annual expenditures per capita
$15726 ($15219 $16233)
$17328 ($16110 $18546)
Inpatient hospitalizations per 1000 members
1897 (1782 2011)
2531 (2177 2886)
Inpatient days per 1000 members
8685 (8440 8930)
11561 (10804 12318)
Outpatient ED visits per 1000 members
6275 (6067 6483)
8011 (7381 8642)
Risk-adjusted rates and 95 confidence intervals 99th percentile outliers excluded HbA1c not in control gt9
35
Expenditures PMPY by County
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
County Average Members Expenditures PMPYExpenditures PMPY
(Risk Adjusted)Fairfield 223295 $5182 $5539 New London 44741 $5913 $5342 New Haven 161763 $5494 $5335 Middlesex 38531 $5359 $5184 Litchfield 43224 $5136 $5118 Tolland 36304 $5047 $5019 Hartford 191415 $4998 $4958 Windham 20934 $5539 $4950
Total 760207 $5255 $5255
36
Expenditures PMPY by HSA Risk Adjusted
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$0
$1000
$2000
$3000
$4000
$5000
$6000
$7000
37
EffectivePreventive Care
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
HEDIS MeasureCT APCD
CommercialNCQA
National HMONCQA
National PPOAvoidance of Antibiotic Treatment in Adults with Acute Bronchitis 268 276 258Anti-Depressant Medication Management 764 664 666Well-Child Visits 798 762 723Breast Cancer Screening 671 732 696
NCQA National HMO and NCQA National PPO benchmark metrics calculated for CY2015 Several other HEDIS measures can be run using the CT APCD data set and compared against the NCQA National HMO and PPO benchmarks Examples include Comprehensive Diabetes Care ndash HbA1C Testing Comprehensive Diabetes Care ndash Medical Attention for Nephrology Comprehensive Diabetes Care ndash Eye Exam Performed Adolescent Well-Care Visits Appropriate Treatment for Children with Upper Respiratory Infection etc
38
Breast Cancer Screening
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
60
62
64
66
68
70
72
Urban Centers (n=3369) Manufacturing Centers (n=10974) Diverse Suburbs (n=12206) Mill Towns (n=16281) Rural Towns (n=16789) Wealthy Suburbs (n=12266)
39
Vermont Blueprintrsquos Hub amp Spoke Model
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
bull Vermontrsquos ldquoHealth Homerdquo program designed to treat Vermonters with chronic opioid addiction
bull Hubs ndash designated providers ndash Provide coordinated care to patients through MAT services
ndash Coordinate referral to ongoing care
bull Spokes ndash teams of healthcare professionalsndash Blueprint Advanced Practice Medical Homes
ndash Federally-Qualified Health Centers
ndash Outpatient substance abuse and primary care providers
40copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Medication Assisted Treatment
bull Vermont Blueprint baseline study comparing medication-assisted treatment (MAT) population versus non-MAT population
bull Study published in the Journal of Substance Abuse Treatment (August 2016)
41
bull The CT APCD is a comparable resource to other statewide APCDs ndash A powerful tool that will only continue to grow with usendash Encompasses a robust set of information including
expenditures procedure codes diagnosis coding drug codes and enhanced value-adds (eg claim type master membermaster provider IDsNPIs MS-DRGs etc)
bull Future considerations to enhance the CT APCDndash Add Medicare and Medicaid claims datandash Continue to strengthen the completeness and validity of data
elements of importance to downstream analytic use cases (eg member race and ethnicity codes) in data collection
Lessons Learned
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
43
Next Steps
44
01Task
02Task
Ensure data quality issues are identified documented communicated and resolved
Data Quality
Continue building breadth of payer database amp complete enclave load
Data ETL
Finalize strategy to ensure site accomplishes PA 13-247 and PA 15-146 intent
Establish Strategy
05Task
Identify leading consumer information and price transparency tools available
Consumer Tool Evaluation04Task
Tasks Until Next Meeting (11917)APCD Development and Strategy Update
Distinguish Critical Paths Across and Within Strategic Priorities and Maintain Focus on ldquoMust Havesrdquo and ldquoQuick Winsrdquo
Ensure APCD staff can generate self-service extracts at little cost with minimal lead time
Deliver First DR Extract03Task
45
Future MeetingsAPCD Development and Strategy Update
November
9Legislative Office
Building Room 1D 300 Capitol Avenue
Hartford
All Payer Claims Database Advisory GroupMeeting
900ndash1100 AM
4
Approval of Minutes
May 11 2017 Advisory Group Meeting
5
APCD Updates amp Project
Status Overview
6
Minnesota - Analysis of Low-Value Health Services inthe Minnesota All Payer Claims Database1
Virginia - VHI Five Most Common Avoidable ER Visits2
State APCD Activity
HealthCostcom latest publicly available transparency website released3
Cost Transparency Websites
SAMHSA - Confidentiality of Alcohol and Drug Abuse Patient Records 42 CFR Part 2
National Policy Update
Recent National DevelopmentsAPCD Updates and Project Status
1) httpwwwhealthstatemnushealthreformallpayerlvsissuebriefpdf2) httpwwwalexandrianewsorg201707virginias-five-most-common-avoidable-er-visits3) httpswwwhealthcostcomconsumer4) httpswwwcgactgov2017actpa2017PA-00154-R00SB-00546-PAhtm
PA 17-154 ndash An Act Concerning Participating Provider Directories4
State Policy Update
7
01Task
02Task
03Task
Ensure data quality issues are identified documented communicated and resolved
Data Quality
Promote data usage as a form of data QA
Preliminary Reporting
Continue building breadth of payer database amp complete enclave load
Data ETL
Identify leading consumer information and price transparency tools available
Consumer Tool Evaluation05Task
Finalize strategy to ensure site accomplishes PA 13-247 and PA 15-146 intent
Establish Strategy06Task
Ensure APCD staff can generate self-service extracts at little cost with minimal lead time
Extract Development04Task
Target Initiatives Since Last MeetingAPCD Development and Strategy Update
Distinguish Critical Paths Across and Within Strategic Priorities and Maintain Focus on ldquoMust Havesrdquo and ldquoQuick Winsrdquo
8
Accomplishments Since Last MeetingAPCD Updates and Project Status
Data Collection Status2016 Commercial data normalization and load into enclave to be completed by May 15th
Data Release Architecture CompletePreliminary data dictionary released Data release extract tool development nearly complete
Medicare Data ApprovedApplication for CMS Medicare data approved Data received and integration in progress
Data Release Training and CoordinationData Release Committee re-engaged and 1st release review scheduled August16th
Preliminary Analysis and End User FeedbackPopulation segmentation and profiling underway value added tables amp software in various phases of implementation (knowledge bases risk scoring software etc)
First Data Release Application1st completed data release application received
9
Data Collection Status UpdateAPCD Updates and Project Status
Eligibility Medical Pharmacy ProviderStatusNotesStart Date End Date Start Date End Date Start Date End Date Start Date End Date
AetnaAetna Health Insurance HMO FI 012012 062017 012012 062017 012012 062017 012012 062017 Submitter is current with file submissions to OnpointAetna Health Insurance HMO on ACAS FI 012012 062017 012012 062017 012012 062017 NA NA Submitter is current with file submissions to OnpointAetna Life Insurance Company Aetna Student Health 012012 062017 012012 062017 NA NA 012012 062017 Submitter is current with file submissions to OnpointAetna Life Insurance Company HMO Medicare 012012 062017 012012 062017 012012 062017 NA NA Submitter is current with file submissions to OnpointAetna Life Insurance Company Traditional 012012 062017 012012 062017 012012 062017 012012 062017 Submitter is current with file submissions to Onpoint
Anthem012012 012017 012012 012017 012012 012017 012012 012017 Submitter to resume data submissions in October 2017
Caremark LLC012012 062017 NA NA 012012 062017 NA NA Submitter is current with file submissions to Onpoint
CignaCigna Health and Life Insurance Company Inc - West 012012 062017 012012 062017 012012 062017 012012 062017 Submitter is current with file submissions to OnpointCigna Health and Life Insurance Company Inc - East 012012 062017 012012 062017 012012 062017 012012 062017 Submitter is current with file submissions to Onpoint
ConnectiCareConnectiCare 012012 052017 012012 052017 012012 052017 012012 052017 Submitter has not yet supplied June 2017 file submissionsConnectiCare Inc - Medicare Advantage 012012 052017 012012 052017 012012 012017 012012 052017 Submitter has not yet supplied June 2017 file submissions
Express Scripts- - NA NA - - NA NA Submitter supplied January 2012 test files on 872017
First Health Life and Health Insurance Company012012 062017 NA NA 012012 062017 NA NA Submitter is current with file submissions to Onpoint
Harvard Pilgrim012012 062017 012012 062017 012012 062017 012012 062017 Submitter is current with file submissions to Onpoint
HealthyCT012014 122014 012014 122014 012014 122014 012014 122014 Submitter no longer active with the CT APCD
United Health GroupeviCore (UHC - Oxford) NA NA 012015 042017 - - 012012 042017 Submitter has not yet supplied May - June 2017 file submissionsOptumHealth Care Solutions Inc (Optum) NA NA 012012 062017 NA NA 012012 062017 Submitter is current with file submissions to OnpointOrthoNet NA NA 012012 062017 NA NA NA NA Submitter is current with file submissions to OnpointOxford Health Plans 012012 062017 012012 052017 012012 062017 012012 062017 Submitter has not yet supplied June 2017 medical claims fileUHC - Golden Rule 012012 062017 012012 062017 012012 062017 012012 062017 Submitter is current with file submissions to OnpointUnitedHealthcare Insurance - Medicare 012012 062017 012012 062017 012012 062017 012012 062017 Submitter is current with file submissions to OnpointUnitedHealthcare Insurance Company 012012 062017 012012 062017 012012 062017 012012 062017 Submitter is current with file submissions to Onpoint
WellCare Health Plans Inc012012 062017 012012 062017 012012 122015 012012 062017 Submitter is current with file submissions to Onpoint
Medicaid- - - - - - - -
Medicare- - - - - - - - Data received 82017
Submission D
elay lt 3 Months or Integration In Progress
Submission O
n Schedule
Submission N
ot Scheduled or ge 3 Months D
elayed
10
APCD Data Release
Update
11
Develop and implement core requirements to achieve DRcapabilities
Administration Data release application dictionary ampsupport materialsSoftwareTools Extract creation and delivery toolSupport Admin support and documentation
Phase 1 Develop DR Process Tools and CapabilitiesEngage potential requestors to ensurecapabilities opportunities and services arerecognized
Phase 2 Promotion and Delivery
Data Release (DR) RecapAPCD Data Release Update
Legislative Charge (PA 13-247) The exchange shall helliphellip and (B) make data in the all-payer claims database available to any state agency insurer employer health care provider consumer of health care services or researcher for the purpose of allowing such person or entity to review such data as it relates to health care utilization costs or quality of health care services
12
End to End application process can take between 17 to 40days depending on time of month an application issubmitted All requests must follow the data releaseprocess outlined by Privacy Policy amp Procedures
Data Release ApplicationRequestor general information project summary research details data selection and securityintegrity
Data Release CommitteeReview application alignment with objectives re-identification risk safeguard adequacy and research design
Data Use Agreement Fees amp ExtractUser agrees to fee schedule DUA requirements Standard extract creation within 5 business days (after 1st release)
S M T W T F S
1 2 3 4 5
6 7 8 9 10 11 12
13 14 15 16 17 18 19
20 21 22 23 24 25 26
27 28 29 39 31
DR Process amp Turn-Around TimeAPCD Data Release Update
13
DR TableField Classification MatrixAPCD Data Release Update
Table Name
Field Classifications
Administrative
Enrollee Coverage
InformationEnrollee
DemographicsClaim
InformationDiagnosis
Information
Procedure Coding amp
DetailFinancial
InformationProvider
InformationPayer
InformationSafe Harbor
Variable Grand TotalEligibility 2 11 1 1 1 1 4 21
Eligibility Supplemental 2 13 9 4 28
Medical 2 3 13 2 7 8 4 1 6 46
Medical Claim Header 2 5 7
Medical Supplemental 4 6 3 11 1 6 31
Medical Claim Diagnosis 1 3 1 5
Medical Claim Icd Procedure 2 14 5 4 1 26
Pharmacy 3 3 11 2 9 2 1 3 34
Pharmacy Supplemental 2 8 4 1 15
Provider 3 2 1 6Grand Total 23 30 10 55 10 15 41 10 5 20 219
Data Release Dictionary Located httpagencyaccesshealthctcommeetings1485450397264-a8f3a430-837b
14
ProviderFacility Directory
512k Unique National Provider Identifiers
Pharmacy Claims
All claimsencounters paid by submitting carrier
Data includes info on Administrative Enrollee Coverage Claim Detail Diagnosis Codes Procedure Codes Financials Payers Providers Safe Harbor (12)
1273M Claims $125B
Medical Claims
All claimsencounters paid by submitting carrier
Data includes info on Administrative Enrollee Coverage Claim Detail Diagnosis Codes Procedure Codes Financials Payers Providers Safe Harbor (12)
747M Claims $304B
Enrollees
CY 2012 ndash Present (n- 1 month)
Data includes info on Administrative Enrollee Coverage Enrollee Demographics Financials Payers Providers Safe Harbor (2)Fully insuredNon-ERISA plans (~900k Lives)
Whatrsquos Available Through DRAPCD Data Release Update
Billing rendering prescribing pharmacy primary care provider IDs (varying completion rate)
Data includes info on Unblended and composite provider IDs and NPIs
15
ERISALives covered under self-
insured ERISA plans
Part 2 SUD claimsSUD claims provided by
Part 2 providers
Denied ClaimsFully denied claims not
collected
Test Result ValuesLab imaging biometrics
and physician derived data
Third Party Data Risk scoring social
determinants knowledge base etc
Dental ClaimsDental claims not required
for submission
Ancillary FinancialsPlan premiums capitation payments performance
payments administrative fees
Whatrsquos Not Available Through DRAPCD Data Release Update
HIPAA Safe Harbor Variables18 HIPAA identifiers
16
18 HIPAA identifiers removed from dataset
Identifiers removed as set forth in 45 CFR 164514
De-identification
De-Identified Data ReleaseAPCD Data Release Update
Age caps applied (over 89 less than 1) amp geography reduced to 3 digit zip
All dates related to service and payments masked
First three digits of zip codes only if the geographic area covered by all zip codes beginning with those three digits has a population greater than 20000 or the zip codes for those areas are changed to 000 in the data set
Supplementary safeguards imposed to reduce unique characteristics
17
Partnerships LicensingAccessibilityValue Add DataProcess
Improvement
Identify third party data that can supplement and enrich within release requirements
Third Party DataIdentify areas of process
improvement and automation
ScalabilityEstablish enclave capability
upon needdemand
Extract v EnclaveIdentify areas of opportunity for ongoing multiple use by
institutions
Engagement
Potential Future ImprovementsAPCD Data Release Update
18
AUGUST
16SEPTEMBER
7SEPTEMBER
15SEPTEMBER
22Committee review and
vote on first data request application
from UConn
DATA RELEASE COMMITTEE MEETING
To be canceled if no additional applications
submitted
DATA RELEASE COMMITTEE MEETING
Review and confirmation of de-
identification methods and implementation
EXTRACT AUDIT
Extract delivered and support channel
opened
DATA RELEASE
Data release activities within the next two months include
Open Action ItemsAPCD Data Release Update
Project Descriptions
bull State Innovation Modelndash Online dashboard of ~30 pace and performance measures
bull Used to monitor performance of SIM bull 12 measures use APCD databull Includes yearly targets for overall Connecticut
ndash Online Scorecard Online dashboard of FQHC and Advanced Network performancebull First health care performance scorecard in CTbull Provides transparency in provider performancebull Utilizes claims based measures from common scorecard and CAHPS surveys
bull Suicide Risk Identificationndash Improves identification of patients at risk of suicide
bull Utilizes APCD claims data EHR data from 5 health care providers and mortality databull Creation of phenotypic algorithm
19
APCD Based Dashboard Measures
Health Care DeliveryPercent of adults with regular source of careChildren well-child visits for at-risk popMammograms for women gt50 last 2 yearsOptimal diabetes care- 2+ annual A1c testsED use- asthma as primary dx (per 10k)
Percent of adults with HTN taking HTN medsFollow-Up after Discharge from the Emergency Department for Mental Health or Alcohol or other Drug
Follow-Up after Hospitalization for Mental Illness
Antidepressant Medication ManagementInitiation and Engagement of Alcohol and Other Drug Dependence Treatment
Health Care Costs
Cost of inpatient care PMPY
Cost of outpatient care PMPY
httpwwwpublichealthuconnedusim_dashhtmlohriNav=7C
Scorecard MeasuresReporting Only
Coordination of Care30 day readmission
PCPs that meet Meaningful Use
Prevention
Non-recommended Cervical Cancer Screening in Adolescent Female
Well-child visits in the third fourth fifth and sixth years of life (Medicaid only)
Frequency of Ongoing Prenatal Care (FPC)
Oral Evaluation Dental Services (Medicaid only)
Acute and Chronic Care
Cardiac strss img Testing in asymptomatic low risk patients
Behavioral HealthAdult major depressive disorder (MDD) Coordination of care of patients with specific co-morbid conditions
Anti-Depressant Medication Management
Initiation and Engagement of Alcohol and Other Drug Dependence Treatment
Follow up after hospitalization for mental illness 7 amp 30 days
21
Provisional Core Measure SetCare CoordinationPlan all-cause readmissionAnnual monitoring for persistent medications (roll-up)PreventionBreast cancer screeningCervical cancer screeningChlamydia screening in womenAdolescent female immunizations HPV
Weight assessment and counseling for nutrition and physical activity for childrenadolescents
Well-child visits in the first 15 months of lifeAdolescent well-care visitsBehavioral health screening (pediatric Medicaid only custom measure)
Acute amp Chronic Care
Medication management for people w asthma
DM HbA1c Testing
DM Diabetes medical attention for nephropathy
Use of imaging studies for low back pain
Avoidance of antibiotic treatment in adults with acute bronchitis
Appr treatment for children with upper respiratory infection
Behavioral Health
Follow-up care for children prescribed ADHD medicationMetabolic Monitoring for Children and Adolescents on Antipsychotics (pediatric Medicaid only custom measure)
Suicide Risk Identification
22
23
CT APCD Data -
Preliminary Analysis
Examples amp Showcase
Title XxSubtitle Xx
Presenter TitleDate
24Proprietary and Confidential 24
Connecticut APCDPreliminary Analysis Examples amp Showcase
CT APCD Advisory Group Meeting August 10 2017
25
bull Data source CY2016 commercial data from the CT APCDbull Focus commercial population-based reportingbull Considerations risk adjustment for age gender and health statusbull Areas of exploration
ndash Multiple views of the CT APCD population total members health exchange members members with diabetes
ndash Expenditures utilization and effective and preventive care ratesndash Analysis by multiple geographic units county Hospital Service
Area (HSA) and Health Reference Group (HRG) bull Conclusion Recap and lessons learned
Presentation Overview
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
26
bull Member Any person covered in a submitterrsquos eligibility databull Average Members Member months divided by 12 (months)bull Expenditures Allowed amount bull Capping Capped outliers in the data at the 99th percentilebull Clinical Risk Groups Individualsrsquo categorized health statusbull County Administrative focus areasbull Hospital Service Area Local hospital marketsbull Health Reference Group Community types bull Rates Expenditures by average membersbull Risk Adjustment Adjusting for differences between member
populations by considering membersrsquo age gender and health status
Key Terms
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
27
Population-Based Reporting
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
bull Reporting units county modified Hospital Service Area (HSA) and Health Reference Group (HRG)
bull Risk adjustment age gender and health status (3M CRGs)
28
CT APCD Population Overview
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Measure Count
Unique Members 875129
Total Member Months 9122482
Average Members 760207
Total Expenditures $40 Billion
Total Expenditures Per Member Per Year (PMPY) $5255
Total Expenditures Per Member Per Month (PMPM) $438
Total expenditures are capped at the 99th percentile
29
Expenditures PMPY by Age amp Gender
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$0
$1000
$2000
$3000
$4000
$5000
$6000
$7000
$8000
$9000
0-18 Female 0-18 Male 18-34 Female 18-34 Male 35-44 Female 35-44 Male 45-54 Female 45-54 Male 55-64 Female 55-64 Male
30
Expenditures PMPY by CRGs
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$-
$5000
$10000
$15000
$20000
$25000
$30000
$35000
$40000
Healthy Acute or Minor Chronic Moderate Chronic Significant Chronic Cancer or Catastrophic
$0
31
CT Health Exchange Population Overview
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
MeasureExchange Members
Non-Exchange Members
Average Members 86941 673266
Percentage of Members 55-64 Years of Age 31 20
Percentage of Members with Chronic Condition(s) 23 19
Expenditures PMPY $5378 $5239
Expenditures PMPY Risk Adjusted $4780 $5316 Expenditures PMPY for Members with Diabetes Risk-Adjusted $17561 $19291
32
CT Exchange vs Non-Exchange Rates
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Rate per 1000 Rate per 1000 (Risk Adj)
Measure Exchange Members
Non-Exchange Members
Exchange Members
Non-Exchange Members
Inpatient Acute Visits 390 328 339 335Medical 210 144 181 147Surgical 140 116 115 119Maternity 41 69 41 69
Outpatient Emergency Visits 1941 1924 1944 1923MRIs 920 803 810 817CT Scans 1108 824 938 844Primary Care Office Visits 15216 18755 16068 18628Psychiatric Visits 9864 9783 9783 11092Chiropractic Visits 3403 7808 3088 7913
Utilization measures are capped at the 99th percentile
33
Expenditure PMPY Diabetes Population
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$-
$5000
$10000
$15000
$20000
$25000
$30000
No Diabetes (n=730838) Diabetes amp no comorbidity (n=16419) Diabetes with comorbidity (n=12950)$0
No Diabetes (n = 730838)
Diabetes No Comorbidity(n = 16419)
Diabetes Comorbidity(n = 12950)
34
Vermont Blueprint for HealthDiabetes HbA1c Control amp Outcomes
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Measure HbA1c in Control HbA1c Not in Control
Members 5619 786
Average annual expenditures per capita
$15726 ($15219 $16233)
$17328 ($16110 $18546)
Inpatient hospitalizations per 1000 members
1897 (1782 2011)
2531 (2177 2886)
Inpatient days per 1000 members
8685 (8440 8930)
11561 (10804 12318)
Outpatient ED visits per 1000 members
6275 (6067 6483)
8011 (7381 8642)
Risk-adjusted rates and 95 confidence intervals 99th percentile outliers excluded HbA1c not in control gt9
35
Expenditures PMPY by County
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
County Average Members Expenditures PMPYExpenditures PMPY
(Risk Adjusted)Fairfield 223295 $5182 $5539 New London 44741 $5913 $5342 New Haven 161763 $5494 $5335 Middlesex 38531 $5359 $5184 Litchfield 43224 $5136 $5118 Tolland 36304 $5047 $5019 Hartford 191415 $4998 $4958 Windham 20934 $5539 $4950
Total 760207 $5255 $5255
36
Expenditures PMPY by HSA Risk Adjusted
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$0
$1000
$2000
$3000
$4000
$5000
$6000
$7000
37
EffectivePreventive Care
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
HEDIS MeasureCT APCD
CommercialNCQA
National HMONCQA
National PPOAvoidance of Antibiotic Treatment in Adults with Acute Bronchitis 268 276 258Anti-Depressant Medication Management 764 664 666Well-Child Visits 798 762 723Breast Cancer Screening 671 732 696
NCQA National HMO and NCQA National PPO benchmark metrics calculated for CY2015 Several other HEDIS measures can be run using the CT APCD data set and compared against the NCQA National HMO and PPO benchmarks Examples include Comprehensive Diabetes Care ndash HbA1C Testing Comprehensive Diabetes Care ndash Medical Attention for Nephrology Comprehensive Diabetes Care ndash Eye Exam Performed Adolescent Well-Care Visits Appropriate Treatment for Children with Upper Respiratory Infection etc
38
Breast Cancer Screening
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
60
62
64
66
68
70
72
Urban Centers (n=3369) Manufacturing Centers (n=10974) Diverse Suburbs (n=12206) Mill Towns (n=16281) Rural Towns (n=16789) Wealthy Suburbs (n=12266)
39
Vermont Blueprintrsquos Hub amp Spoke Model
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
bull Vermontrsquos ldquoHealth Homerdquo program designed to treat Vermonters with chronic opioid addiction
bull Hubs ndash designated providers ndash Provide coordinated care to patients through MAT services
ndash Coordinate referral to ongoing care
bull Spokes ndash teams of healthcare professionalsndash Blueprint Advanced Practice Medical Homes
ndash Federally-Qualified Health Centers
ndash Outpatient substance abuse and primary care providers
40copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Medication Assisted Treatment
bull Vermont Blueprint baseline study comparing medication-assisted treatment (MAT) population versus non-MAT population
bull Study published in the Journal of Substance Abuse Treatment (August 2016)
41
bull The CT APCD is a comparable resource to other statewide APCDs ndash A powerful tool that will only continue to grow with usendash Encompasses a robust set of information including
expenditures procedure codes diagnosis coding drug codes and enhanced value-adds (eg claim type master membermaster provider IDsNPIs MS-DRGs etc)
bull Future considerations to enhance the CT APCDndash Add Medicare and Medicaid claims datandash Continue to strengthen the completeness and validity of data
elements of importance to downstream analytic use cases (eg member race and ethnicity codes) in data collection
Lessons Learned
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
43
Next Steps
44
01Task
02Task
Ensure data quality issues are identified documented communicated and resolved
Data Quality
Continue building breadth of payer database amp complete enclave load
Data ETL
Finalize strategy to ensure site accomplishes PA 13-247 and PA 15-146 intent
Establish Strategy
05Task
Identify leading consumer information and price transparency tools available
Consumer Tool Evaluation04Task
Tasks Until Next Meeting (11917)APCD Development and Strategy Update
Distinguish Critical Paths Across and Within Strategic Priorities and Maintain Focus on ldquoMust Havesrdquo and ldquoQuick Winsrdquo
Ensure APCD staff can generate self-service extracts at little cost with minimal lead time
Deliver First DR Extract03Task
45
Future MeetingsAPCD Development and Strategy Update
November
9Legislative Office
Building Room 1D 300 Capitol Avenue
Hartford
All Payer Claims Database Advisory GroupMeeting
900ndash1100 AM
5
APCD Updates amp Project
Status Overview
6
Minnesota - Analysis of Low-Value Health Services inthe Minnesota All Payer Claims Database1
Virginia - VHI Five Most Common Avoidable ER Visits2
State APCD Activity
HealthCostcom latest publicly available transparency website released3
Cost Transparency Websites
SAMHSA - Confidentiality of Alcohol and Drug Abuse Patient Records 42 CFR Part 2
National Policy Update
Recent National DevelopmentsAPCD Updates and Project Status
1) httpwwwhealthstatemnushealthreformallpayerlvsissuebriefpdf2) httpwwwalexandrianewsorg201707virginias-five-most-common-avoidable-er-visits3) httpswwwhealthcostcomconsumer4) httpswwwcgactgov2017actpa2017PA-00154-R00SB-00546-PAhtm
PA 17-154 ndash An Act Concerning Participating Provider Directories4
State Policy Update
7
01Task
02Task
03Task
Ensure data quality issues are identified documented communicated and resolved
Data Quality
Promote data usage as a form of data QA
Preliminary Reporting
Continue building breadth of payer database amp complete enclave load
Data ETL
Identify leading consumer information and price transparency tools available
Consumer Tool Evaluation05Task
Finalize strategy to ensure site accomplishes PA 13-247 and PA 15-146 intent
Establish Strategy06Task
Ensure APCD staff can generate self-service extracts at little cost with minimal lead time
Extract Development04Task
Target Initiatives Since Last MeetingAPCD Development and Strategy Update
Distinguish Critical Paths Across and Within Strategic Priorities and Maintain Focus on ldquoMust Havesrdquo and ldquoQuick Winsrdquo
8
Accomplishments Since Last MeetingAPCD Updates and Project Status
Data Collection Status2016 Commercial data normalization and load into enclave to be completed by May 15th
Data Release Architecture CompletePreliminary data dictionary released Data release extract tool development nearly complete
Medicare Data ApprovedApplication for CMS Medicare data approved Data received and integration in progress
Data Release Training and CoordinationData Release Committee re-engaged and 1st release review scheduled August16th
Preliminary Analysis and End User FeedbackPopulation segmentation and profiling underway value added tables amp software in various phases of implementation (knowledge bases risk scoring software etc)
First Data Release Application1st completed data release application received
9
Data Collection Status UpdateAPCD Updates and Project Status
Eligibility Medical Pharmacy ProviderStatusNotesStart Date End Date Start Date End Date Start Date End Date Start Date End Date
AetnaAetna Health Insurance HMO FI 012012 062017 012012 062017 012012 062017 012012 062017 Submitter is current with file submissions to OnpointAetna Health Insurance HMO on ACAS FI 012012 062017 012012 062017 012012 062017 NA NA Submitter is current with file submissions to OnpointAetna Life Insurance Company Aetna Student Health 012012 062017 012012 062017 NA NA 012012 062017 Submitter is current with file submissions to OnpointAetna Life Insurance Company HMO Medicare 012012 062017 012012 062017 012012 062017 NA NA Submitter is current with file submissions to OnpointAetna Life Insurance Company Traditional 012012 062017 012012 062017 012012 062017 012012 062017 Submitter is current with file submissions to Onpoint
Anthem012012 012017 012012 012017 012012 012017 012012 012017 Submitter to resume data submissions in October 2017
Caremark LLC012012 062017 NA NA 012012 062017 NA NA Submitter is current with file submissions to Onpoint
CignaCigna Health and Life Insurance Company Inc - West 012012 062017 012012 062017 012012 062017 012012 062017 Submitter is current with file submissions to OnpointCigna Health and Life Insurance Company Inc - East 012012 062017 012012 062017 012012 062017 012012 062017 Submitter is current with file submissions to Onpoint
ConnectiCareConnectiCare 012012 052017 012012 052017 012012 052017 012012 052017 Submitter has not yet supplied June 2017 file submissionsConnectiCare Inc - Medicare Advantage 012012 052017 012012 052017 012012 012017 012012 052017 Submitter has not yet supplied June 2017 file submissions
Express Scripts- - NA NA - - NA NA Submitter supplied January 2012 test files on 872017
First Health Life and Health Insurance Company012012 062017 NA NA 012012 062017 NA NA Submitter is current with file submissions to Onpoint
Harvard Pilgrim012012 062017 012012 062017 012012 062017 012012 062017 Submitter is current with file submissions to Onpoint
HealthyCT012014 122014 012014 122014 012014 122014 012014 122014 Submitter no longer active with the CT APCD
United Health GroupeviCore (UHC - Oxford) NA NA 012015 042017 - - 012012 042017 Submitter has not yet supplied May - June 2017 file submissionsOptumHealth Care Solutions Inc (Optum) NA NA 012012 062017 NA NA 012012 062017 Submitter is current with file submissions to OnpointOrthoNet NA NA 012012 062017 NA NA NA NA Submitter is current with file submissions to OnpointOxford Health Plans 012012 062017 012012 052017 012012 062017 012012 062017 Submitter has not yet supplied June 2017 medical claims fileUHC - Golden Rule 012012 062017 012012 062017 012012 062017 012012 062017 Submitter is current with file submissions to OnpointUnitedHealthcare Insurance - Medicare 012012 062017 012012 062017 012012 062017 012012 062017 Submitter is current with file submissions to OnpointUnitedHealthcare Insurance Company 012012 062017 012012 062017 012012 062017 012012 062017 Submitter is current with file submissions to Onpoint
WellCare Health Plans Inc012012 062017 012012 062017 012012 122015 012012 062017 Submitter is current with file submissions to Onpoint
Medicaid- - - - - - - -
Medicare- - - - - - - - Data received 82017
Submission D
elay lt 3 Months or Integration In Progress
Submission O
n Schedule
Submission N
ot Scheduled or ge 3 Months D
elayed
10
APCD Data Release
Update
11
Develop and implement core requirements to achieve DRcapabilities
Administration Data release application dictionary ampsupport materialsSoftwareTools Extract creation and delivery toolSupport Admin support and documentation
Phase 1 Develop DR Process Tools and CapabilitiesEngage potential requestors to ensurecapabilities opportunities and services arerecognized
Phase 2 Promotion and Delivery
Data Release (DR) RecapAPCD Data Release Update
Legislative Charge (PA 13-247) The exchange shall helliphellip and (B) make data in the all-payer claims database available to any state agency insurer employer health care provider consumer of health care services or researcher for the purpose of allowing such person or entity to review such data as it relates to health care utilization costs or quality of health care services
12
End to End application process can take between 17 to 40days depending on time of month an application issubmitted All requests must follow the data releaseprocess outlined by Privacy Policy amp Procedures
Data Release ApplicationRequestor general information project summary research details data selection and securityintegrity
Data Release CommitteeReview application alignment with objectives re-identification risk safeguard adequacy and research design
Data Use Agreement Fees amp ExtractUser agrees to fee schedule DUA requirements Standard extract creation within 5 business days (after 1st release)
S M T W T F S
1 2 3 4 5
6 7 8 9 10 11 12
13 14 15 16 17 18 19
20 21 22 23 24 25 26
27 28 29 39 31
DR Process amp Turn-Around TimeAPCD Data Release Update
13
DR TableField Classification MatrixAPCD Data Release Update
Table Name
Field Classifications
Administrative
Enrollee Coverage
InformationEnrollee
DemographicsClaim
InformationDiagnosis
Information
Procedure Coding amp
DetailFinancial
InformationProvider
InformationPayer
InformationSafe Harbor
Variable Grand TotalEligibility 2 11 1 1 1 1 4 21
Eligibility Supplemental 2 13 9 4 28
Medical 2 3 13 2 7 8 4 1 6 46
Medical Claim Header 2 5 7
Medical Supplemental 4 6 3 11 1 6 31
Medical Claim Diagnosis 1 3 1 5
Medical Claim Icd Procedure 2 14 5 4 1 26
Pharmacy 3 3 11 2 9 2 1 3 34
Pharmacy Supplemental 2 8 4 1 15
Provider 3 2 1 6Grand Total 23 30 10 55 10 15 41 10 5 20 219
Data Release Dictionary Located httpagencyaccesshealthctcommeetings1485450397264-a8f3a430-837b
14
ProviderFacility Directory
512k Unique National Provider Identifiers
Pharmacy Claims
All claimsencounters paid by submitting carrier
Data includes info on Administrative Enrollee Coverage Claim Detail Diagnosis Codes Procedure Codes Financials Payers Providers Safe Harbor (12)
1273M Claims $125B
Medical Claims
All claimsencounters paid by submitting carrier
Data includes info on Administrative Enrollee Coverage Claim Detail Diagnosis Codes Procedure Codes Financials Payers Providers Safe Harbor (12)
747M Claims $304B
Enrollees
CY 2012 ndash Present (n- 1 month)
Data includes info on Administrative Enrollee Coverage Enrollee Demographics Financials Payers Providers Safe Harbor (2)Fully insuredNon-ERISA plans (~900k Lives)
Whatrsquos Available Through DRAPCD Data Release Update
Billing rendering prescribing pharmacy primary care provider IDs (varying completion rate)
Data includes info on Unblended and composite provider IDs and NPIs
15
ERISALives covered under self-
insured ERISA plans
Part 2 SUD claimsSUD claims provided by
Part 2 providers
Denied ClaimsFully denied claims not
collected
Test Result ValuesLab imaging biometrics
and physician derived data
Third Party Data Risk scoring social
determinants knowledge base etc
Dental ClaimsDental claims not required
for submission
Ancillary FinancialsPlan premiums capitation payments performance
payments administrative fees
Whatrsquos Not Available Through DRAPCD Data Release Update
HIPAA Safe Harbor Variables18 HIPAA identifiers
16
18 HIPAA identifiers removed from dataset
Identifiers removed as set forth in 45 CFR 164514
De-identification
De-Identified Data ReleaseAPCD Data Release Update
Age caps applied (over 89 less than 1) amp geography reduced to 3 digit zip
All dates related to service and payments masked
First three digits of zip codes only if the geographic area covered by all zip codes beginning with those three digits has a population greater than 20000 or the zip codes for those areas are changed to 000 in the data set
Supplementary safeguards imposed to reduce unique characteristics
17
Partnerships LicensingAccessibilityValue Add DataProcess
Improvement
Identify third party data that can supplement and enrich within release requirements
Third Party DataIdentify areas of process
improvement and automation
ScalabilityEstablish enclave capability
upon needdemand
Extract v EnclaveIdentify areas of opportunity for ongoing multiple use by
institutions
Engagement
Potential Future ImprovementsAPCD Data Release Update
18
AUGUST
16SEPTEMBER
7SEPTEMBER
15SEPTEMBER
22Committee review and
vote on first data request application
from UConn
DATA RELEASE COMMITTEE MEETING
To be canceled if no additional applications
submitted
DATA RELEASE COMMITTEE MEETING
Review and confirmation of de-
identification methods and implementation
EXTRACT AUDIT
Extract delivered and support channel
opened
DATA RELEASE
Data release activities within the next two months include
Open Action ItemsAPCD Data Release Update
Project Descriptions
bull State Innovation Modelndash Online dashboard of ~30 pace and performance measures
bull Used to monitor performance of SIM bull 12 measures use APCD databull Includes yearly targets for overall Connecticut
ndash Online Scorecard Online dashboard of FQHC and Advanced Network performancebull First health care performance scorecard in CTbull Provides transparency in provider performancebull Utilizes claims based measures from common scorecard and CAHPS surveys
bull Suicide Risk Identificationndash Improves identification of patients at risk of suicide
bull Utilizes APCD claims data EHR data from 5 health care providers and mortality databull Creation of phenotypic algorithm
19
APCD Based Dashboard Measures
Health Care DeliveryPercent of adults with regular source of careChildren well-child visits for at-risk popMammograms for women gt50 last 2 yearsOptimal diabetes care- 2+ annual A1c testsED use- asthma as primary dx (per 10k)
Percent of adults with HTN taking HTN medsFollow-Up after Discharge from the Emergency Department for Mental Health or Alcohol or other Drug
Follow-Up after Hospitalization for Mental Illness
Antidepressant Medication ManagementInitiation and Engagement of Alcohol and Other Drug Dependence Treatment
Health Care Costs
Cost of inpatient care PMPY
Cost of outpatient care PMPY
httpwwwpublichealthuconnedusim_dashhtmlohriNav=7C
Scorecard MeasuresReporting Only
Coordination of Care30 day readmission
PCPs that meet Meaningful Use
Prevention
Non-recommended Cervical Cancer Screening in Adolescent Female
Well-child visits in the third fourth fifth and sixth years of life (Medicaid only)
Frequency of Ongoing Prenatal Care (FPC)
Oral Evaluation Dental Services (Medicaid only)
Acute and Chronic Care
Cardiac strss img Testing in asymptomatic low risk patients
Behavioral HealthAdult major depressive disorder (MDD) Coordination of care of patients with specific co-morbid conditions
Anti-Depressant Medication Management
Initiation and Engagement of Alcohol and Other Drug Dependence Treatment
Follow up after hospitalization for mental illness 7 amp 30 days
21
Provisional Core Measure SetCare CoordinationPlan all-cause readmissionAnnual monitoring for persistent medications (roll-up)PreventionBreast cancer screeningCervical cancer screeningChlamydia screening in womenAdolescent female immunizations HPV
Weight assessment and counseling for nutrition and physical activity for childrenadolescents
Well-child visits in the first 15 months of lifeAdolescent well-care visitsBehavioral health screening (pediatric Medicaid only custom measure)
Acute amp Chronic Care
Medication management for people w asthma
DM HbA1c Testing
DM Diabetes medical attention for nephropathy
Use of imaging studies for low back pain
Avoidance of antibiotic treatment in adults with acute bronchitis
Appr treatment for children with upper respiratory infection
Behavioral Health
Follow-up care for children prescribed ADHD medicationMetabolic Monitoring for Children and Adolescents on Antipsychotics (pediatric Medicaid only custom measure)
Suicide Risk Identification
22
23
CT APCD Data -
Preliminary Analysis
Examples amp Showcase
Title XxSubtitle Xx
Presenter TitleDate
24Proprietary and Confidential 24
Connecticut APCDPreliminary Analysis Examples amp Showcase
CT APCD Advisory Group Meeting August 10 2017
25
bull Data source CY2016 commercial data from the CT APCDbull Focus commercial population-based reportingbull Considerations risk adjustment for age gender and health statusbull Areas of exploration
ndash Multiple views of the CT APCD population total members health exchange members members with diabetes
ndash Expenditures utilization and effective and preventive care ratesndash Analysis by multiple geographic units county Hospital Service
Area (HSA) and Health Reference Group (HRG) bull Conclusion Recap and lessons learned
Presentation Overview
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
26
bull Member Any person covered in a submitterrsquos eligibility databull Average Members Member months divided by 12 (months)bull Expenditures Allowed amount bull Capping Capped outliers in the data at the 99th percentilebull Clinical Risk Groups Individualsrsquo categorized health statusbull County Administrative focus areasbull Hospital Service Area Local hospital marketsbull Health Reference Group Community types bull Rates Expenditures by average membersbull Risk Adjustment Adjusting for differences between member
populations by considering membersrsquo age gender and health status
Key Terms
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
27
Population-Based Reporting
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
bull Reporting units county modified Hospital Service Area (HSA) and Health Reference Group (HRG)
bull Risk adjustment age gender and health status (3M CRGs)
28
CT APCD Population Overview
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Measure Count
Unique Members 875129
Total Member Months 9122482
Average Members 760207
Total Expenditures $40 Billion
Total Expenditures Per Member Per Year (PMPY) $5255
Total Expenditures Per Member Per Month (PMPM) $438
Total expenditures are capped at the 99th percentile
29
Expenditures PMPY by Age amp Gender
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$0
$1000
$2000
$3000
$4000
$5000
$6000
$7000
$8000
$9000
0-18 Female 0-18 Male 18-34 Female 18-34 Male 35-44 Female 35-44 Male 45-54 Female 45-54 Male 55-64 Female 55-64 Male
30
Expenditures PMPY by CRGs
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$-
$5000
$10000
$15000
$20000
$25000
$30000
$35000
$40000
Healthy Acute or Minor Chronic Moderate Chronic Significant Chronic Cancer or Catastrophic
$0
31
CT Health Exchange Population Overview
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
MeasureExchange Members
Non-Exchange Members
Average Members 86941 673266
Percentage of Members 55-64 Years of Age 31 20
Percentage of Members with Chronic Condition(s) 23 19
Expenditures PMPY $5378 $5239
Expenditures PMPY Risk Adjusted $4780 $5316 Expenditures PMPY for Members with Diabetes Risk-Adjusted $17561 $19291
32
CT Exchange vs Non-Exchange Rates
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Rate per 1000 Rate per 1000 (Risk Adj)
Measure Exchange Members
Non-Exchange Members
Exchange Members
Non-Exchange Members
Inpatient Acute Visits 390 328 339 335Medical 210 144 181 147Surgical 140 116 115 119Maternity 41 69 41 69
Outpatient Emergency Visits 1941 1924 1944 1923MRIs 920 803 810 817CT Scans 1108 824 938 844Primary Care Office Visits 15216 18755 16068 18628Psychiatric Visits 9864 9783 9783 11092Chiropractic Visits 3403 7808 3088 7913
Utilization measures are capped at the 99th percentile
33
Expenditure PMPY Diabetes Population
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$-
$5000
$10000
$15000
$20000
$25000
$30000
No Diabetes (n=730838) Diabetes amp no comorbidity (n=16419) Diabetes with comorbidity (n=12950)$0
No Diabetes (n = 730838)
Diabetes No Comorbidity(n = 16419)
Diabetes Comorbidity(n = 12950)
34
Vermont Blueprint for HealthDiabetes HbA1c Control amp Outcomes
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Measure HbA1c in Control HbA1c Not in Control
Members 5619 786
Average annual expenditures per capita
$15726 ($15219 $16233)
$17328 ($16110 $18546)
Inpatient hospitalizations per 1000 members
1897 (1782 2011)
2531 (2177 2886)
Inpatient days per 1000 members
8685 (8440 8930)
11561 (10804 12318)
Outpatient ED visits per 1000 members
6275 (6067 6483)
8011 (7381 8642)
Risk-adjusted rates and 95 confidence intervals 99th percentile outliers excluded HbA1c not in control gt9
35
Expenditures PMPY by County
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
County Average Members Expenditures PMPYExpenditures PMPY
(Risk Adjusted)Fairfield 223295 $5182 $5539 New London 44741 $5913 $5342 New Haven 161763 $5494 $5335 Middlesex 38531 $5359 $5184 Litchfield 43224 $5136 $5118 Tolland 36304 $5047 $5019 Hartford 191415 $4998 $4958 Windham 20934 $5539 $4950
Total 760207 $5255 $5255
36
Expenditures PMPY by HSA Risk Adjusted
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$0
$1000
$2000
$3000
$4000
$5000
$6000
$7000
37
EffectivePreventive Care
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
HEDIS MeasureCT APCD
CommercialNCQA
National HMONCQA
National PPOAvoidance of Antibiotic Treatment in Adults with Acute Bronchitis 268 276 258Anti-Depressant Medication Management 764 664 666Well-Child Visits 798 762 723Breast Cancer Screening 671 732 696
NCQA National HMO and NCQA National PPO benchmark metrics calculated for CY2015 Several other HEDIS measures can be run using the CT APCD data set and compared against the NCQA National HMO and PPO benchmarks Examples include Comprehensive Diabetes Care ndash HbA1C Testing Comprehensive Diabetes Care ndash Medical Attention for Nephrology Comprehensive Diabetes Care ndash Eye Exam Performed Adolescent Well-Care Visits Appropriate Treatment for Children with Upper Respiratory Infection etc
38
Breast Cancer Screening
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
60
62
64
66
68
70
72
Urban Centers (n=3369) Manufacturing Centers (n=10974) Diverse Suburbs (n=12206) Mill Towns (n=16281) Rural Towns (n=16789) Wealthy Suburbs (n=12266)
39
Vermont Blueprintrsquos Hub amp Spoke Model
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
bull Vermontrsquos ldquoHealth Homerdquo program designed to treat Vermonters with chronic opioid addiction
bull Hubs ndash designated providers ndash Provide coordinated care to patients through MAT services
ndash Coordinate referral to ongoing care
bull Spokes ndash teams of healthcare professionalsndash Blueprint Advanced Practice Medical Homes
ndash Federally-Qualified Health Centers
ndash Outpatient substance abuse and primary care providers
40copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Medication Assisted Treatment
bull Vermont Blueprint baseline study comparing medication-assisted treatment (MAT) population versus non-MAT population
bull Study published in the Journal of Substance Abuse Treatment (August 2016)
41
bull The CT APCD is a comparable resource to other statewide APCDs ndash A powerful tool that will only continue to grow with usendash Encompasses a robust set of information including
expenditures procedure codes diagnosis coding drug codes and enhanced value-adds (eg claim type master membermaster provider IDsNPIs MS-DRGs etc)
bull Future considerations to enhance the CT APCDndash Add Medicare and Medicaid claims datandash Continue to strengthen the completeness and validity of data
elements of importance to downstream analytic use cases (eg member race and ethnicity codes) in data collection
Lessons Learned
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
43
Next Steps
44
01Task
02Task
Ensure data quality issues are identified documented communicated and resolved
Data Quality
Continue building breadth of payer database amp complete enclave load
Data ETL
Finalize strategy to ensure site accomplishes PA 13-247 and PA 15-146 intent
Establish Strategy
05Task
Identify leading consumer information and price transparency tools available
Consumer Tool Evaluation04Task
Tasks Until Next Meeting (11917)APCD Development and Strategy Update
Distinguish Critical Paths Across and Within Strategic Priorities and Maintain Focus on ldquoMust Havesrdquo and ldquoQuick Winsrdquo
Ensure APCD staff can generate self-service extracts at little cost with minimal lead time
Deliver First DR Extract03Task
45
Future MeetingsAPCD Development and Strategy Update
November
9Legislative Office
Building Room 1D 300 Capitol Avenue
Hartford
All Payer Claims Database Advisory GroupMeeting
900ndash1100 AM
6
Minnesota - Analysis of Low-Value Health Services inthe Minnesota All Payer Claims Database1
Virginia - VHI Five Most Common Avoidable ER Visits2
State APCD Activity
HealthCostcom latest publicly available transparency website released3
Cost Transparency Websites
SAMHSA - Confidentiality of Alcohol and Drug Abuse Patient Records 42 CFR Part 2
National Policy Update
Recent National DevelopmentsAPCD Updates and Project Status
1) httpwwwhealthstatemnushealthreformallpayerlvsissuebriefpdf2) httpwwwalexandrianewsorg201707virginias-five-most-common-avoidable-er-visits3) httpswwwhealthcostcomconsumer4) httpswwwcgactgov2017actpa2017PA-00154-R00SB-00546-PAhtm
PA 17-154 ndash An Act Concerning Participating Provider Directories4
State Policy Update
7
01Task
02Task
03Task
Ensure data quality issues are identified documented communicated and resolved
Data Quality
Promote data usage as a form of data QA
Preliminary Reporting
Continue building breadth of payer database amp complete enclave load
Data ETL
Identify leading consumer information and price transparency tools available
Consumer Tool Evaluation05Task
Finalize strategy to ensure site accomplishes PA 13-247 and PA 15-146 intent
Establish Strategy06Task
Ensure APCD staff can generate self-service extracts at little cost with minimal lead time
Extract Development04Task
Target Initiatives Since Last MeetingAPCD Development and Strategy Update
Distinguish Critical Paths Across and Within Strategic Priorities and Maintain Focus on ldquoMust Havesrdquo and ldquoQuick Winsrdquo
8
Accomplishments Since Last MeetingAPCD Updates and Project Status
Data Collection Status2016 Commercial data normalization and load into enclave to be completed by May 15th
Data Release Architecture CompletePreliminary data dictionary released Data release extract tool development nearly complete
Medicare Data ApprovedApplication for CMS Medicare data approved Data received and integration in progress
Data Release Training and CoordinationData Release Committee re-engaged and 1st release review scheduled August16th
Preliminary Analysis and End User FeedbackPopulation segmentation and profiling underway value added tables amp software in various phases of implementation (knowledge bases risk scoring software etc)
First Data Release Application1st completed data release application received
9
Data Collection Status UpdateAPCD Updates and Project Status
Eligibility Medical Pharmacy ProviderStatusNotesStart Date End Date Start Date End Date Start Date End Date Start Date End Date
AetnaAetna Health Insurance HMO FI 012012 062017 012012 062017 012012 062017 012012 062017 Submitter is current with file submissions to OnpointAetna Health Insurance HMO on ACAS FI 012012 062017 012012 062017 012012 062017 NA NA Submitter is current with file submissions to OnpointAetna Life Insurance Company Aetna Student Health 012012 062017 012012 062017 NA NA 012012 062017 Submitter is current with file submissions to OnpointAetna Life Insurance Company HMO Medicare 012012 062017 012012 062017 012012 062017 NA NA Submitter is current with file submissions to OnpointAetna Life Insurance Company Traditional 012012 062017 012012 062017 012012 062017 012012 062017 Submitter is current with file submissions to Onpoint
Anthem012012 012017 012012 012017 012012 012017 012012 012017 Submitter to resume data submissions in October 2017
Caremark LLC012012 062017 NA NA 012012 062017 NA NA Submitter is current with file submissions to Onpoint
CignaCigna Health and Life Insurance Company Inc - West 012012 062017 012012 062017 012012 062017 012012 062017 Submitter is current with file submissions to OnpointCigna Health and Life Insurance Company Inc - East 012012 062017 012012 062017 012012 062017 012012 062017 Submitter is current with file submissions to Onpoint
ConnectiCareConnectiCare 012012 052017 012012 052017 012012 052017 012012 052017 Submitter has not yet supplied June 2017 file submissionsConnectiCare Inc - Medicare Advantage 012012 052017 012012 052017 012012 012017 012012 052017 Submitter has not yet supplied June 2017 file submissions
Express Scripts- - NA NA - - NA NA Submitter supplied January 2012 test files on 872017
First Health Life and Health Insurance Company012012 062017 NA NA 012012 062017 NA NA Submitter is current with file submissions to Onpoint
Harvard Pilgrim012012 062017 012012 062017 012012 062017 012012 062017 Submitter is current with file submissions to Onpoint
HealthyCT012014 122014 012014 122014 012014 122014 012014 122014 Submitter no longer active with the CT APCD
United Health GroupeviCore (UHC - Oxford) NA NA 012015 042017 - - 012012 042017 Submitter has not yet supplied May - June 2017 file submissionsOptumHealth Care Solutions Inc (Optum) NA NA 012012 062017 NA NA 012012 062017 Submitter is current with file submissions to OnpointOrthoNet NA NA 012012 062017 NA NA NA NA Submitter is current with file submissions to OnpointOxford Health Plans 012012 062017 012012 052017 012012 062017 012012 062017 Submitter has not yet supplied June 2017 medical claims fileUHC - Golden Rule 012012 062017 012012 062017 012012 062017 012012 062017 Submitter is current with file submissions to OnpointUnitedHealthcare Insurance - Medicare 012012 062017 012012 062017 012012 062017 012012 062017 Submitter is current with file submissions to OnpointUnitedHealthcare Insurance Company 012012 062017 012012 062017 012012 062017 012012 062017 Submitter is current with file submissions to Onpoint
WellCare Health Plans Inc012012 062017 012012 062017 012012 122015 012012 062017 Submitter is current with file submissions to Onpoint
Medicaid- - - - - - - -
Medicare- - - - - - - - Data received 82017
Submission D
elay lt 3 Months or Integration In Progress
Submission O
n Schedule
Submission N
ot Scheduled or ge 3 Months D
elayed
10
APCD Data Release
Update
11
Develop and implement core requirements to achieve DRcapabilities
Administration Data release application dictionary ampsupport materialsSoftwareTools Extract creation and delivery toolSupport Admin support and documentation
Phase 1 Develop DR Process Tools and CapabilitiesEngage potential requestors to ensurecapabilities opportunities and services arerecognized
Phase 2 Promotion and Delivery
Data Release (DR) RecapAPCD Data Release Update
Legislative Charge (PA 13-247) The exchange shall helliphellip and (B) make data in the all-payer claims database available to any state agency insurer employer health care provider consumer of health care services or researcher for the purpose of allowing such person or entity to review such data as it relates to health care utilization costs or quality of health care services
12
End to End application process can take between 17 to 40days depending on time of month an application issubmitted All requests must follow the data releaseprocess outlined by Privacy Policy amp Procedures
Data Release ApplicationRequestor general information project summary research details data selection and securityintegrity
Data Release CommitteeReview application alignment with objectives re-identification risk safeguard adequacy and research design
Data Use Agreement Fees amp ExtractUser agrees to fee schedule DUA requirements Standard extract creation within 5 business days (after 1st release)
S M T W T F S
1 2 3 4 5
6 7 8 9 10 11 12
13 14 15 16 17 18 19
20 21 22 23 24 25 26
27 28 29 39 31
DR Process amp Turn-Around TimeAPCD Data Release Update
13
DR TableField Classification MatrixAPCD Data Release Update
Table Name
Field Classifications
Administrative
Enrollee Coverage
InformationEnrollee
DemographicsClaim
InformationDiagnosis
Information
Procedure Coding amp
DetailFinancial
InformationProvider
InformationPayer
InformationSafe Harbor
Variable Grand TotalEligibility 2 11 1 1 1 1 4 21
Eligibility Supplemental 2 13 9 4 28
Medical 2 3 13 2 7 8 4 1 6 46
Medical Claim Header 2 5 7
Medical Supplemental 4 6 3 11 1 6 31
Medical Claim Diagnosis 1 3 1 5
Medical Claim Icd Procedure 2 14 5 4 1 26
Pharmacy 3 3 11 2 9 2 1 3 34
Pharmacy Supplemental 2 8 4 1 15
Provider 3 2 1 6Grand Total 23 30 10 55 10 15 41 10 5 20 219
Data Release Dictionary Located httpagencyaccesshealthctcommeetings1485450397264-a8f3a430-837b
14
ProviderFacility Directory
512k Unique National Provider Identifiers
Pharmacy Claims
All claimsencounters paid by submitting carrier
Data includes info on Administrative Enrollee Coverage Claim Detail Diagnosis Codes Procedure Codes Financials Payers Providers Safe Harbor (12)
1273M Claims $125B
Medical Claims
All claimsencounters paid by submitting carrier
Data includes info on Administrative Enrollee Coverage Claim Detail Diagnosis Codes Procedure Codes Financials Payers Providers Safe Harbor (12)
747M Claims $304B
Enrollees
CY 2012 ndash Present (n- 1 month)
Data includes info on Administrative Enrollee Coverage Enrollee Demographics Financials Payers Providers Safe Harbor (2)Fully insuredNon-ERISA plans (~900k Lives)
Whatrsquos Available Through DRAPCD Data Release Update
Billing rendering prescribing pharmacy primary care provider IDs (varying completion rate)
Data includes info on Unblended and composite provider IDs and NPIs
15
ERISALives covered under self-
insured ERISA plans
Part 2 SUD claimsSUD claims provided by
Part 2 providers
Denied ClaimsFully denied claims not
collected
Test Result ValuesLab imaging biometrics
and physician derived data
Third Party Data Risk scoring social
determinants knowledge base etc
Dental ClaimsDental claims not required
for submission
Ancillary FinancialsPlan premiums capitation payments performance
payments administrative fees
Whatrsquos Not Available Through DRAPCD Data Release Update
HIPAA Safe Harbor Variables18 HIPAA identifiers
16
18 HIPAA identifiers removed from dataset
Identifiers removed as set forth in 45 CFR 164514
De-identification
De-Identified Data ReleaseAPCD Data Release Update
Age caps applied (over 89 less than 1) amp geography reduced to 3 digit zip
All dates related to service and payments masked
First three digits of zip codes only if the geographic area covered by all zip codes beginning with those three digits has a population greater than 20000 or the zip codes for those areas are changed to 000 in the data set
Supplementary safeguards imposed to reduce unique characteristics
17
Partnerships LicensingAccessibilityValue Add DataProcess
Improvement
Identify third party data that can supplement and enrich within release requirements
Third Party DataIdentify areas of process
improvement and automation
ScalabilityEstablish enclave capability
upon needdemand
Extract v EnclaveIdentify areas of opportunity for ongoing multiple use by
institutions
Engagement
Potential Future ImprovementsAPCD Data Release Update
18
AUGUST
16SEPTEMBER
7SEPTEMBER
15SEPTEMBER
22Committee review and
vote on first data request application
from UConn
DATA RELEASE COMMITTEE MEETING
To be canceled if no additional applications
submitted
DATA RELEASE COMMITTEE MEETING
Review and confirmation of de-
identification methods and implementation
EXTRACT AUDIT
Extract delivered and support channel
opened
DATA RELEASE
Data release activities within the next two months include
Open Action ItemsAPCD Data Release Update
Project Descriptions
bull State Innovation Modelndash Online dashboard of ~30 pace and performance measures
bull Used to monitor performance of SIM bull 12 measures use APCD databull Includes yearly targets for overall Connecticut
ndash Online Scorecard Online dashboard of FQHC and Advanced Network performancebull First health care performance scorecard in CTbull Provides transparency in provider performancebull Utilizes claims based measures from common scorecard and CAHPS surveys
bull Suicide Risk Identificationndash Improves identification of patients at risk of suicide
bull Utilizes APCD claims data EHR data from 5 health care providers and mortality databull Creation of phenotypic algorithm
19
APCD Based Dashboard Measures
Health Care DeliveryPercent of adults with regular source of careChildren well-child visits for at-risk popMammograms for women gt50 last 2 yearsOptimal diabetes care- 2+ annual A1c testsED use- asthma as primary dx (per 10k)
Percent of adults with HTN taking HTN medsFollow-Up after Discharge from the Emergency Department for Mental Health or Alcohol or other Drug
Follow-Up after Hospitalization for Mental Illness
Antidepressant Medication ManagementInitiation and Engagement of Alcohol and Other Drug Dependence Treatment
Health Care Costs
Cost of inpatient care PMPY
Cost of outpatient care PMPY
httpwwwpublichealthuconnedusim_dashhtmlohriNav=7C
Scorecard MeasuresReporting Only
Coordination of Care30 day readmission
PCPs that meet Meaningful Use
Prevention
Non-recommended Cervical Cancer Screening in Adolescent Female
Well-child visits in the third fourth fifth and sixth years of life (Medicaid only)
Frequency of Ongoing Prenatal Care (FPC)
Oral Evaluation Dental Services (Medicaid only)
Acute and Chronic Care
Cardiac strss img Testing in asymptomatic low risk patients
Behavioral HealthAdult major depressive disorder (MDD) Coordination of care of patients with specific co-morbid conditions
Anti-Depressant Medication Management
Initiation and Engagement of Alcohol and Other Drug Dependence Treatment
Follow up after hospitalization for mental illness 7 amp 30 days
21
Provisional Core Measure SetCare CoordinationPlan all-cause readmissionAnnual monitoring for persistent medications (roll-up)PreventionBreast cancer screeningCervical cancer screeningChlamydia screening in womenAdolescent female immunizations HPV
Weight assessment and counseling for nutrition and physical activity for childrenadolescents
Well-child visits in the first 15 months of lifeAdolescent well-care visitsBehavioral health screening (pediatric Medicaid only custom measure)
Acute amp Chronic Care
Medication management for people w asthma
DM HbA1c Testing
DM Diabetes medical attention for nephropathy
Use of imaging studies for low back pain
Avoidance of antibiotic treatment in adults with acute bronchitis
Appr treatment for children with upper respiratory infection
Behavioral Health
Follow-up care for children prescribed ADHD medicationMetabolic Monitoring for Children and Adolescents on Antipsychotics (pediatric Medicaid only custom measure)
Suicide Risk Identification
22
23
CT APCD Data -
Preliminary Analysis
Examples amp Showcase
Title XxSubtitle Xx
Presenter TitleDate
24Proprietary and Confidential 24
Connecticut APCDPreliminary Analysis Examples amp Showcase
CT APCD Advisory Group Meeting August 10 2017
25
bull Data source CY2016 commercial data from the CT APCDbull Focus commercial population-based reportingbull Considerations risk adjustment for age gender and health statusbull Areas of exploration
ndash Multiple views of the CT APCD population total members health exchange members members with diabetes
ndash Expenditures utilization and effective and preventive care ratesndash Analysis by multiple geographic units county Hospital Service
Area (HSA) and Health Reference Group (HRG) bull Conclusion Recap and lessons learned
Presentation Overview
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
26
bull Member Any person covered in a submitterrsquos eligibility databull Average Members Member months divided by 12 (months)bull Expenditures Allowed amount bull Capping Capped outliers in the data at the 99th percentilebull Clinical Risk Groups Individualsrsquo categorized health statusbull County Administrative focus areasbull Hospital Service Area Local hospital marketsbull Health Reference Group Community types bull Rates Expenditures by average membersbull Risk Adjustment Adjusting for differences between member
populations by considering membersrsquo age gender and health status
Key Terms
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
27
Population-Based Reporting
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
bull Reporting units county modified Hospital Service Area (HSA) and Health Reference Group (HRG)
bull Risk adjustment age gender and health status (3M CRGs)
28
CT APCD Population Overview
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Measure Count
Unique Members 875129
Total Member Months 9122482
Average Members 760207
Total Expenditures $40 Billion
Total Expenditures Per Member Per Year (PMPY) $5255
Total Expenditures Per Member Per Month (PMPM) $438
Total expenditures are capped at the 99th percentile
29
Expenditures PMPY by Age amp Gender
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$0
$1000
$2000
$3000
$4000
$5000
$6000
$7000
$8000
$9000
0-18 Female 0-18 Male 18-34 Female 18-34 Male 35-44 Female 35-44 Male 45-54 Female 45-54 Male 55-64 Female 55-64 Male
30
Expenditures PMPY by CRGs
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$-
$5000
$10000
$15000
$20000
$25000
$30000
$35000
$40000
Healthy Acute or Minor Chronic Moderate Chronic Significant Chronic Cancer or Catastrophic
$0
31
CT Health Exchange Population Overview
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
MeasureExchange Members
Non-Exchange Members
Average Members 86941 673266
Percentage of Members 55-64 Years of Age 31 20
Percentage of Members with Chronic Condition(s) 23 19
Expenditures PMPY $5378 $5239
Expenditures PMPY Risk Adjusted $4780 $5316 Expenditures PMPY for Members with Diabetes Risk-Adjusted $17561 $19291
32
CT Exchange vs Non-Exchange Rates
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Rate per 1000 Rate per 1000 (Risk Adj)
Measure Exchange Members
Non-Exchange Members
Exchange Members
Non-Exchange Members
Inpatient Acute Visits 390 328 339 335Medical 210 144 181 147Surgical 140 116 115 119Maternity 41 69 41 69
Outpatient Emergency Visits 1941 1924 1944 1923MRIs 920 803 810 817CT Scans 1108 824 938 844Primary Care Office Visits 15216 18755 16068 18628Psychiatric Visits 9864 9783 9783 11092Chiropractic Visits 3403 7808 3088 7913
Utilization measures are capped at the 99th percentile
33
Expenditure PMPY Diabetes Population
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$-
$5000
$10000
$15000
$20000
$25000
$30000
No Diabetes (n=730838) Diabetes amp no comorbidity (n=16419) Diabetes with comorbidity (n=12950)$0
No Diabetes (n = 730838)
Diabetes No Comorbidity(n = 16419)
Diabetes Comorbidity(n = 12950)
34
Vermont Blueprint for HealthDiabetes HbA1c Control amp Outcomes
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Measure HbA1c in Control HbA1c Not in Control
Members 5619 786
Average annual expenditures per capita
$15726 ($15219 $16233)
$17328 ($16110 $18546)
Inpatient hospitalizations per 1000 members
1897 (1782 2011)
2531 (2177 2886)
Inpatient days per 1000 members
8685 (8440 8930)
11561 (10804 12318)
Outpatient ED visits per 1000 members
6275 (6067 6483)
8011 (7381 8642)
Risk-adjusted rates and 95 confidence intervals 99th percentile outliers excluded HbA1c not in control gt9
35
Expenditures PMPY by County
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
County Average Members Expenditures PMPYExpenditures PMPY
(Risk Adjusted)Fairfield 223295 $5182 $5539 New London 44741 $5913 $5342 New Haven 161763 $5494 $5335 Middlesex 38531 $5359 $5184 Litchfield 43224 $5136 $5118 Tolland 36304 $5047 $5019 Hartford 191415 $4998 $4958 Windham 20934 $5539 $4950
Total 760207 $5255 $5255
36
Expenditures PMPY by HSA Risk Adjusted
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$0
$1000
$2000
$3000
$4000
$5000
$6000
$7000
37
EffectivePreventive Care
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
HEDIS MeasureCT APCD
CommercialNCQA
National HMONCQA
National PPOAvoidance of Antibiotic Treatment in Adults with Acute Bronchitis 268 276 258Anti-Depressant Medication Management 764 664 666Well-Child Visits 798 762 723Breast Cancer Screening 671 732 696
NCQA National HMO and NCQA National PPO benchmark metrics calculated for CY2015 Several other HEDIS measures can be run using the CT APCD data set and compared against the NCQA National HMO and PPO benchmarks Examples include Comprehensive Diabetes Care ndash HbA1C Testing Comprehensive Diabetes Care ndash Medical Attention for Nephrology Comprehensive Diabetes Care ndash Eye Exam Performed Adolescent Well-Care Visits Appropriate Treatment for Children with Upper Respiratory Infection etc
38
Breast Cancer Screening
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
60
62
64
66
68
70
72
Urban Centers (n=3369) Manufacturing Centers (n=10974) Diverse Suburbs (n=12206) Mill Towns (n=16281) Rural Towns (n=16789) Wealthy Suburbs (n=12266)
39
Vermont Blueprintrsquos Hub amp Spoke Model
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
bull Vermontrsquos ldquoHealth Homerdquo program designed to treat Vermonters with chronic opioid addiction
bull Hubs ndash designated providers ndash Provide coordinated care to patients through MAT services
ndash Coordinate referral to ongoing care
bull Spokes ndash teams of healthcare professionalsndash Blueprint Advanced Practice Medical Homes
ndash Federally-Qualified Health Centers
ndash Outpatient substance abuse and primary care providers
40copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Medication Assisted Treatment
bull Vermont Blueprint baseline study comparing medication-assisted treatment (MAT) population versus non-MAT population
bull Study published in the Journal of Substance Abuse Treatment (August 2016)
41
bull The CT APCD is a comparable resource to other statewide APCDs ndash A powerful tool that will only continue to grow with usendash Encompasses a robust set of information including
expenditures procedure codes diagnosis coding drug codes and enhanced value-adds (eg claim type master membermaster provider IDsNPIs MS-DRGs etc)
bull Future considerations to enhance the CT APCDndash Add Medicare and Medicaid claims datandash Continue to strengthen the completeness and validity of data
elements of importance to downstream analytic use cases (eg member race and ethnicity codes) in data collection
Lessons Learned
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
43
Next Steps
44
01Task
02Task
Ensure data quality issues are identified documented communicated and resolved
Data Quality
Continue building breadth of payer database amp complete enclave load
Data ETL
Finalize strategy to ensure site accomplishes PA 13-247 and PA 15-146 intent
Establish Strategy
05Task
Identify leading consumer information and price transparency tools available
Consumer Tool Evaluation04Task
Tasks Until Next Meeting (11917)APCD Development and Strategy Update
Distinguish Critical Paths Across and Within Strategic Priorities and Maintain Focus on ldquoMust Havesrdquo and ldquoQuick Winsrdquo
Ensure APCD staff can generate self-service extracts at little cost with minimal lead time
Deliver First DR Extract03Task
45
Future MeetingsAPCD Development and Strategy Update
November
9Legislative Office
Building Room 1D 300 Capitol Avenue
Hartford
All Payer Claims Database Advisory GroupMeeting
900ndash1100 AM
7
01Task
02Task
03Task
Ensure data quality issues are identified documented communicated and resolved
Data Quality
Promote data usage as a form of data QA
Preliminary Reporting
Continue building breadth of payer database amp complete enclave load
Data ETL
Identify leading consumer information and price transparency tools available
Consumer Tool Evaluation05Task
Finalize strategy to ensure site accomplishes PA 13-247 and PA 15-146 intent
Establish Strategy06Task
Ensure APCD staff can generate self-service extracts at little cost with minimal lead time
Extract Development04Task
Target Initiatives Since Last MeetingAPCD Development and Strategy Update
Distinguish Critical Paths Across and Within Strategic Priorities and Maintain Focus on ldquoMust Havesrdquo and ldquoQuick Winsrdquo
8
Accomplishments Since Last MeetingAPCD Updates and Project Status
Data Collection Status2016 Commercial data normalization and load into enclave to be completed by May 15th
Data Release Architecture CompletePreliminary data dictionary released Data release extract tool development nearly complete
Medicare Data ApprovedApplication for CMS Medicare data approved Data received and integration in progress
Data Release Training and CoordinationData Release Committee re-engaged and 1st release review scheduled August16th
Preliminary Analysis and End User FeedbackPopulation segmentation and profiling underway value added tables amp software in various phases of implementation (knowledge bases risk scoring software etc)
First Data Release Application1st completed data release application received
9
Data Collection Status UpdateAPCD Updates and Project Status
Eligibility Medical Pharmacy ProviderStatusNotesStart Date End Date Start Date End Date Start Date End Date Start Date End Date
AetnaAetna Health Insurance HMO FI 012012 062017 012012 062017 012012 062017 012012 062017 Submitter is current with file submissions to OnpointAetna Health Insurance HMO on ACAS FI 012012 062017 012012 062017 012012 062017 NA NA Submitter is current with file submissions to OnpointAetna Life Insurance Company Aetna Student Health 012012 062017 012012 062017 NA NA 012012 062017 Submitter is current with file submissions to OnpointAetna Life Insurance Company HMO Medicare 012012 062017 012012 062017 012012 062017 NA NA Submitter is current with file submissions to OnpointAetna Life Insurance Company Traditional 012012 062017 012012 062017 012012 062017 012012 062017 Submitter is current with file submissions to Onpoint
Anthem012012 012017 012012 012017 012012 012017 012012 012017 Submitter to resume data submissions in October 2017
Caremark LLC012012 062017 NA NA 012012 062017 NA NA Submitter is current with file submissions to Onpoint
CignaCigna Health and Life Insurance Company Inc - West 012012 062017 012012 062017 012012 062017 012012 062017 Submitter is current with file submissions to OnpointCigna Health and Life Insurance Company Inc - East 012012 062017 012012 062017 012012 062017 012012 062017 Submitter is current with file submissions to Onpoint
ConnectiCareConnectiCare 012012 052017 012012 052017 012012 052017 012012 052017 Submitter has not yet supplied June 2017 file submissionsConnectiCare Inc - Medicare Advantage 012012 052017 012012 052017 012012 012017 012012 052017 Submitter has not yet supplied June 2017 file submissions
Express Scripts- - NA NA - - NA NA Submitter supplied January 2012 test files on 872017
First Health Life and Health Insurance Company012012 062017 NA NA 012012 062017 NA NA Submitter is current with file submissions to Onpoint
Harvard Pilgrim012012 062017 012012 062017 012012 062017 012012 062017 Submitter is current with file submissions to Onpoint
HealthyCT012014 122014 012014 122014 012014 122014 012014 122014 Submitter no longer active with the CT APCD
United Health GroupeviCore (UHC - Oxford) NA NA 012015 042017 - - 012012 042017 Submitter has not yet supplied May - June 2017 file submissionsOptumHealth Care Solutions Inc (Optum) NA NA 012012 062017 NA NA 012012 062017 Submitter is current with file submissions to OnpointOrthoNet NA NA 012012 062017 NA NA NA NA Submitter is current with file submissions to OnpointOxford Health Plans 012012 062017 012012 052017 012012 062017 012012 062017 Submitter has not yet supplied June 2017 medical claims fileUHC - Golden Rule 012012 062017 012012 062017 012012 062017 012012 062017 Submitter is current with file submissions to OnpointUnitedHealthcare Insurance - Medicare 012012 062017 012012 062017 012012 062017 012012 062017 Submitter is current with file submissions to OnpointUnitedHealthcare Insurance Company 012012 062017 012012 062017 012012 062017 012012 062017 Submitter is current with file submissions to Onpoint
WellCare Health Plans Inc012012 062017 012012 062017 012012 122015 012012 062017 Submitter is current with file submissions to Onpoint
Medicaid- - - - - - - -
Medicare- - - - - - - - Data received 82017
Submission D
elay lt 3 Months or Integration In Progress
Submission O
n Schedule
Submission N
ot Scheduled or ge 3 Months D
elayed
10
APCD Data Release
Update
11
Develop and implement core requirements to achieve DRcapabilities
Administration Data release application dictionary ampsupport materialsSoftwareTools Extract creation and delivery toolSupport Admin support and documentation
Phase 1 Develop DR Process Tools and CapabilitiesEngage potential requestors to ensurecapabilities opportunities and services arerecognized
Phase 2 Promotion and Delivery
Data Release (DR) RecapAPCD Data Release Update
Legislative Charge (PA 13-247) The exchange shall helliphellip and (B) make data in the all-payer claims database available to any state agency insurer employer health care provider consumer of health care services or researcher for the purpose of allowing such person or entity to review such data as it relates to health care utilization costs or quality of health care services
12
End to End application process can take between 17 to 40days depending on time of month an application issubmitted All requests must follow the data releaseprocess outlined by Privacy Policy amp Procedures
Data Release ApplicationRequestor general information project summary research details data selection and securityintegrity
Data Release CommitteeReview application alignment with objectives re-identification risk safeguard adequacy and research design
Data Use Agreement Fees amp ExtractUser agrees to fee schedule DUA requirements Standard extract creation within 5 business days (after 1st release)
S M T W T F S
1 2 3 4 5
6 7 8 9 10 11 12
13 14 15 16 17 18 19
20 21 22 23 24 25 26
27 28 29 39 31
DR Process amp Turn-Around TimeAPCD Data Release Update
13
DR TableField Classification MatrixAPCD Data Release Update
Table Name
Field Classifications
Administrative
Enrollee Coverage
InformationEnrollee
DemographicsClaim
InformationDiagnosis
Information
Procedure Coding amp
DetailFinancial
InformationProvider
InformationPayer
InformationSafe Harbor
Variable Grand TotalEligibility 2 11 1 1 1 1 4 21
Eligibility Supplemental 2 13 9 4 28
Medical 2 3 13 2 7 8 4 1 6 46
Medical Claim Header 2 5 7
Medical Supplemental 4 6 3 11 1 6 31
Medical Claim Diagnosis 1 3 1 5
Medical Claim Icd Procedure 2 14 5 4 1 26
Pharmacy 3 3 11 2 9 2 1 3 34
Pharmacy Supplemental 2 8 4 1 15
Provider 3 2 1 6Grand Total 23 30 10 55 10 15 41 10 5 20 219
Data Release Dictionary Located httpagencyaccesshealthctcommeetings1485450397264-a8f3a430-837b
14
ProviderFacility Directory
512k Unique National Provider Identifiers
Pharmacy Claims
All claimsencounters paid by submitting carrier
Data includes info on Administrative Enrollee Coverage Claim Detail Diagnosis Codes Procedure Codes Financials Payers Providers Safe Harbor (12)
1273M Claims $125B
Medical Claims
All claimsencounters paid by submitting carrier
Data includes info on Administrative Enrollee Coverage Claim Detail Diagnosis Codes Procedure Codes Financials Payers Providers Safe Harbor (12)
747M Claims $304B
Enrollees
CY 2012 ndash Present (n- 1 month)
Data includes info on Administrative Enrollee Coverage Enrollee Demographics Financials Payers Providers Safe Harbor (2)Fully insuredNon-ERISA plans (~900k Lives)
Whatrsquos Available Through DRAPCD Data Release Update
Billing rendering prescribing pharmacy primary care provider IDs (varying completion rate)
Data includes info on Unblended and composite provider IDs and NPIs
15
ERISALives covered under self-
insured ERISA plans
Part 2 SUD claimsSUD claims provided by
Part 2 providers
Denied ClaimsFully denied claims not
collected
Test Result ValuesLab imaging biometrics
and physician derived data
Third Party Data Risk scoring social
determinants knowledge base etc
Dental ClaimsDental claims not required
for submission
Ancillary FinancialsPlan premiums capitation payments performance
payments administrative fees
Whatrsquos Not Available Through DRAPCD Data Release Update
HIPAA Safe Harbor Variables18 HIPAA identifiers
16
18 HIPAA identifiers removed from dataset
Identifiers removed as set forth in 45 CFR 164514
De-identification
De-Identified Data ReleaseAPCD Data Release Update
Age caps applied (over 89 less than 1) amp geography reduced to 3 digit zip
All dates related to service and payments masked
First three digits of zip codes only if the geographic area covered by all zip codes beginning with those three digits has a population greater than 20000 or the zip codes for those areas are changed to 000 in the data set
Supplementary safeguards imposed to reduce unique characteristics
17
Partnerships LicensingAccessibilityValue Add DataProcess
Improvement
Identify third party data that can supplement and enrich within release requirements
Third Party DataIdentify areas of process
improvement and automation
ScalabilityEstablish enclave capability
upon needdemand
Extract v EnclaveIdentify areas of opportunity for ongoing multiple use by
institutions
Engagement
Potential Future ImprovementsAPCD Data Release Update
18
AUGUST
16SEPTEMBER
7SEPTEMBER
15SEPTEMBER
22Committee review and
vote on first data request application
from UConn
DATA RELEASE COMMITTEE MEETING
To be canceled if no additional applications
submitted
DATA RELEASE COMMITTEE MEETING
Review and confirmation of de-
identification methods and implementation
EXTRACT AUDIT
Extract delivered and support channel
opened
DATA RELEASE
Data release activities within the next two months include
Open Action ItemsAPCD Data Release Update
Project Descriptions
bull State Innovation Modelndash Online dashboard of ~30 pace and performance measures
bull Used to monitor performance of SIM bull 12 measures use APCD databull Includes yearly targets for overall Connecticut
ndash Online Scorecard Online dashboard of FQHC and Advanced Network performancebull First health care performance scorecard in CTbull Provides transparency in provider performancebull Utilizes claims based measures from common scorecard and CAHPS surveys
bull Suicide Risk Identificationndash Improves identification of patients at risk of suicide
bull Utilizes APCD claims data EHR data from 5 health care providers and mortality databull Creation of phenotypic algorithm
19
APCD Based Dashboard Measures
Health Care DeliveryPercent of adults with regular source of careChildren well-child visits for at-risk popMammograms for women gt50 last 2 yearsOptimal diabetes care- 2+ annual A1c testsED use- asthma as primary dx (per 10k)
Percent of adults with HTN taking HTN medsFollow-Up after Discharge from the Emergency Department for Mental Health or Alcohol or other Drug
Follow-Up after Hospitalization for Mental Illness
Antidepressant Medication ManagementInitiation and Engagement of Alcohol and Other Drug Dependence Treatment
Health Care Costs
Cost of inpatient care PMPY
Cost of outpatient care PMPY
httpwwwpublichealthuconnedusim_dashhtmlohriNav=7C
Scorecard MeasuresReporting Only
Coordination of Care30 day readmission
PCPs that meet Meaningful Use
Prevention
Non-recommended Cervical Cancer Screening in Adolescent Female
Well-child visits in the third fourth fifth and sixth years of life (Medicaid only)
Frequency of Ongoing Prenatal Care (FPC)
Oral Evaluation Dental Services (Medicaid only)
Acute and Chronic Care
Cardiac strss img Testing in asymptomatic low risk patients
Behavioral HealthAdult major depressive disorder (MDD) Coordination of care of patients with specific co-morbid conditions
Anti-Depressant Medication Management
Initiation and Engagement of Alcohol and Other Drug Dependence Treatment
Follow up after hospitalization for mental illness 7 amp 30 days
21
Provisional Core Measure SetCare CoordinationPlan all-cause readmissionAnnual monitoring for persistent medications (roll-up)PreventionBreast cancer screeningCervical cancer screeningChlamydia screening in womenAdolescent female immunizations HPV
Weight assessment and counseling for nutrition and physical activity for childrenadolescents
Well-child visits in the first 15 months of lifeAdolescent well-care visitsBehavioral health screening (pediatric Medicaid only custom measure)
Acute amp Chronic Care
Medication management for people w asthma
DM HbA1c Testing
DM Diabetes medical attention for nephropathy
Use of imaging studies for low back pain
Avoidance of antibiotic treatment in adults with acute bronchitis
Appr treatment for children with upper respiratory infection
Behavioral Health
Follow-up care for children prescribed ADHD medicationMetabolic Monitoring for Children and Adolescents on Antipsychotics (pediatric Medicaid only custom measure)
Suicide Risk Identification
22
23
CT APCD Data -
Preliminary Analysis
Examples amp Showcase
Title XxSubtitle Xx
Presenter TitleDate
24Proprietary and Confidential 24
Connecticut APCDPreliminary Analysis Examples amp Showcase
CT APCD Advisory Group Meeting August 10 2017
25
bull Data source CY2016 commercial data from the CT APCDbull Focus commercial population-based reportingbull Considerations risk adjustment for age gender and health statusbull Areas of exploration
ndash Multiple views of the CT APCD population total members health exchange members members with diabetes
ndash Expenditures utilization and effective and preventive care ratesndash Analysis by multiple geographic units county Hospital Service
Area (HSA) and Health Reference Group (HRG) bull Conclusion Recap and lessons learned
Presentation Overview
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
26
bull Member Any person covered in a submitterrsquos eligibility databull Average Members Member months divided by 12 (months)bull Expenditures Allowed amount bull Capping Capped outliers in the data at the 99th percentilebull Clinical Risk Groups Individualsrsquo categorized health statusbull County Administrative focus areasbull Hospital Service Area Local hospital marketsbull Health Reference Group Community types bull Rates Expenditures by average membersbull Risk Adjustment Adjusting for differences between member
populations by considering membersrsquo age gender and health status
Key Terms
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
27
Population-Based Reporting
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
bull Reporting units county modified Hospital Service Area (HSA) and Health Reference Group (HRG)
bull Risk adjustment age gender and health status (3M CRGs)
28
CT APCD Population Overview
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Measure Count
Unique Members 875129
Total Member Months 9122482
Average Members 760207
Total Expenditures $40 Billion
Total Expenditures Per Member Per Year (PMPY) $5255
Total Expenditures Per Member Per Month (PMPM) $438
Total expenditures are capped at the 99th percentile
29
Expenditures PMPY by Age amp Gender
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$0
$1000
$2000
$3000
$4000
$5000
$6000
$7000
$8000
$9000
0-18 Female 0-18 Male 18-34 Female 18-34 Male 35-44 Female 35-44 Male 45-54 Female 45-54 Male 55-64 Female 55-64 Male
30
Expenditures PMPY by CRGs
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$-
$5000
$10000
$15000
$20000
$25000
$30000
$35000
$40000
Healthy Acute or Minor Chronic Moderate Chronic Significant Chronic Cancer or Catastrophic
$0
31
CT Health Exchange Population Overview
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
MeasureExchange Members
Non-Exchange Members
Average Members 86941 673266
Percentage of Members 55-64 Years of Age 31 20
Percentage of Members with Chronic Condition(s) 23 19
Expenditures PMPY $5378 $5239
Expenditures PMPY Risk Adjusted $4780 $5316 Expenditures PMPY for Members with Diabetes Risk-Adjusted $17561 $19291
32
CT Exchange vs Non-Exchange Rates
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Rate per 1000 Rate per 1000 (Risk Adj)
Measure Exchange Members
Non-Exchange Members
Exchange Members
Non-Exchange Members
Inpatient Acute Visits 390 328 339 335Medical 210 144 181 147Surgical 140 116 115 119Maternity 41 69 41 69
Outpatient Emergency Visits 1941 1924 1944 1923MRIs 920 803 810 817CT Scans 1108 824 938 844Primary Care Office Visits 15216 18755 16068 18628Psychiatric Visits 9864 9783 9783 11092Chiropractic Visits 3403 7808 3088 7913
Utilization measures are capped at the 99th percentile
33
Expenditure PMPY Diabetes Population
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$-
$5000
$10000
$15000
$20000
$25000
$30000
No Diabetes (n=730838) Diabetes amp no comorbidity (n=16419) Diabetes with comorbidity (n=12950)$0
No Diabetes (n = 730838)
Diabetes No Comorbidity(n = 16419)
Diabetes Comorbidity(n = 12950)
34
Vermont Blueprint for HealthDiabetes HbA1c Control amp Outcomes
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Measure HbA1c in Control HbA1c Not in Control
Members 5619 786
Average annual expenditures per capita
$15726 ($15219 $16233)
$17328 ($16110 $18546)
Inpatient hospitalizations per 1000 members
1897 (1782 2011)
2531 (2177 2886)
Inpatient days per 1000 members
8685 (8440 8930)
11561 (10804 12318)
Outpatient ED visits per 1000 members
6275 (6067 6483)
8011 (7381 8642)
Risk-adjusted rates and 95 confidence intervals 99th percentile outliers excluded HbA1c not in control gt9
35
Expenditures PMPY by County
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
County Average Members Expenditures PMPYExpenditures PMPY
(Risk Adjusted)Fairfield 223295 $5182 $5539 New London 44741 $5913 $5342 New Haven 161763 $5494 $5335 Middlesex 38531 $5359 $5184 Litchfield 43224 $5136 $5118 Tolland 36304 $5047 $5019 Hartford 191415 $4998 $4958 Windham 20934 $5539 $4950
Total 760207 $5255 $5255
36
Expenditures PMPY by HSA Risk Adjusted
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$0
$1000
$2000
$3000
$4000
$5000
$6000
$7000
37
EffectivePreventive Care
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
HEDIS MeasureCT APCD
CommercialNCQA
National HMONCQA
National PPOAvoidance of Antibiotic Treatment in Adults with Acute Bronchitis 268 276 258Anti-Depressant Medication Management 764 664 666Well-Child Visits 798 762 723Breast Cancer Screening 671 732 696
NCQA National HMO and NCQA National PPO benchmark metrics calculated for CY2015 Several other HEDIS measures can be run using the CT APCD data set and compared against the NCQA National HMO and PPO benchmarks Examples include Comprehensive Diabetes Care ndash HbA1C Testing Comprehensive Diabetes Care ndash Medical Attention for Nephrology Comprehensive Diabetes Care ndash Eye Exam Performed Adolescent Well-Care Visits Appropriate Treatment for Children with Upper Respiratory Infection etc
38
Breast Cancer Screening
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
60
62
64
66
68
70
72
Urban Centers (n=3369) Manufacturing Centers (n=10974) Diverse Suburbs (n=12206) Mill Towns (n=16281) Rural Towns (n=16789) Wealthy Suburbs (n=12266)
39
Vermont Blueprintrsquos Hub amp Spoke Model
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
bull Vermontrsquos ldquoHealth Homerdquo program designed to treat Vermonters with chronic opioid addiction
bull Hubs ndash designated providers ndash Provide coordinated care to patients through MAT services
ndash Coordinate referral to ongoing care
bull Spokes ndash teams of healthcare professionalsndash Blueprint Advanced Practice Medical Homes
ndash Federally-Qualified Health Centers
ndash Outpatient substance abuse and primary care providers
40copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Medication Assisted Treatment
bull Vermont Blueprint baseline study comparing medication-assisted treatment (MAT) population versus non-MAT population
bull Study published in the Journal of Substance Abuse Treatment (August 2016)
41
bull The CT APCD is a comparable resource to other statewide APCDs ndash A powerful tool that will only continue to grow with usendash Encompasses a robust set of information including
expenditures procedure codes diagnosis coding drug codes and enhanced value-adds (eg claim type master membermaster provider IDsNPIs MS-DRGs etc)
bull Future considerations to enhance the CT APCDndash Add Medicare and Medicaid claims datandash Continue to strengthen the completeness and validity of data
elements of importance to downstream analytic use cases (eg member race and ethnicity codes) in data collection
Lessons Learned
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
43
Next Steps
44
01Task
02Task
Ensure data quality issues are identified documented communicated and resolved
Data Quality
Continue building breadth of payer database amp complete enclave load
Data ETL
Finalize strategy to ensure site accomplishes PA 13-247 and PA 15-146 intent
Establish Strategy
05Task
Identify leading consumer information and price transparency tools available
Consumer Tool Evaluation04Task
Tasks Until Next Meeting (11917)APCD Development and Strategy Update
Distinguish Critical Paths Across and Within Strategic Priorities and Maintain Focus on ldquoMust Havesrdquo and ldquoQuick Winsrdquo
Ensure APCD staff can generate self-service extracts at little cost with minimal lead time
Deliver First DR Extract03Task
45
Future MeetingsAPCD Development and Strategy Update
November
9Legislative Office
Building Room 1D 300 Capitol Avenue
Hartford
All Payer Claims Database Advisory GroupMeeting
900ndash1100 AM
8
Accomplishments Since Last MeetingAPCD Updates and Project Status
Data Collection Status2016 Commercial data normalization and load into enclave to be completed by May 15th
Data Release Architecture CompletePreliminary data dictionary released Data release extract tool development nearly complete
Medicare Data ApprovedApplication for CMS Medicare data approved Data received and integration in progress
Data Release Training and CoordinationData Release Committee re-engaged and 1st release review scheduled August16th
Preliminary Analysis and End User FeedbackPopulation segmentation and profiling underway value added tables amp software in various phases of implementation (knowledge bases risk scoring software etc)
First Data Release Application1st completed data release application received
9
Data Collection Status UpdateAPCD Updates and Project Status
Eligibility Medical Pharmacy ProviderStatusNotesStart Date End Date Start Date End Date Start Date End Date Start Date End Date
AetnaAetna Health Insurance HMO FI 012012 062017 012012 062017 012012 062017 012012 062017 Submitter is current with file submissions to OnpointAetna Health Insurance HMO on ACAS FI 012012 062017 012012 062017 012012 062017 NA NA Submitter is current with file submissions to OnpointAetna Life Insurance Company Aetna Student Health 012012 062017 012012 062017 NA NA 012012 062017 Submitter is current with file submissions to OnpointAetna Life Insurance Company HMO Medicare 012012 062017 012012 062017 012012 062017 NA NA Submitter is current with file submissions to OnpointAetna Life Insurance Company Traditional 012012 062017 012012 062017 012012 062017 012012 062017 Submitter is current with file submissions to Onpoint
Anthem012012 012017 012012 012017 012012 012017 012012 012017 Submitter to resume data submissions in October 2017
Caremark LLC012012 062017 NA NA 012012 062017 NA NA Submitter is current with file submissions to Onpoint
CignaCigna Health and Life Insurance Company Inc - West 012012 062017 012012 062017 012012 062017 012012 062017 Submitter is current with file submissions to OnpointCigna Health and Life Insurance Company Inc - East 012012 062017 012012 062017 012012 062017 012012 062017 Submitter is current with file submissions to Onpoint
ConnectiCareConnectiCare 012012 052017 012012 052017 012012 052017 012012 052017 Submitter has not yet supplied June 2017 file submissionsConnectiCare Inc - Medicare Advantage 012012 052017 012012 052017 012012 012017 012012 052017 Submitter has not yet supplied June 2017 file submissions
Express Scripts- - NA NA - - NA NA Submitter supplied January 2012 test files on 872017
First Health Life and Health Insurance Company012012 062017 NA NA 012012 062017 NA NA Submitter is current with file submissions to Onpoint
Harvard Pilgrim012012 062017 012012 062017 012012 062017 012012 062017 Submitter is current with file submissions to Onpoint
HealthyCT012014 122014 012014 122014 012014 122014 012014 122014 Submitter no longer active with the CT APCD
United Health GroupeviCore (UHC - Oxford) NA NA 012015 042017 - - 012012 042017 Submitter has not yet supplied May - June 2017 file submissionsOptumHealth Care Solutions Inc (Optum) NA NA 012012 062017 NA NA 012012 062017 Submitter is current with file submissions to OnpointOrthoNet NA NA 012012 062017 NA NA NA NA Submitter is current with file submissions to OnpointOxford Health Plans 012012 062017 012012 052017 012012 062017 012012 062017 Submitter has not yet supplied June 2017 medical claims fileUHC - Golden Rule 012012 062017 012012 062017 012012 062017 012012 062017 Submitter is current with file submissions to OnpointUnitedHealthcare Insurance - Medicare 012012 062017 012012 062017 012012 062017 012012 062017 Submitter is current with file submissions to OnpointUnitedHealthcare Insurance Company 012012 062017 012012 062017 012012 062017 012012 062017 Submitter is current with file submissions to Onpoint
WellCare Health Plans Inc012012 062017 012012 062017 012012 122015 012012 062017 Submitter is current with file submissions to Onpoint
Medicaid- - - - - - - -
Medicare- - - - - - - - Data received 82017
Submission D
elay lt 3 Months or Integration In Progress
Submission O
n Schedule
Submission N
ot Scheduled or ge 3 Months D
elayed
10
APCD Data Release
Update
11
Develop and implement core requirements to achieve DRcapabilities
Administration Data release application dictionary ampsupport materialsSoftwareTools Extract creation and delivery toolSupport Admin support and documentation
Phase 1 Develop DR Process Tools and CapabilitiesEngage potential requestors to ensurecapabilities opportunities and services arerecognized
Phase 2 Promotion and Delivery
Data Release (DR) RecapAPCD Data Release Update
Legislative Charge (PA 13-247) The exchange shall helliphellip and (B) make data in the all-payer claims database available to any state agency insurer employer health care provider consumer of health care services or researcher for the purpose of allowing such person or entity to review such data as it relates to health care utilization costs or quality of health care services
12
End to End application process can take between 17 to 40days depending on time of month an application issubmitted All requests must follow the data releaseprocess outlined by Privacy Policy amp Procedures
Data Release ApplicationRequestor general information project summary research details data selection and securityintegrity
Data Release CommitteeReview application alignment with objectives re-identification risk safeguard adequacy and research design
Data Use Agreement Fees amp ExtractUser agrees to fee schedule DUA requirements Standard extract creation within 5 business days (after 1st release)
S M T W T F S
1 2 3 4 5
6 7 8 9 10 11 12
13 14 15 16 17 18 19
20 21 22 23 24 25 26
27 28 29 39 31
DR Process amp Turn-Around TimeAPCD Data Release Update
13
DR TableField Classification MatrixAPCD Data Release Update
Table Name
Field Classifications
Administrative
Enrollee Coverage
InformationEnrollee
DemographicsClaim
InformationDiagnosis
Information
Procedure Coding amp
DetailFinancial
InformationProvider
InformationPayer
InformationSafe Harbor
Variable Grand TotalEligibility 2 11 1 1 1 1 4 21
Eligibility Supplemental 2 13 9 4 28
Medical 2 3 13 2 7 8 4 1 6 46
Medical Claim Header 2 5 7
Medical Supplemental 4 6 3 11 1 6 31
Medical Claim Diagnosis 1 3 1 5
Medical Claim Icd Procedure 2 14 5 4 1 26
Pharmacy 3 3 11 2 9 2 1 3 34
Pharmacy Supplemental 2 8 4 1 15
Provider 3 2 1 6Grand Total 23 30 10 55 10 15 41 10 5 20 219
Data Release Dictionary Located httpagencyaccesshealthctcommeetings1485450397264-a8f3a430-837b
14
ProviderFacility Directory
512k Unique National Provider Identifiers
Pharmacy Claims
All claimsencounters paid by submitting carrier
Data includes info on Administrative Enrollee Coverage Claim Detail Diagnosis Codes Procedure Codes Financials Payers Providers Safe Harbor (12)
1273M Claims $125B
Medical Claims
All claimsencounters paid by submitting carrier
Data includes info on Administrative Enrollee Coverage Claim Detail Diagnosis Codes Procedure Codes Financials Payers Providers Safe Harbor (12)
747M Claims $304B
Enrollees
CY 2012 ndash Present (n- 1 month)
Data includes info on Administrative Enrollee Coverage Enrollee Demographics Financials Payers Providers Safe Harbor (2)Fully insuredNon-ERISA plans (~900k Lives)
Whatrsquos Available Through DRAPCD Data Release Update
Billing rendering prescribing pharmacy primary care provider IDs (varying completion rate)
Data includes info on Unblended and composite provider IDs and NPIs
15
ERISALives covered under self-
insured ERISA plans
Part 2 SUD claimsSUD claims provided by
Part 2 providers
Denied ClaimsFully denied claims not
collected
Test Result ValuesLab imaging biometrics
and physician derived data
Third Party Data Risk scoring social
determinants knowledge base etc
Dental ClaimsDental claims not required
for submission
Ancillary FinancialsPlan premiums capitation payments performance
payments administrative fees
Whatrsquos Not Available Through DRAPCD Data Release Update
HIPAA Safe Harbor Variables18 HIPAA identifiers
16
18 HIPAA identifiers removed from dataset
Identifiers removed as set forth in 45 CFR 164514
De-identification
De-Identified Data ReleaseAPCD Data Release Update
Age caps applied (over 89 less than 1) amp geography reduced to 3 digit zip
All dates related to service and payments masked
First three digits of zip codes only if the geographic area covered by all zip codes beginning with those three digits has a population greater than 20000 or the zip codes for those areas are changed to 000 in the data set
Supplementary safeguards imposed to reduce unique characteristics
17
Partnerships LicensingAccessibilityValue Add DataProcess
Improvement
Identify third party data that can supplement and enrich within release requirements
Third Party DataIdentify areas of process
improvement and automation
ScalabilityEstablish enclave capability
upon needdemand
Extract v EnclaveIdentify areas of opportunity for ongoing multiple use by
institutions
Engagement
Potential Future ImprovementsAPCD Data Release Update
18
AUGUST
16SEPTEMBER
7SEPTEMBER
15SEPTEMBER
22Committee review and
vote on first data request application
from UConn
DATA RELEASE COMMITTEE MEETING
To be canceled if no additional applications
submitted
DATA RELEASE COMMITTEE MEETING
Review and confirmation of de-
identification methods and implementation
EXTRACT AUDIT
Extract delivered and support channel
opened
DATA RELEASE
Data release activities within the next two months include
Open Action ItemsAPCD Data Release Update
Project Descriptions
bull State Innovation Modelndash Online dashboard of ~30 pace and performance measures
bull Used to monitor performance of SIM bull 12 measures use APCD databull Includes yearly targets for overall Connecticut
ndash Online Scorecard Online dashboard of FQHC and Advanced Network performancebull First health care performance scorecard in CTbull Provides transparency in provider performancebull Utilizes claims based measures from common scorecard and CAHPS surveys
bull Suicide Risk Identificationndash Improves identification of patients at risk of suicide
bull Utilizes APCD claims data EHR data from 5 health care providers and mortality databull Creation of phenotypic algorithm
19
APCD Based Dashboard Measures
Health Care DeliveryPercent of adults with regular source of careChildren well-child visits for at-risk popMammograms for women gt50 last 2 yearsOptimal diabetes care- 2+ annual A1c testsED use- asthma as primary dx (per 10k)
Percent of adults with HTN taking HTN medsFollow-Up after Discharge from the Emergency Department for Mental Health or Alcohol or other Drug
Follow-Up after Hospitalization for Mental Illness
Antidepressant Medication ManagementInitiation and Engagement of Alcohol and Other Drug Dependence Treatment
Health Care Costs
Cost of inpatient care PMPY
Cost of outpatient care PMPY
httpwwwpublichealthuconnedusim_dashhtmlohriNav=7C
Scorecard MeasuresReporting Only
Coordination of Care30 day readmission
PCPs that meet Meaningful Use
Prevention
Non-recommended Cervical Cancer Screening in Adolescent Female
Well-child visits in the third fourth fifth and sixth years of life (Medicaid only)
Frequency of Ongoing Prenatal Care (FPC)
Oral Evaluation Dental Services (Medicaid only)
Acute and Chronic Care
Cardiac strss img Testing in asymptomatic low risk patients
Behavioral HealthAdult major depressive disorder (MDD) Coordination of care of patients with specific co-morbid conditions
Anti-Depressant Medication Management
Initiation and Engagement of Alcohol and Other Drug Dependence Treatment
Follow up after hospitalization for mental illness 7 amp 30 days
21
Provisional Core Measure SetCare CoordinationPlan all-cause readmissionAnnual monitoring for persistent medications (roll-up)PreventionBreast cancer screeningCervical cancer screeningChlamydia screening in womenAdolescent female immunizations HPV
Weight assessment and counseling for nutrition and physical activity for childrenadolescents
Well-child visits in the first 15 months of lifeAdolescent well-care visitsBehavioral health screening (pediatric Medicaid only custom measure)
Acute amp Chronic Care
Medication management for people w asthma
DM HbA1c Testing
DM Diabetes medical attention for nephropathy
Use of imaging studies for low back pain
Avoidance of antibiotic treatment in adults with acute bronchitis
Appr treatment for children with upper respiratory infection
Behavioral Health
Follow-up care for children prescribed ADHD medicationMetabolic Monitoring for Children and Adolescents on Antipsychotics (pediatric Medicaid only custom measure)
Suicide Risk Identification
22
23
CT APCD Data -
Preliminary Analysis
Examples amp Showcase
Title XxSubtitle Xx
Presenter TitleDate
24Proprietary and Confidential 24
Connecticut APCDPreliminary Analysis Examples amp Showcase
CT APCD Advisory Group Meeting August 10 2017
25
bull Data source CY2016 commercial data from the CT APCDbull Focus commercial population-based reportingbull Considerations risk adjustment for age gender and health statusbull Areas of exploration
ndash Multiple views of the CT APCD population total members health exchange members members with diabetes
ndash Expenditures utilization and effective and preventive care ratesndash Analysis by multiple geographic units county Hospital Service
Area (HSA) and Health Reference Group (HRG) bull Conclusion Recap and lessons learned
Presentation Overview
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
26
bull Member Any person covered in a submitterrsquos eligibility databull Average Members Member months divided by 12 (months)bull Expenditures Allowed amount bull Capping Capped outliers in the data at the 99th percentilebull Clinical Risk Groups Individualsrsquo categorized health statusbull County Administrative focus areasbull Hospital Service Area Local hospital marketsbull Health Reference Group Community types bull Rates Expenditures by average membersbull Risk Adjustment Adjusting for differences between member
populations by considering membersrsquo age gender and health status
Key Terms
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
27
Population-Based Reporting
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
bull Reporting units county modified Hospital Service Area (HSA) and Health Reference Group (HRG)
bull Risk adjustment age gender and health status (3M CRGs)
28
CT APCD Population Overview
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Measure Count
Unique Members 875129
Total Member Months 9122482
Average Members 760207
Total Expenditures $40 Billion
Total Expenditures Per Member Per Year (PMPY) $5255
Total Expenditures Per Member Per Month (PMPM) $438
Total expenditures are capped at the 99th percentile
29
Expenditures PMPY by Age amp Gender
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$0
$1000
$2000
$3000
$4000
$5000
$6000
$7000
$8000
$9000
0-18 Female 0-18 Male 18-34 Female 18-34 Male 35-44 Female 35-44 Male 45-54 Female 45-54 Male 55-64 Female 55-64 Male
30
Expenditures PMPY by CRGs
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$-
$5000
$10000
$15000
$20000
$25000
$30000
$35000
$40000
Healthy Acute or Minor Chronic Moderate Chronic Significant Chronic Cancer or Catastrophic
$0
31
CT Health Exchange Population Overview
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
MeasureExchange Members
Non-Exchange Members
Average Members 86941 673266
Percentage of Members 55-64 Years of Age 31 20
Percentage of Members with Chronic Condition(s) 23 19
Expenditures PMPY $5378 $5239
Expenditures PMPY Risk Adjusted $4780 $5316 Expenditures PMPY for Members with Diabetes Risk-Adjusted $17561 $19291
32
CT Exchange vs Non-Exchange Rates
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Rate per 1000 Rate per 1000 (Risk Adj)
Measure Exchange Members
Non-Exchange Members
Exchange Members
Non-Exchange Members
Inpatient Acute Visits 390 328 339 335Medical 210 144 181 147Surgical 140 116 115 119Maternity 41 69 41 69
Outpatient Emergency Visits 1941 1924 1944 1923MRIs 920 803 810 817CT Scans 1108 824 938 844Primary Care Office Visits 15216 18755 16068 18628Psychiatric Visits 9864 9783 9783 11092Chiropractic Visits 3403 7808 3088 7913
Utilization measures are capped at the 99th percentile
33
Expenditure PMPY Diabetes Population
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$-
$5000
$10000
$15000
$20000
$25000
$30000
No Diabetes (n=730838) Diabetes amp no comorbidity (n=16419) Diabetes with comorbidity (n=12950)$0
No Diabetes (n = 730838)
Diabetes No Comorbidity(n = 16419)
Diabetes Comorbidity(n = 12950)
34
Vermont Blueprint for HealthDiabetes HbA1c Control amp Outcomes
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Measure HbA1c in Control HbA1c Not in Control
Members 5619 786
Average annual expenditures per capita
$15726 ($15219 $16233)
$17328 ($16110 $18546)
Inpatient hospitalizations per 1000 members
1897 (1782 2011)
2531 (2177 2886)
Inpatient days per 1000 members
8685 (8440 8930)
11561 (10804 12318)
Outpatient ED visits per 1000 members
6275 (6067 6483)
8011 (7381 8642)
Risk-adjusted rates and 95 confidence intervals 99th percentile outliers excluded HbA1c not in control gt9
35
Expenditures PMPY by County
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
County Average Members Expenditures PMPYExpenditures PMPY
(Risk Adjusted)Fairfield 223295 $5182 $5539 New London 44741 $5913 $5342 New Haven 161763 $5494 $5335 Middlesex 38531 $5359 $5184 Litchfield 43224 $5136 $5118 Tolland 36304 $5047 $5019 Hartford 191415 $4998 $4958 Windham 20934 $5539 $4950
Total 760207 $5255 $5255
36
Expenditures PMPY by HSA Risk Adjusted
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$0
$1000
$2000
$3000
$4000
$5000
$6000
$7000
37
EffectivePreventive Care
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
HEDIS MeasureCT APCD
CommercialNCQA
National HMONCQA
National PPOAvoidance of Antibiotic Treatment in Adults with Acute Bronchitis 268 276 258Anti-Depressant Medication Management 764 664 666Well-Child Visits 798 762 723Breast Cancer Screening 671 732 696
NCQA National HMO and NCQA National PPO benchmark metrics calculated for CY2015 Several other HEDIS measures can be run using the CT APCD data set and compared against the NCQA National HMO and PPO benchmarks Examples include Comprehensive Diabetes Care ndash HbA1C Testing Comprehensive Diabetes Care ndash Medical Attention for Nephrology Comprehensive Diabetes Care ndash Eye Exam Performed Adolescent Well-Care Visits Appropriate Treatment for Children with Upper Respiratory Infection etc
38
Breast Cancer Screening
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
60
62
64
66
68
70
72
Urban Centers (n=3369) Manufacturing Centers (n=10974) Diverse Suburbs (n=12206) Mill Towns (n=16281) Rural Towns (n=16789) Wealthy Suburbs (n=12266)
39
Vermont Blueprintrsquos Hub amp Spoke Model
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
bull Vermontrsquos ldquoHealth Homerdquo program designed to treat Vermonters with chronic opioid addiction
bull Hubs ndash designated providers ndash Provide coordinated care to patients through MAT services
ndash Coordinate referral to ongoing care
bull Spokes ndash teams of healthcare professionalsndash Blueprint Advanced Practice Medical Homes
ndash Federally-Qualified Health Centers
ndash Outpatient substance abuse and primary care providers
40copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Medication Assisted Treatment
bull Vermont Blueprint baseline study comparing medication-assisted treatment (MAT) population versus non-MAT population
bull Study published in the Journal of Substance Abuse Treatment (August 2016)
41
bull The CT APCD is a comparable resource to other statewide APCDs ndash A powerful tool that will only continue to grow with usendash Encompasses a robust set of information including
expenditures procedure codes diagnosis coding drug codes and enhanced value-adds (eg claim type master membermaster provider IDsNPIs MS-DRGs etc)
bull Future considerations to enhance the CT APCDndash Add Medicare and Medicaid claims datandash Continue to strengthen the completeness and validity of data
elements of importance to downstream analytic use cases (eg member race and ethnicity codes) in data collection
Lessons Learned
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
43
Next Steps
44
01Task
02Task
Ensure data quality issues are identified documented communicated and resolved
Data Quality
Continue building breadth of payer database amp complete enclave load
Data ETL
Finalize strategy to ensure site accomplishes PA 13-247 and PA 15-146 intent
Establish Strategy
05Task
Identify leading consumer information and price transparency tools available
Consumer Tool Evaluation04Task
Tasks Until Next Meeting (11917)APCD Development and Strategy Update
Distinguish Critical Paths Across and Within Strategic Priorities and Maintain Focus on ldquoMust Havesrdquo and ldquoQuick Winsrdquo
Ensure APCD staff can generate self-service extracts at little cost with minimal lead time
Deliver First DR Extract03Task
45
Future MeetingsAPCD Development and Strategy Update
November
9Legislative Office
Building Room 1D 300 Capitol Avenue
Hartford
All Payer Claims Database Advisory GroupMeeting
900ndash1100 AM
9
Data Collection Status UpdateAPCD Updates and Project Status
Eligibility Medical Pharmacy ProviderStatusNotesStart Date End Date Start Date End Date Start Date End Date Start Date End Date
AetnaAetna Health Insurance HMO FI 012012 062017 012012 062017 012012 062017 012012 062017 Submitter is current with file submissions to OnpointAetna Health Insurance HMO on ACAS FI 012012 062017 012012 062017 012012 062017 NA NA Submitter is current with file submissions to OnpointAetna Life Insurance Company Aetna Student Health 012012 062017 012012 062017 NA NA 012012 062017 Submitter is current with file submissions to OnpointAetna Life Insurance Company HMO Medicare 012012 062017 012012 062017 012012 062017 NA NA Submitter is current with file submissions to OnpointAetna Life Insurance Company Traditional 012012 062017 012012 062017 012012 062017 012012 062017 Submitter is current with file submissions to Onpoint
Anthem012012 012017 012012 012017 012012 012017 012012 012017 Submitter to resume data submissions in October 2017
Caremark LLC012012 062017 NA NA 012012 062017 NA NA Submitter is current with file submissions to Onpoint
CignaCigna Health and Life Insurance Company Inc - West 012012 062017 012012 062017 012012 062017 012012 062017 Submitter is current with file submissions to OnpointCigna Health and Life Insurance Company Inc - East 012012 062017 012012 062017 012012 062017 012012 062017 Submitter is current with file submissions to Onpoint
ConnectiCareConnectiCare 012012 052017 012012 052017 012012 052017 012012 052017 Submitter has not yet supplied June 2017 file submissionsConnectiCare Inc - Medicare Advantage 012012 052017 012012 052017 012012 012017 012012 052017 Submitter has not yet supplied June 2017 file submissions
Express Scripts- - NA NA - - NA NA Submitter supplied January 2012 test files on 872017
First Health Life and Health Insurance Company012012 062017 NA NA 012012 062017 NA NA Submitter is current with file submissions to Onpoint
Harvard Pilgrim012012 062017 012012 062017 012012 062017 012012 062017 Submitter is current with file submissions to Onpoint
HealthyCT012014 122014 012014 122014 012014 122014 012014 122014 Submitter no longer active with the CT APCD
United Health GroupeviCore (UHC - Oxford) NA NA 012015 042017 - - 012012 042017 Submitter has not yet supplied May - June 2017 file submissionsOptumHealth Care Solutions Inc (Optum) NA NA 012012 062017 NA NA 012012 062017 Submitter is current with file submissions to OnpointOrthoNet NA NA 012012 062017 NA NA NA NA Submitter is current with file submissions to OnpointOxford Health Plans 012012 062017 012012 052017 012012 062017 012012 062017 Submitter has not yet supplied June 2017 medical claims fileUHC - Golden Rule 012012 062017 012012 062017 012012 062017 012012 062017 Submitter is current with file submissions to OnpointUnitedHealthcare Insurance - Medicare 012012 062017 012012 062017 012012 062017 012012 062017 Submitter is current with file submissions to OnpointUnitedHealthcare Insurance Company 012012 062017 012012 062017 012012 062017 012012 062017 Submitter is current with file submissions to Onpoint
WellCare Health Plans Inc012012 062017 012012 062017 012012 122015 012012 062017 Submitter is current with file submissions to Onpoint
Medicaid- - - - - - - -
Medicare- - - - - - - - Data received 82017
Submission D
elay lt 3 Months or Integration In Progress
Submission O
n Schedule
Submission N
ot Scheduled or ge 3 Months D
elayed
10
APCD Data Release
Update
11
Develop and implement core requirements to achieve DRcapabilities
Administration Data release application dictionary ampsupport materialsSoftwareTools Extract creation and delivery toolSupport Admin support and documentation
Phase 1 Develop DR Process Tools and CapabilitiesEngage potential requestors to ensurecapabilities opportunities and services arerecognized
Phase 2 Promotion and Delivery
Data Release (DR) RecapAPCD Data Release Update
Legislative Charge (PA 13-247) The exchange shall helliphellip and (B) make data in the all-payer claims database available to any state agency insurer employer health care provider consumer of health care services or researcher for the purpose of allowing such person or entity to review such data as it relates to health care utilization costs or quality of health care services
12
End to End application process can take between 17 to 40days depending on time of month an application issubmitted All requests must follow the data releaseprocess outlined by Privacy Policy amp Procedures
Data Release ApplicationRequestor general information project summary research details data selection and securityintegrity
Data Release CommitteeReview application alignment with objectives re-identification risk safeguard adequacy and research design
Data Use Agreement Fees amp ExtractUser agrees to fee schedule DUA requirements Standard extract creation within 5 business days (after 1st release)
S M T W T F S
1 2 3 4 5
6 7 8 9 10 11 12
13 14 15 16 17 18 19
20 21 22 23 24 25 26
27 28 29 39 31
DR Process amp Turn-Around TimeAPCD Data Release Update
13
DR TableField Classification MatrixAPCD Data Release Update
Table Name
Field Classifications
Administrative
Enrollee Coverage
InformationEnrollee
DemographicsClaim
InformationDiagnosis
Information
Procedure Coding amp
DetailFinancial
InformationProvider
InformationPayer
InformationSafe Harbor
Variable Grand TotalEligibility 2 11 1 1 1 1 4 21
Eligibility Supplemental 2 13 9 4 28
Medical 2 3 13 2 7 8 4 1 6 46
Medical Claim Header 2 5 7
Medical Supplemental 4 6 3 11 1 6 31
Medical Claim Diagnosis 1 3 1 5
Medical Claim Icd Procedure 2 14 5 4 1 26
Pharmacy 3 3 11 2 9 2 1 3 34
Pharmacy Supplemental 2 8 4 1 15
Provider 3 2 1 6Grand Total 23 30 10 55 10 15 41 10 5 20 219
Data Release Dictionary Located httpagencyaccesshealthctcommeetings1485450397264-a8f3a430-837b
14
ProviderFacility Directory
512k Unique National Provider Identifiers
Pharmacy Claims
All claimsencounters paid by submitting carrier
Data includes info on Administrative Enrollee Coverage Claim Detail Diagnosis Codes Procedure Codes Financials Payers Providers Safe Harbor (12)
1273M Claims $125B
Medical Claims
All claimsencounters paid by submitting carrier
Data includes info on Administrative Enrollee Coverage Claim Detail Diagnosis Codes Procedure Codes Financials Payers Providers Safe Harbor (12)
747M Claims $304B
Enrollees
CY 2012 ndash Present (n- 1 month)
Data includes info on Administrative Enrollee Coverage Enrollee Demographics Financials Payers Providers Safe Harbor (2)Fully insuredNon-ERISA plans (~900k Lives)
Whatrsquos Available Through DRAPCD Data Release Update
Billing rendering prescribing pharmacy primary care provider IDs (varying completion rate)
Data includes info on Unblended and composite provider IDs and NPIs
15
ERISALives covered under self-
insured ERISA plans
Part 2 SUD claimsSUD claims provided by
Part 2 providers
Denied ClaimsFully denied claims not
collected
Test Result ValuesLab imaging biometrics
and physician derived data
Third Party Data Risk scoring social
determinants knowledge base etc
Dental ClaimsDental claims not required
for submission
Ancillary FinancialsPlan premiums capitation payments performance
payments administrative fees
Whatrsquos Not Available Through DRAPCD Data Release Update
HIPAA Safe Harbor Variables18 HIPAA identifiers
16
18 HIPAA identifiers removed from dataset
Identifiers removed as set forth in 45 CFR 164514
De-identification
De-Identified Data ReleaseAPCD Data Release Update
Age caps applied (over 89 less than 1) amp geography reduced to 3 digit zip
All dates related to service and payments masked
First three digits of zip codes only if the geographic area covered by all zip codes beginning with those three digits has a population greater than 20000 or the zip codes for those areas are changed to 000 in the data set
Supplementary safeguards imposed to reduce unique characteristics
17
Partnerships LicensingAccessibilityValue Add DataProcess
Improvement
Identify third party data that can supplement and enrich within release requirements
Third Party DataIdentify areas of process
improvement and automation
ScalabilityEstablish enclave capability
upon needdemand
Extract v EnclaveIdentify areas of opportunity for ongoing multiple use by
institutions
Engagement
Potential Future ImprovementsAPCD Data Release Update
18
AUGUST
16SEPTEMBER
7SEPTEMBER
15SEPTEMBER
22Committee review and
vote on first data request application
from UConn
DATA RELEASE COMMITTEE MEETING
To be canceled if no additional applications
submitted
DATA RELEASE COMMITTEE MEETING
Review and confirmation of de-
identification methods and implementation
EXTRACT AUDIT
Extract delivered and support channel
opened
DATA RELEASE
Data release activities within the next two months include
Open Action ItemsAPCD Data Release Update
Project Descriptions
bull State Innovation Modelndash Online dashboard of ~30 pace and performance measures
bull Used to monitor performance of SIM bull 12 measures use APCD databull Includes yearly targets for overall Connecticut
ndash Online Scorecard Online dashboard of FQHC and Advanced Network performancebull First health care performance scorecard in CTbull Provides transparency in provider performancebull Utilizes claims based measures from common scorecard and CAHPS surveys
bull Suicide Risk Identificationndash Improves identification of patients at risk of suicide
bull Utilizes APCD claims data EHR data from 5 health care providers and mortality databull Creation of phenotypic algorithm
19
APCD Based Dashboard Measures
Health Care DeliveryPercent of adults with regular source of careChildren well-child visits for at-risk popMammograms for women gt50 last 2 yearsOptimal diabetes care- 2+ annual A1c testsED use- asthma as primary dx (per 10k)
Percent of adults with HTN taking HTN medsFollow-Up after Discharge from the Emergency Department for Mental Health or Alcohol or other Drug
Follow-Up after Hospitalization for Mental Illness
Antidepressant Medication ManagementInitiation and Engagement of Alcohol and Other Drug Dependence Treatment
Health Care Costs
Cost of inpatient care PMPY
Cost of outpatient care PMPY
httpwwwpublichealthuconnedusim_dashhtmlohriNav=7C
Scorecard MeasuresReporting Only
Coordination of Care30 day readmission
PCPs that meet Meaningful Use
Prevention
Non-recommended Cervical Cancer Screening in Adolescent Female
Well-child visits in the third fourth fifth and sixth years of life (Medicaid only)
Frequency of Ongoing Prenatal Care (FPC)
Oral Evaluation Dental Services (Medicaid only)
Acute and Chronic Care
Cardiac strss img Testing in asymptomatic low risk patients
Behavioral HealthAdult major depressive disorder (MDD) Coordination of care of patients with specific co-morbid conditions
Anti-Depressant Medication Management
Initiation and Engagement of Alcohol and Other Drug Dependence Treatment
Follow up after hospitalization for mental illness 7 amp 30 days
21
Provisional Core Measure SetCare CoordinationPlan all-cause readmissionAnnual monitoring for persistent medications (roll-up)PreventionBreast cancer screeningCervical cancer screeningChlamydia screening in womenAdolescent female immunizations HPV
Weight assessment and counseling for nutrition and physical activity for childrenadolescents
Well-child visits in the first 15 months of lifeAdolescent well-care visitsBehavioral health screening (pediatric Medicaid only custom measure)
Acute amp Chronic Care
Medication management for people w asthma
DM HbA1c Testing
DM Diabetes medical attention for nephropathy
Use of imaging studies for low back pain
Avoidance of antibiotic treatment in adults with acute bronchitis
Appr treatment for children with upper respiratory infection
Behavioral Health
Follow-up care for children prescribed ADHD medicationMetabolic Monitoring for Children and Adolescents on Antipsychotics (pediatric Medicaid only custom measure)
Suicide Risk Identification
22
23
CT APCD Data -
Preliminary Analysis
Examples amp Showcase
Title XxSubtitle Xx
Presenter TitleDate
24Proprietary and Confidential 24
Connecticut APCDPreliminary Analysis Examples amp Showcase
CT APCD Advisory Group Meeting August 10 2017
25
bull Data source CY2016 commercial data from the CT APCDbull Focus commercial population-based reportingbull Considerations risk adjustment for age gender and health statusbull Areas of exploration
ndash Multiple views of the CT APCD population total members health exchange members members with diabetes
ndash Expenditures utilization and effective and preventive care ratesndash Analysis by multiple geographic units county Hospital Service
Area (HSA) and Health Reference Group (HRG) bull Conclusion Recap and lessons learned
Presentation Overview
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
26
bull Member Any person covered in a submitterrsquos eligibility databull Average Members Member months divided by 12 (months)bull Expenditures Allowed amount bull Capping Capped outliers in the data at the 99th percentilebull Clinical Risk Groups Individualsrsquo categorized health statusbull County Administrative focus areasbull Hospital Service Area Local hospital marketsbull Health Reference Group Community types bull Rates Expenditures by average membersbull Risk Adjustment Adjusting for differences between member
populations by considering membersrsquo age gender and health status
Key Terms
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
27
Population-Based Reporting
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
bull Reporting units county modified Hospital Service Area (HSA) and Health Reference Group (HRG)
bull Risk adjustment age gender and health status (3M CRGs)
28
CT APCD Population Overview
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Measure Count
Unique Members 875129
Total Member Months 9122482
Average Members 760207
Total Expenditures $40 Billion
Total Expenditures Per Member Per Year (PMPY) $5255
Total Expenditures Per Member Per Month (PMPM) $438
Total expenditures are capped at the 99th percentile
29
Expenditures PMPY by Age amp Gender
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$0
$1000
$2000
$3000
$4000
$5000
$6000
$7000
$8000
$9000
0-18 Female 0-18 Male 18-34 Female 18-34 Male 35-44 Female 35-44 Male 45-54 Female 45-54 Male 55-64 Female 55-64 Male
30
Expenditures PMPY by CRGs
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$-
$5000
$10000
$15000
$20000
$25000
$30000
$35000
$40000
Healthy Acute or Minor Chronic Moderate Chronic Significant Chronic Cancer or Catastrophic
$0
31
CT Health Exchange Population Overview
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
MeasureExchange Members
Non-Exchange Members
Average Members 86941 673266
Percentage of Members 55-64 Years of Age 31 20
Percentage of Members with Chronic Condition(s) 23 19
Expenditures PMPY $5378 $5239
Expenditures PMPY Risk Adjusted $4780 $5316 Expenditures PMPY for Members with Diabetes Risk-Adjusted $17561 $19291
32
CT Exchange vs Non-Exchange Rates
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Rate per 1000 Rate per 1000 (Risk Adj)
Measure Exchange Members
Non-Exchange Members
Exchange Members
Non-Exchange Members
Inpatient Acute Visits 390 328 339 335Medical 210 144 181 147Surgical 140 116 115 119Maternity 41 69 41 69
Outpatient Emergency Visits 1941 1924 1944 1923MRIs 920 803 810 817CT Scans 1108 824 938 844Primary Care Office Visits 15216 18755 16068 18628Psychiatric Visits 9864 9783 9783 11092Chiropractic Visits 3403 7808 3088 7913
Utilization measures are capped at the 99th percentile
33
Expenditure PMPY Diabetes Population
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$-
$5000
$10000
$15000
$20000
$25000
$30000
No Diabetes (n=730838) Diabetes amp no comorbidity (n=16419) Diabetes with comorbidity (n=12950)$0
No Diabetes (n = 730838)
Diabetes No Comorbidity(n = 16419)
Diabetes Comorbidity(n = 12950)
34
Vermont Blueprint for HealthDiabetes HbA1c Control amp Outcomes
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Measure HbA1c in Control HbA1c Not in Control
Members 5619 786
Average annual expenditures per capita
$15726 ($15219 $16233)
$17328 ($16110 $18546)
Inpatient hospitalizations per 1000 members
1897 (1782 2011)
2531 (2177 2886)
Inpatient days per 1000 members
8685 (8440 8930)
11561 (10804 12318)
Outpatient ED visits per 1000 members
6275 (6067 6483)
8011 (7381 8642)
Risk-adjusted rates and 95 confidence intervals 99th percentile outliers excluded HbA1c not in control gt9
35
Expenditures PMPY by County
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
County Average Members Expenditures PMPYExpenditures PMPY
(Risk Adjusted)Fairfield 223295 $5182 $5539 New London 44741 $5913 $5342 New Haven 161763 $5494 $5335 Middlesex 38531 $5359 $5184 Litchfield 43224 $5136 $5118 Tolland 36304 $5047 $5019 Hartford 191415 $4998 $4958 Windham 20934 $5539 $4950
Total 760207 $5255 $5255
36
Expenditures PMPY by HSA Risk Adjusted
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$0
$1000
$2000
$3000
$4000
$5000
$6000
$7000
37
EffectivePreventive Care
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
HEDIS MeasureCT APCD
CommercialNCQA
National HMONCQA
National PPOAvoidance of Antibiotic Treatment in Adults with Acute Bronchitis 268 276 258Anti-Depressant Medication Management 764 664 666Well-Child Visits 798 762 723Breast Cancer Screening 671 732 696
NCQA National HMO and NCQA National PPO benchmark metrics calculated for CY2015 Several other HEDIS measures can be run using the CT APCD data set and compared against the NCQA National HMO and PPO benchmarks Examples include Comprehensive Diabetes Care ndash HbA1C Testing Comprehensive Diabetes Care ndash Medical Attention for Nephrology Comprehensive Diabetes Care ndash Eye Exam Performed Adolescent Well-Care Visits Appropriate Treatment for Children with Upper Respiratory Infection etc
38
Breast Cancer Screening
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
60
62
64
66
68
70
72
Urban Centers (n=3369) Manufacturing Centers (n=10974) Diverse Suburbs (n=12206) Mill Towns (n=16281) Rural Towns (n=16789) Wealthy Suburbs (n=12266)
39
Vermont Blueprintrsquos Hub amp Spoke Model
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
bull Vermontrsquos ldquoHealth Homerdquo program designed to treat Vermonters with chronic opioid addiction
bull Hubs ndash designated providers ndash Provide coordinated care to patients through MAT services
ndash Coordinate referral to ongoing care
bull Spokes ndash teams of healthcare professionalsndash Blueprint Advanced Practice Medical Homes
ndash Federally-Qualified Health Centers
ndash Outpatient substance abuse and primary care providers
40copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Medication Assisted Treatment
bull Vermont Blueprint baseline study comparing medication-assisted treatment (MAT) population versus non-MAT population
bull Study published in the Journal of Substance Abuse Treatment (August 2016)
41
bull The CT APCD is a comparable resource to other statewide APCDs ndash A powerful tool that will only continue to grow with usendash Encompasses a robust set of information including
expenditures procedure codes diagnosis coding drug codes and enhanced value-adds (eg claim type master membermaster provider IDsNPIs MS-DRGs etc)
bull Future considerations to enhance the CT APCDndash Add Medicare and Medicaid claims datandash Continue to strengthen the completeness and validity of data
elements of importance to downstream analytic use cases (eg member race and ethnicity codes) in data collection
Lessons Learned
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
43
Next Steps
44
01Task
02Task
Ensure data quality issues are identified documented communicated and resolved
Data Quality
Continue building breadth of payer database amp complete enclave load
Data ETL
Finalize strategy to ensure site accomplishes PA 13-247 and PA 15-146 intent
Establish Strategy
05Task
Identify leading consumer information and price transparency tools available
Consumer Tool Evaluation04Task
Tasks Until Next Meeting (11917)APCD Development and Strategy Update
Distinguish Critical Paths Across and Within Strategic Priorities and Maintain Focus on ldquoMust Havesrdquo and ldquoQuick Winsrdquo
Ensure APCD staff can generate self-service extracts at little cost with minimal lead time
Deliver First DR Extract03Task
45
Future MeetingsAPCD Development and Strategy Update
November
9Legislative Office
Building Room 1D 300 Capitol Avenue
Hartford
All Payer Claims Database Advisory GroupMeeting
900ndash1100 AM
10
APCD Data Release
Update
11
Develop and implement core requirements to achieve DRcapabilities
Administration Data release application dictionary ampsupport materialsSoftwareTools Extract creation and delivery toolSupport Admin support and documentation
Phase 1 Develop DR Process Tools and CapabilitiesEngage potential requestors to ensurecapabilities opportunities and services arerecognized
Phase 2 Promotion and Delivery
Data Release (DR) RecapAPCD Data Release Update
Legislative Charge (PA 13-247) The exchange shall helliphellip and (B) make data in the all-payer claims database available to any state agency insurer employer health care provider consumer of health care services or researcher for the purpose of allowing such person or entity to review such data as it relates to health care utilization costs or quality of health care services
12
End to End application process can take between 17 to 40days depending on time of month an application issubmitted All requests must follow the data releaseprocess outlined by Privacy Policy amp Procedures
Data Release ApplicationRequestor general information project summary research details data selection and securityintegrity
Data Release CommitteeReview application alignment with objectives re-identification risk safeguard adequacy and research design
Data Use Agreement Fees amp ExtractUser agrees to fee schedule DUA requirements Standard extract creation within 5 business days (after 1st release)
S M T W T F S
1 2 3 4 5
6 7 8 9 10 11 12
13 14 15 16 17 18 19
20 21 22 23 24 25 26
27 28 29 39 31
DR Process amp Turn-Around TimeAPCD Data Release Update
13
DR TableField Classification MatrixAPCD Data Release Update
Table Name
Field Classifications
Administrative
Enrollee Coverage
InformationEnrollee
DemographicsClaim
InformationDiagnosis
Information
Procedure Coding amp
DetailFinancial
InformationProvider
InformationPayer
InformationSafe Harbor
Variable Grand TotalEligibility 2 11 1 1 1 1 4 21
Eligibility Supplemental 2 13 9 4 28
Medical 2 3 13 2 7 8 4 1 6 46
Medical Claim Header 2 5 7
Medical Supplemental 4 6 3 11 1 6 31
Medical Claim Diagnosis 1 3 1 5
Medical Claim Icd Procedure 2 14 5 4 1 26
Pharmacy 3 3 11 2 9 2 1 3 34
Pharmacy Supplemental 2 8 4 1 15
Provider 3 2 1 6Grand Total 23 30 10 55 10 15 41 10 5 20 219
Data Release Dictionary Located httpagencyaccesshealthctcommeetings1485450397264-a8f3a430-837b
14
ProviderFacility Directory
512k Unique National Provider Identifiers
Pharmacy Claims
All claimsencounters paid by submitting carrier
Data includes info on Administrative Enrollee Coverage Claim Detail Diagnosis Codes Procedure Codes Financials Payers Providers Safe Harbor (12)
1273M Claims $125B
Medical Claims
All claimsencounters paid by submitting carrier
Data includes info on Administrative Enrollee Coverage Claim Detail Diagnosis Codes Procedure Codes Financials Payers Providers Safe Harbor (12)
747M Claims $304B
Enrollees
CY 2012 ndash Present (n- 1 month)
Data includes info on Administrative Enrollee Coverage Enrollee Demographics Financials Payers Providers Safe Harbor (2)Fully insuredNon-ERISA plans (~900k Lives)
Whatrsquos Available Through DRAPCD Data Release Update
Billing rendering prescribing pharmacy primary care provider IDs (varying completion rate)
Data includes info on Unblended and composite provider IDs and NPIs
15
ERISALives covered under self-
insured ERISA plans
Part 2 SUD claimsSUD claims provided by
Part 2 providers
Denied ClaimsFully denied claims not
collected
Test Result ValuesLab imaging biometrics
and physician derived data
Third Party Data Risk scoring social
determinants knowledge base etc
Dental ClaimsDental claims not required
for submission
Ancillary FinancialsPlan premiums capitation payments performance
payments administrative fees
Whatrsquos Not Available Through DRAPCD Data Release Update
HIPAA Safe Harbor Variables18 HIPAA identifiers
16
18 HIPAA identifiers removed from dataset
Identifiers removed as set forth in 45 CFR 164514
De-identification
De-Identified Data ReleaseAPCD Data Release Update
Age caps applied (over 89 less than 1) amp geography reduced to 3 digit zip
All dates related to service and payments masked
First three digits of zip codes only if the geographic area covered by all zip codes beginning with those three digits has a population greater than 20000 or the zip codes for those areas are changed to 000 in the data set
Supplementary safeguards imposed to reduce unique characteristics
17
Partnerships LicensingAccessibilityValue Add DataProcess
Improvement
Identify third party data that can supplement and enrich within release requirements
Third Party DataIdentify areas of process
improvement and automation
ScalabilityEstablish enclave capability
upon needdemand
Extract v EnclaveIdentify areas of opportunity for ongoing multiple use by
institutions
Engagement
Potential Future ImprovementsAPCD Data Release Update
18
AUGUST
16SEPTEMBER
7SEPTEMBER
15SEPTEMBER
22Committee review and
vote on first data request application
from UConn
DATA RELEASE COMMITTEE MEETING
To be canceled if no additional applications
submitted
DATA RELEASE COMMITTEE MEETING
Review and confirmation of de-
identification methods and implementation
EXTRACT AUDIT
Extract delivered and support channel
opened
DATA RELEASE
Data release activities within the next two months include
Open Action ItemsAPCD Data Release Update
Project Descriptions
bull State Innovation Modelndash Online dashboard of ~30 pace and performance measures
bull Used to monitor performance of SIM bull 12 measures use APCD databull Includes yearly targets for overall Connecticut
ndash Online Scorecard Online dashboard of FQHC and Advanced Network performancebull First health care performance scorecard in CTbull Provides transparency in provider performancebull Utilizes claims based measures from common scorecard and CAHPS surveys
bull Suicide Risk Identificationndash Improves identification of patients at risk of suicide
bull Utilizes APCD claims data EHR data from 5 health care providers and mortality databull Creation of phenotypic algorithm
19
APCD Based Dashboard Measures
Health Care DeliveryPercent of adults with regular source of careChildren well-child visits for at-risk popMammograms for women gt50 last 2 yearsOptimal diabetes care- 2+ annual A1c testsED use- asthma as primary dx (per 10k)
Percent of adults with HTN taking HTN medsFollow-Up after Discharge from the Emergency Department for Mental Health or Alcohol or other Drug
Follow-Up after Hospitalization for Mental Illness
Antidepressant Medication ManagementInitiation and Engagement of Alcohol and Other Drug Dependence Treatment
Health Care Costs
Cost of inpatient care PMPY
Cost of outpatient care PMPY
httpwwwpublichealthuconnedusim_dashhtmlohriNav=7C
Scorecard MeasuresReporting Only
Coordination of Care30 day readmission
PCPs that meet Meaningful Use
Prevention
Non-recommended Cervical Cancer Screening in Adolescent Female
Well-child visits in the third fourth fifth and sixth years of life (Medicaid only)
Frequency of Ongoing Prenatal Care (FPC)
Oral Evaluation Dental Services (Medicaid only)
Acute and Chronic Care
Cardiac strss img Testing in asymptomatic low risk patients
Behavioral HealthAdult major depressive disorder (MDD) Coordination of care of patients with specific co-morbid conditions
Anti-Depressant Medication Management
Initiation and Engagement of Alcohol and Other Drug Dependence Treatment
Follow up after hospitalization for mental illness 7 amp 30 days
21
Provisional Core Measure SetCare CoordinationPlan all-cause readmissionAnnual monitoring for persistent medications (roll-up)PreventionBreast cancer screeningCervical cancer screeningChlamydia screening in womenAdolescent female immunizations HPV
Weight assessment and counseling for nutrition and physical activity for childrenadolescents
Well-child visits in the first 15 months of lifeAdolescent well-care visitsBehavioral health screening (pediatric Medicaid only custom measure)
Acute amp Chronic Care
Medication management for people w asthma
DM HbA1c Testing
DM Diabetes medical attention for nephropathy
Use of imaging studies for low back pain
Avoidance of antibiotic treatment in adults with acute bronchitis
Appr treatment for children with upper respiratory infection
Behavioral Health
Follow-up care for children prescribed ADHD medicationMetabolic Monitoring for Children and Adolescents on Antipsychotics (pediatric Medicaid only custom measure)
Suicide Risk Identification
22
23
CT APCD Data -
Preliminary Analysis
Examples amp Showcase
Title XxSubtitle Xx
Presenter TitleDate
24Proprietary and Confidential 24
Connecticut APCDPreliminary Analysis Examples amp Showcase
CT APCD Advisory Group Meeting August 10 2017
25
bull Data source CY2016 commercial data from the CT APCDbull Focus commercial population-based reportingbull Considerations risk adjustment for age gender and health statusbull Areas of exploration
ndash Multiple views of the CT APCD population total members health exchange members members with diabetes
ndash Expenditures utilization and effective and preventive care ratesndash Analysis by multiple geographic units county Hospital Service
Area (HSA) and Health Reference Group (HRG) bull Conclusion Recap and lessons learned
Presentation Overview
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
26
bull Member Any person covered in a submitterrsquos eligibility databull Average Members Member months divided by 12 (months)bull Expenditures Allowed amount bull Capping Capped outliers in the data at the 99th percentilebull Clinical Risk Groups Individualsrsquo categorized health statusbull County Administrative focus areasbull Hospital Service Area Local hospital marketsbull Health Reference Group Community types bull Rates Expenditures by average membersbull Risk Adjustment Adjusting for differences between member
populations by considering membersrsquo age gender and health status
Key Terms
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
27
Population-Based Reporting
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
bull Reporting units county modified Hospital Service Area (HSA) and Health Reference Group (HRG)
bull Risk adjustment age gender and health status (3M CRGs)
28
CT APCD Population Overview
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Measure Count
Unique Members 875129
Total Member Months 9122482
Average Members 760207
Total Expenditures $40 Billion
Total Expenditures Per Member Per Year (PMPY) $5255
Total Expenditures Per Member Per Month (PMPM) $438
Total expenditures are capped at the 99th percentile
29
Expenditures PMPY by Age amp Gender
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$0
$1000
$2000
$3000
$4000
$5000
$6000
$7000
$8000
$9000
0-18 Female 0-18 Male 18-34 Female 18-34 Male 35-44 Female 35-44 Male 45-54 Female 45-54 Male 55-64 Female 55-64 Male
30
Expenditures PMPY by CRGs
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$-
$5000
$10000
$15000
$20000
$25000
$30000
$35000
$40000
Healthy Acute or Minor Chronic Moderate Chronic Significant Chronic Cancer or Catastrophic
$0
31
CT Health Exchange Population Overview
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
MeasureExchange Members
Non-Exchange Members
Average Members 86941 673266
Percentage of Members 55-64 Years of Age 31 20
Percentage of Members with Chronic Condition(s) 23 19
Expenditures PMPY $5378 $5239
Expenditures PMPY Risk Adjusted $4780 $5316 Expenditures PMPY for Members with Diabetes Risk-Adjusted $17561 $19291
32
CT Exchange vs Non-Exchange Rates
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Rate per 1000 Rate per 1000 (Risk Adj)
Measure Exchange Members
Non-Exchange Members
Exchange Members
Non-Exchange Members
Inpatient Acute Visits 390 328 339 335Medical 210 144 181 147Surgical 140 116 115 119Maternity 41 69 41 69
Outpatient Emergency Visits 1941 1924 1944 1923MRIs 920 803 810 817CT Scans 1108 824 938 844Primary Care Office Visits 15216 18755 16068 18628Psychiatric Visits 9864 9783 9783 11092Chiropractic Visits 3403 7808 3088 7913
Utilization measures are capped at the 99th percentile
33
Expenditure PMPY Diabetes Population
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$-
$5000
$10000
$15000
$20000
$25000
$30000
No Diabetes (n=730838) Diabetes amp no comorbidity (n=16419) Diabetes with comorbidity (n=12950)$0
No Diabetes (n = 730838)
Diabetes No Comorbidity(n = 16419)
Diabetes Comorbidity(n = 12950)
34
Vermont Blueprint for HealthDiabetes HbA1c Control amp Outcomes
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Measure HbA1c in Control HbA1c Not in Control
Members 5619 786
Average annual expenditures per capita
$15726 ($15219 $16233)
$17328 ($16110 $18546)
Inpatient hospitalizations per 1000 members
1897 (1782 2011)
2531 (2177 2886)
Inpatient days per 1000 members
8685 (8440 8930)
11561 (10804 12318)
Outpatient ED visits per 1000 members
6275 (6067 6483)
8011 (7381 8642)
Risk-adjusted rates and 95 confidence intervals 99th percentile outliers excluded HbA1c not in control gt9
35
Expenditures PMPY by County
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
County Average Members Expenditures PMPYExpenditures PMPY
(Risk Adjusted)Fairfield 223295 $5182 $5539 New London 44741 $5913 $5342 New Haven 161763 $5494 $5335 Middlesex 38531 $5359 $5184 Litchfield 43224 $5136 $5118 Tolland 36304 $5047 $5019 Hartford 191415 $4998 $4958 Windham 20934 $5539 $4950
Total 760207 $5255 $5255
36
Expenditures PMPY by HSA Risk Adjusted
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$0
$1000
$2000
$3000
$4000
$5000
$6000
$7000
37
EffectivePreventive Care
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
HEDIS MeasureCT APCD
CommercialNCQA
National HMONCQA
National PPOAvoidance of Antibiotic Treatment in Adults with Acute Bronchitis 268 276 258Anti-Depressant Medication Management 764 664 666Well-Child Visits 798 762 723Breast Cancer Screening 671 732 696
NCQA National HMO and NCQA National PPO benchmark metrics calculated for CY2015 Several other HEDIS measures can be run using the CT APCD data set and compared against the NCQA National HMO and PPO benchmarks Examples include Comprehensive Diabetes Care ndash HbA1C Testing Comprehensive Diabetes Care ndash Medical Attention for Nephrology Comprehensive Diabetes Care ndash Eye Exam Performed Adolescent Well-Care Visits Appropriate Treatment for Children with Upper Respiratory Infection etc
38
Breast Cancer Screening
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
60
62
64
66
68
70
72
Urban Centers (n=3369) Manufacturing Centers (n=10974) Diverse Suburbs (n=12206) Mill Towns (n=16281) Rural Towns (n=16789) Wealthy Suburbs (n=12266)
39
Vermont Blueprintrsquos Hub amp Spoke Model
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
bull Vermontrsquos ldquoHealth Homerdquo program designed to treat Vermonters with chronic opioid addiction
bull Hubs ndash designated providers ndash Provide coordinated care to patients through MAT services
ndash Coordinate referral to ongoing care
bull Spokes ndash teams of healthcare professionalsndash Blueprint Advanced Practice Medical Homes
ndash Federally-Qualified Health Centers
ndash Outpatient substance abuse and primary care providers
40copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Medication Assisted Treatment
bull Vermont Blueprint baseline study comparing medication-assisted treatment (MAT) population versus non-MAT population
bull Study published in the Journal of Substance Abuse Treatment (August 2016)
41
bull The CT APCD is a comparable resource to other statewide APCDs ndash A powerful tool that will only continue to grow with usendash Encompasses a robust set of information including
expenditures procedure codes diagnosis coding drug codes and enhanced value-adds (eg claim type master membermaster provider IDsNPIs MS-DRGs etc)
bull Future considerations to enhance the CT APCDndash Add Medicare and Medicaid claims datandash Continue to strengthen the completeness and validity of data
elements of importance to downstream analytic use cases (eg member race and ethnicity codes) in data collection
Lessons Learned
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
43
Next Steps
44
01Task
02Task
Ensure data quality issues are identified documented communicated and resolved
Data Quality
Continue building breadth of payer database amp complete enclave load
Data ETL
Finalize strategy to ensure site accomplishes PA 13-247 and PA 15-146 intent
Establish Strategy
05Task
Identify leading consumer information and price transparency tools available
Consumer Tool Evaluation04Task
Tasks Until Next Meeting (11917)APCD Development and Strategy Update
Distinguish Critical Paths Across and Within Strategic Priorities and Maintain Focus on ldquoMust Havesrdquo and ldquoQuick Winsrdquo
Ensure APCD staff can generate self-service extracts at little cost with minimal lead time
Deliver First DR Extract03Task
45
Future MeetingsAPCD Development and Strategy Update
November
9Legislative Office
Building Room 1D 300 Capitol Avenue
Hartford
All Payer Claims Database Advisory GroupMeeting
900ndash1100 AM
11
Develop and implement core requirements to achieve DRcapabilities
Administration Data release application dictionary ampsupport materialsSoftwareTools Extract creation and delivery toolSupport Admin support and documentation
Phase 1 Develop DR Process Tools and CapabilitiesEngage potential requestors to ensurecapabilities opportunities and services arerecognized
Phase 2 Promotion and Delivery
Data Release (DR) RecapAPCD Data Release Update
Legislative Charge (PA 13-247) The exchange shall helliphellip and (B) make data in the all-payer claims database available to any state agency insurer employer health care provider consumer of health care services or researcher for the purpose of allowing such person or entity to review such data as it relates to health care utilization costs or quality of health care services
12
End to End application process can take between 17 to 40days depending on time of month an application issubmitted All requests must follow the data releaseprocess outlined by Privacy Policy amp Procedures
Data Release ApplicationRequestor general information project summary research details data selection and securityintegrity
Data Release CommitteeReview application alignment with objectives re-identification risk safeguard adequacy and research design
Data Use Agreement Fees amp ExtractUser agrees to fee schedule DUA requirements Standard extract creation within 5 business days (after 1st release)
S M T W T F S
1 2 3 4 5
6 7 8 9 10 11 12
13 14 15 16 17 18 19
20 21 22 23 24 25 26
27 28 29 39 31
DR Process amp Turn-Around TimeAPCD Data Release Update
13
DR TableField Classification MatrixAPCD Data Release Update
Table Name
Field Classifications
Administrative
Enrollee Coverage
InformationEnrollee
DemographicsClaim
InformationDiagnosis
Information
Procedure Coding amp
DetailFinancial
InformationProvider
InformationPayer
InformationSafe Harbor
Variable Grand TotalEligibility 2 11 1 1 1 1 4 21
Eligibility Supplemental 2 13 9 4 28
Medical 2 3 13 2 7 8 4 1 6 46
Medical Claim Header 2 5 7
Medical Supplemental 4 6 3 11 1 6 31
Medical Claim Diagnosis 1 3 1 5
Medical Claim Icd Procedure 2 14 5 4 1 26
Pharmacy 3 3 11 2 9 2 1 3 34
Pharmacy Supplemental 2 8 4 1 15
Provider 3 2 1 6Grand Total 23 30 10 55 10 15 41 10 5 20 219
Data Release Dictionary Located httpagencyaccesshealthctcommeetings1485450397264-a8f3a430-837b
14
ProviderFacility Directory
512k Unique National Provider Identifiers
Pharmacy Claims
All claimsencounters paid by submitting carrier
Data includes info on Administrative Enrollee Coverage Claim Detail Diagnosis Codes Procedure Codes Financials Payers Providers Safe Harbor (12)
1273M Claims $125B
Medical Claims
All claimsencounters paid by submitting carrier
Data includes info on Administrative Enrollee Coverage Claim Detail Diagnosis Codes Procedure Codes Financials Payers Providers Safe Harbor (12)
747M Claims $304B
Enrollees
CY 2012 ndash Present (n- 1 month)
Data includes info on Administrative Enrollee Coverage Enrollee Demographics Financials Payers Providers Safe Harbor (2)Fully insuredNon-ERISA plans (~900k Lives)
Whatrsquos Available Through DRAPCD Data Release Update
Billing rendering prescribing pharmacy primary care provider IDs (varying completion rate)
Data includes info on Unblended and composite provider IDs and NPIs
15
ERISALives covered under self-
insured ERISA plans
Part 2 SUD claimsSUD claims provided by
Part 2 providers
Denied ClaimsFully denied claims not
collected
Test Result ValuesLab imaging biometrics
and physician derived data
Third Party Data Risk scoring social
determinants knowledge base etc
Dental ClaimsDental claims not required
for submission
Ancillary FinancialsPlan premiums capitation payments performance
payments administrative fees
Whatrsquos Not Available Through DRAPCD Data Release Update
HIPAA Safe Harbor Variables18 HIPAA identifiers
16
18 HIPAA identifiers removed from dataset
Identifiers removed as set forth in 45 CFR 164514
De-identification
De-Identified Data ReleaseAPCD Data Release Update
Age caps applied (over 89 less than 1) amp geography reduced to 3 digit zip
All dates related to service and payments masked
First three digits of zip codes only if the geographic area covered by all zip codes beginning with those three digits has a population greater than 20000 or the zip codes for those areas are changed to 000 in the data set
Supplementary safeguards imposed to reduce unique characteristics
17
Partnerships LicensingAccessibilityValue Add DataProcess
Improvement
Identify third party data that can supplement and enrich within release requirements
Third Party DataIdentify areas of process
improvement and automation
ScalabilityEstablish enclave capability
upon needdemand
Extract v EnclaveIdentify areas of opportunity for ongoing multiple use by
institutions
Engagement
Potential Future ImprovementsAPCD Data Release Update
18
AUGUST
16SEPTEMBER
7SEPTEMBER
15SEPTEMBER
22Committee review and
vote on first data request application
from UConn
DATA RELEASE COMMITTEE MEETING
To be canceled if no additional applications
submitted
DATA RELEASE COMMITTEE MEETING
Review and confirmation of de-
identification methods and implementation
EXTRACT AUDIT
Extract delivered and support channel
opened
DATA RELEASE
Data release activities within the next two months include
Open Action ItemsAPCD Data Release Update
Project Descriptions
bull State Innovation Modelndash Online dashboard of ~30 pace and performance measures
bull Used to monitor performance of SIM bull 12 measures use APCD databull Includes yearly targets for overall Connecticut
ndash Online Scorecard Online dashboard of FQHC and Advanced Network performancebull First health care performance scorecard in CTbull Provides transparency in provider performancebull Utilizes claims based measures from common scorecard and CAHPS surveys
bull Suicide Risk Identificationndash Improves identification of patients at risk of suicide
bull Utilizes APCD claims data EHR data from 5 health care providers and mortality databull Creation of phenotypic algorithm
19
APCD Based Dashboard Measures
Health Care DeliveryPercent of adults with regular source of careChildren well-child visits for at-risk popMammograms for women gt50 last 2 yearsOptimal diabetes care- 2+ annual A1c testsED use- asthma as primary dx (per 10k)
Percent of adults with HTN taking HTN medsFollow-Up after Discharge from the Emergency Department for Mental Health or Alcohol or other Drug
Follow-Up after Hospitalization for Mental Illness
Antidepressant Medication ManagementInitiation and Engagement of Alcohol and Other Drug Dependence Treatment
Health Care Costs
Cost of inpatient care PMPY
Cost of outpatient care PMPY
httpwwwpublichealthuconnedusim_dashhtmlohriNav=7C
Scorecard MeasuresReporting Only
Coordination of Care30 day readmission
PCPs that meet Meaningful Use
Prevention
Non-recommended Cervical Cancer Screening in Adolescent Female
Well-child visits in the third fourth fifth and sixth years of life (Medicaid only)
Frequency of Ongoing Prenatal Care (FPC)
Oral Evaluation Dental Services (Medicaid only)
Acute and Chronic Care
Cardiac strss img Testing in asymptomatic low risk patients
Behavioral HealthAdult major depressive disorder (MDD) Coordination of care of patients with specific co-morbid conditions
Anti-Depressant Medication Management
Initiation and Engagement of Alcohol and Other Drug Dependence Treatment
Follow up after hospitalization for mental illness 7 amp 30 days
21
Provisional Core Measure SetCare CoordinationPlan all-cause readmissionAnnual monitoring for persistent medications (roll-up)PreventionBreast cancer screeningCervical cancer screeningChlamydia screening in womenAdolescent female immunizations HPV
Weight assessment and counseling for nutrition and physical activity for childrenadolescents
Well-child visits in the first 15 months of lifeAdolescent well-care visitsBehavioral health screening (pediatric Medicaid only custom measure)
Acute amp Chronic Care
Medication management for people w asthma
DM HbA1c Testing
DM Diabetes medical attention for nephropathy
Use of imaging studies for low back pain
Avoidance of antibiotic treatment in adults with acute bronchitis
Appr treatment for children with upper respiratory infection
Behavioral Health
Follow-up care for children prescribed ADHD medicationMetabolic Monitoring for Children and Adolescents on Antipsychotics (pediatric Medicaid only custom measure)
Suicide Risk Identification
22
23
CT APCD Data -
Preliminary Analysis
Examples amp Showcase
Title XxSubtitle Xx
Presenter TitleDate
24Proprietary and Confidential 24
Connecticut APCDPreliminary Analysis Examples amp Showcase
CT APCD Advisory Group Meeting August 10 2017
25
bull Data source CY2016 commercial data from the CT APCDbull Focus commercial population-based reportingbull Considerations risk adjustment for age gender and health statusbull Areas of exploration
ndash Multiple views of the CT APCD population total members health exchange members members with diabetes
ndash Expenditures utilization and effective and preventive care ratesndash Analysis by multiple geographic units county Hospital Service
Area (HSA) and Health Reference Group (HRG) bull Conclusion Recap and lessons learned
Presentation Overview
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
26
bull Member Any person covered in a submitterrsquos eligibility databull Average Members Member months divided by 12 (months)bull Expenditures Allowed amount bull Capping Capped outliers in the data at the 99th percentilebull Clinical Risk Groups Individualsrsquo categorized health statusbull County Administrative focus areasbull Hospital Service Area Local hospital marketsbull Health Reference Group Community types bull Rates Expenditures by average membersbull Risk Adjustment Adjusting for differences between member
populations by considering membersrsquo age gender and health status
Key Terms
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
27
Population-Based Reporting
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
bull Reporting units county modified Hospital Service Area (HSA) and Health Reference Group (HRG)
bull Risk adjustment age gender and health status (3M CRGs)
28
CT APCD Population Overview
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Measure Count
Unique Members 875129
Total Member Months 9122482
Average Members 760207
Total Expenditures $40 Billion
Total Expenditures Per Member Per Year (PMPY) $5255
Total Expenditures Per Member Per Month (PMPM) $438
Total expenditures are capped at the 99th percentile
29
Expenditures PMPY by Age amp Gender
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$0
$1000
$2000
$3000
$4000
$5000
$6000
$7000
$8000
$9000
0-18 Female 0-18 Male 18-34 Female 18-34 Male 35-44 Female 35-44 Male 45-54 Female 45-54 Male 55-64 Female 55-64 Male
30
Expenditures PMPY by CRGs
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$-
$5000
$10000
$15000
$20000
$25000
$30000
$35000
$40000
Healthy Acute or Minor Chronic Moderate Chronic Significant Chronic Cancer or Catastrophic
$0
31
CT Health Exchange Population Overview
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
MeasureExchange Members
Non-Exchange Members
Average Members 86941 673266
Percentage of Members 55-64 Years of Age 31 20
Percentage of Members with Chronic Condition(s) 23 19
Expenditures PMPY $5378 $5239
Expenditures PMPY Risk Adjusted $4780 $5316 Expenditures PMPY for Members with Diabetes Risk-Adjusted $17561 $19291
32
CT Exchange vs Non-Exchange Rates
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Rate per 1000 Rate per 1000 (Risk Adj)
Measure Exchange Members
Non-Exchange Members
Exchange Members
Non-Exchange Members
Inpatient Acute Visits 390 328 339 335Medical 210 144 181 147Surgical 140 116 115 119Maternity 41 69 41 69
Outpatient Emergency Visits 1941 1924 1944 1923MRIs 920 803 810 817CT Scans 1108 824 938 844Primary Care Office Visits 15216 18755 16068 18628Psychiatric Visits 9864 9783 9783 11092Chiropractic Visits 3403 7808 3088 7913
Utilization measures are capped at the 99th percentile
33
Expenditure PMPY Diabetes Population
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$-
$5000
$10000
$15000
$20000
$25000
$30000
No Diabetes (n=730838) Diabetes amp no comorbidity (n=16419) Diabetes with comorbidity (n=12950)$0
No Diabetes (n = 730838)
Diabetes No Comorbidity(n = 16419)
Diabetes Comorbidity(n = 12950)
34
Vermont Blueprint for HealthDiabetes HbA1c Control amp Outcomes
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Measure HbA1c in Control HbA1c Not in Control
Members 5619 786
Average annual expenditures per capita
$15726 ($15219 $16233)
$17328 ($16110 $18546)
Inpatient hospitalizations per 1000 members
1897 (1782 2011)
2531 (2177 2886)
Inpatient days per 1000 members
8685 (8440 8930)
11561 (10804 12318)
Outpatient ED visits per 1000 members
6275 (6067 6483)
8011 (7381 8642)
Risk-adjusted rates and 95 confidence intervals 99th percentile outliers excluded HbA1c not in control gt9
35
Expenditures PMPY by County
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
County Average Members Expenditures PMPYExpenditures PMPY
(Risk Adjusted)Fairfield 223295 $5182 $5539 New London 44741 $5913 $5342 New Haven 161763 $5494 $5335 Middlesex 38531 $5359 $5184 Litchfield 43224 $5136 $5118 Tolland 36304 $5047 $5019 Hartford 191415 $4998 $4958 Windham 20934 $5539 $4950
Total 760207 $5255 $5255
36
Expenditures PMPY by HSA Risk Adjusted
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$0
$1000
$2000
$3000
$4000
$5000
$6000
$7000
37
EffectivePreventive Care
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
HEDIS MeasureCT APCD
CommercialNCQA
National HMONCQA
National PPOAvoidance of Antibiotic Treatment in Adults with Acute Bronchitis 268 276 258Anti-Depressant Medication Management 764 664 666Well-Child Visits 798 762 723Breast Cancer Screening 671 732 696
NCQA National HMO and NCQA National PPO benchmark metrics calculated for CY2015 Several other HEDIS measures can be run using the CT APCD data set and compared against the NCQA National HMO and PPO benchmarks Examples include Comprehensive Diabetes Care ndash HbA1C Testing Comprehensive Diabetes Care ndash Medical Attention for Nephrology Comprehensive Diabetes Care ndash Eye Exam Performed Adolescent Well-Care Visits Appropriate Treatment for Children with Upper Respiratory Infection etc
38
Breast Cancer Screening
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
60
62
64
66
68
70
72
Urban Centers (n=3369) Manufacturing Centers (n=10974) Diverse Suburbs (n=12206) Mill Towns (n=16281) Rural Towns (n=16789) Wealthy Suburbs (n=12266)
39
Vermont Blueprintrsquos Hub amp Spoke Model
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
bull Vermontrsquos ldquoHealth Homerdquo program designed to treat Vermonters with chronic opioid addiction
bull Hubs ndash designated providers ndash Provide coordinated care to patients through MAT services
ndash Coordinate referral to ongoing care
bull Spokes ndash teams of healthcare professionalsndash Blueprint Advanced Practice Medical Homes
ndash Federally-Qualified Health Centers
ndash Outpatient substance abuse and primary care providers
40copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Medication Assisted Treatment
bull Vermont Blueprint baseline study comparing medication-assisted treatment (MAT) population versus non-MAT population
bull Study published in the Journal of Substance Abuse Treatment (August 2016)
41
bull The CT APCD is a comparable resource to other statewide APCDs ndash A powerful tool that will only continue to grow with usendash Encompasses a robust set of information including
expenditures procedure codes diagnosis coding drug codes and enhanced value-adds (eg claim type master membermaster provider IDsNPIs MS-DRGs etc)
bull Future considerations to enhance the CT APCDndash Add Medicare and Medicaid claims datandash Continue to strengthen the completeness and validity of data
elements of importance to downstream analytic use cases (eg member race and ethnicity codes) in data collection
Lessons Learned
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
43
Next Steps
44
01Task
02Task
Ensure data quality issues are identified documented communicated and resolved
Data Quality
Continue building breadth of payer database amp complete enclave load
Data ETL
Finalize strategy to ensure site accomplishes PA 13-247 and PA 15-146 intent
Establish Strategy
05Task
Identify leading consumer information and price transparency tools available
Consumer Tool Evaluation04Task
Tasks Until Next Meeting (11917)APCD Development and Strategy Update
Distinguish Critical Paths Across and Within Strategic Priorities and Maintain Focus on ldquoMust Havesrdquo and ldquoQuick Winsrdquo
Ensure APCD staff can generate self-service extracts at little cost with minimal lead time
Deliver First DR Extract03Task
45
Future MeetingsAPCD Development and Strategy Update
November
9Legislative Office
Building Room 1D 300 Capitol Avenue
Hartford
All Payer Claims Database Advisory GroupMeeting
900ndash1100 AM
12
End to End application process can take between 17 to 40days depending on time of month an application issubmitted All requests must follow the data releaseprocess outlined by Privacy Policy amp Procedures
Data Release ApplicationRequestor general information project summary research details data selection and securityintegrity
Data Release CommitteeReview application alignment with objectives re-identification risk safeguard adequacy and research design
Data Use Agreement Fees amp ExtractUser agrees to fee schedule DUA requirements Standard extract creation within 5 business days (after 1st release)
S M T W T F S
1 2 3 4 5
6 7 8 9 10 11 12
13 14 15 16 17 18 19
20 21 22 23 24 25 26
27 28 29 39 31
DR Process amp Turn-Around TimeAPCD Data Release Update
13
DR TableField Classification MatrixAPCD Data Release Update
Table Name
Field Classifications
Administrative
Enrollee Coverage
InformationEnrollee
DemographicsClaim
InformationDiagnosis
Information
Procedure Coding amp
DetailFinancial
InformationProvider
InformationPayer
InformationSafe Harbor
Variable Grand TotalEligibility 2 11 1 1 1 1 4 21
Eligibility Supplemental 2 13 9 4 28
Medical 2 3 13 2 7 8 4 1 6 46
Medical Claim Header 2 5 7
Medical Supplemental 4 6 3 11 1 6 31
Medical Claim Diagnosis 1 3 1 5
Medical Claim Icd Procedure 2 14 5 4 1 26
Pharmacy 3 3 11 2 9 2 1 3 34
Pharmacy Supplemental 2 8 4 1 15
Provider 3 2 1 6Grand Total 23 30 10 55 10 15 41 10 5 20 219
Data Release Dictionary Located httpagencyaccesshealthctcommeetings1485450397264-a8f3a430-837b
14
ProviderFacility Directory
512k Unique National Provider Identifiers
Pharmacy Claims
All claimsencounters paid by submitting carrier
Data includes info on Administrative Enrollee Coverage Claim Detail Diagnosis Codes Procedure Codes Financials Payers Providers Safe Harbor (12)
1273M Claims $125B
Medical Claims
All claimsencounters paid by submitting carrier
Data includes info on Administrative Enrollee Coverage Claim Detail Diagnosis Codes Procedure Codes Financials Payers Providers Safe Harbor (12)
747M Claims $304B
Enrollees
CY 2012 ndash Present (n- 1 month)
Data includes info on Administrative Enrollee Coverage Enrollee Demographics Financials Payers Providers Safe Harbor (2)Fully insuredNon-ERISA plans (~900k Lives)
Whatrsquos Available Through DRAPCD Data Release Update
Billing rendering prescribing pharmacy primary care provider IDs (varying completion rate)
Data includes info on Unblended and composite provider IDs and NPIs
15
ERISALives covered under self-
insured ERISA plans
Part 2 SUD claimsSUD claims provided by
Part 2 providers
Denied ClaimsFully denied claims not
collected
Test Result ValuesLab imaging biometrics
and physician derived data
Third Party Data Risk scoring social
determinants knowledge base etc
Dental ClaimsDental claims not required
for submission
Ancillary FinancialsPlan premiums capitation payments performance
payments administrative fees
Whatrsquos Not Available Through DRAPCD Data Release Update
HIPAA Safe Harbor Variables18 HIPAA identifiers
16
18 HIPAA identifiers removed from dataset
Identifiers removed as set forth in 45 CFR 164514
De-identification
De-Identified Data ReleaseAPCD Data Release Update
Age caps applied (over 89 less than 1) amp geography reduced to 3 digit zip
All dates related to service and payments masked
First three digits of zip codes only if the geographic area covered by all zip codes beginning with those three digits has a population greater than 20000 or the zip codes for those areas are changed to 000 in the data set
Supplementary safeguards imposed to reduce unique characteristics
17
Partnerships LicensingAccessibilityValue Add DataProcess
Improvement
Identify third party data that can supplement and enrich within release requirements
Third Party DataIdentify areas of process
improvement and automation
ScalabilityEstablish enclave capability
upon needdemand
Extract v EnclaveIdentify areas of opportunity for ongoing multiple use by
institutions
Engagement
Potential Future ImprovementsAPCD Data Release Update
18
AUGUST
16SEPTEMBER
7SEPTEMBER
15SEPTEMBER
22Committee review and
vote on first data request application
from UConn
DATA RELEASE COMMITTEE MEETING
To be canceled if no additional applications
submitted
DATA RELEASE COMMITTEE MEETING
Review and confirmation of de-
identification methods and implementation
EXTRACT AUDIT
Extract delivered and support channel
opened
DATA RELEASE
Data release activities within the next two months include
Open Action ItemsAPCD Data Release Update
Project Descriptions
bull State Innovation Modelndash Online dashboard of ~30 pace and performance measures
bull Used to monitor performance of SIM bull 12 measures use APCD databull Includes yearly targets for overall Connecticut
ndash Online Scorecard Online dashboard of FQHC and Advanced Network performancebull First health care performance scorecard in CTbull Provides transparency in provider performancebull Utilizes claims based measures from common scorecard and CAHPS surveys
bull Suicide Risk Identificationndash Improves identification of patients at risk of suicide
bull Utilizes APCD claims data EHR data from 5 health care providers and mortality databull Creation of phenotypic algorithm
19
APCD Based Dashboard Measures
Health Care DeliveryPercent of adults with regular source of careChildren well-child visits for at-risk popMammograms for women gt50 last 2 yearsOptimal diabetes care- 2+ annual A1c testsED use- asthma as primary dx (per 10k)
Percent of adults with HTN taking HTN medsFollow-Up after Discharge from the Emergency Department for Mental Health or Alcohol or other Drug
Follow-Up after Hospitalization for Mental Illness
Antidepressant Medication ManagementInitiation and Engagement of Alcohol and Other Drug Dependence Treatment
Health Care Costs
Cost of inpatient care PMPY
Cost of outpatient care PMPY
httpwwwpublichealthuconnedusim_dashhtmlohriNav=7C
Scorecard MeasuresReporting Only
Coordination of Care30 day readmission
PCPs that meet Meaningful Use
Prevention
Non-recommended Cervical Cancer Screening in Adolescent Female
Well-child visits in the third fourth fifth and sixth years of life (Medicaid only)
Frequency of Ongoing Prenatal Care (FPC)
Oral Evaluation Dental Services (Medicaid only)
Acute and Chronic Care
Cardiac strss img Testing in asymptomatic low risk patients
Behavioral HealthAdult major depressive disorder (MDD) Coordination of care of patients with specific co-morbid conditions
Anti-Depressant Medication Management
Initiation and Engagement of Alcohol and Other Drug Dependence Treatment
Follow up after hospitalization for mental illness 7 amp 30 days
21
Provisional Core Measure SetCare CoordinationPlan all-cause readmissionAnnual monitoring for persistent medications (roll-up)PreventionBreast cancer screeningCervical cancer screeningChlamydia screening in womenAdolescent female immunizations HPV
Weight assessment and counseling for nutrition and physical activity for childrenadolescents
Well-child visits in the first 15 months of lifeAdolescent well-care visitsBehavioral health screening (pediatric Medicaid only custom measure)
Acute amp Chronic Care
Medication management for people w asthma
DM HbA1c Testing
DM Diabetes medical attention for nephropathy
Use of imaging studies for low back pain
Avoidance of antibiotic treatment in adults with acute bronchitis
Appr treatment for children with upper respiratory infection
Behavioral Health
Follow-up care for children prescribed ADHD medicationMetabolic Monitoring for Children and Adolescents on Antipsychotics (pediatric Medicaid only custom measure)
Suicide Risk Identification
22
23
CT APCD Data -
Preliminary Analysis
Examples amp Showcase
Title XxSubtitle Xx
Presenter TitleDate
24Proprietary and Confidential 24
Connecticut APCDPreliminary Analysis Examples amp Showcase
CT APCD Advisory Group Meeting August 10 2017
25
bull Data source CY2016 commercial data from the CT APCDbull Focus commercial population-based reportingbull Considerations risk adjustment for age gender and health statusbull Areas of exploration
ndash Multiple views of the CT APCD population total members health exchange members members with diabetes
ndash Expenditures utilization and effective and preventive care ratesndash Analysis by multiple geographic units county Hospital Service
Area (HSA) and Health Reference Group (HRG) bull Conclusion Recap and lessons learned
Presentation Overview
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
26
bull Member Any person covered in a submitterrsquos eligibility databull Average Members Member months divided by 12 (months)bull Expenditures Allowed amount bull Capping Capped outliers in the data at the 99th percentilebull Clinical Risk Groups Individualsrsquo categorized health statusbull County Administrative focus areasbull Hospital Service Area Local hospital marketsbull Health Reference Group Community types bull Rates Expenditures by average membersbull Risk Adjustment Adjusting for differences between member
populations by considering membersrsquo age gender and health status
Key Terms
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
27
Population-Based Reporting
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
bull Reporting units county modified Hospital Service Area (HSA) and Health Reference Group (HRG)
bull Risk adjustment age gender and health status (3M CRGs)
28
CT APCD Population Overview
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Measure Count
Unique Members 875129
Total Member Months 9122482
Average Members 760207
Total Expenditures $40 Billion
Total Expenditures Per Member Per Year (PMPY) $5255
Total Expenditures Per Member Per Month (PMPM) $438
Total expenditures are capped at the 99th percentile
29
Expenditures PMPY by Age amp Gender
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$0
$1000
$2000
$3000
$4000
$5000
$6000
$7000
$8000
$9000
0-18 Female 0-18 Male 18-34 Female 18-34 Male 35-44 Female 35-44 Male 45-54 Female 45-54 Male 55-64 Female 55-64 Male
30
Expenditures PMPY by CRGs
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$-
$5000
$10000
$15000
$20000
$25000
$30000
$35000
$40000
Healthy Acute or Minor Chronic Moderate Chronic Significant Chronic Cancer or Catastrophic
$0
31
CT Health Exchange Population Overview
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
MeasureExchange Members
Non-Exchange Members
Average Members 86941 673266
Percentage of Members 55-64 Years of Age 31 20
Percentage of Members with Chronic Condition(s) 23 19
Expenditures PMPY $5378 $5239
Expenditures PMPY Risk Adjusted $4780 $5316 Expenditures PMPY for Members with Diabetes Risk-Adjusted $17561 $19291
32
CT Exchange vs Non-Exchange Rates
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Rate per 1000 Rate per 1000 (Risk Adj)
Measure Exchange Members
Non-Exchange Members
Exchange Members
Non-Exchange Members
Inpatient Acute Visits 390 328 339 335Medical 210 144 181 147Surgical 140 116 115 119Maternity 41 69 41 69
Outpatient Emergency Visits 1941 1924 1944 1923MRIs 920 803 810 817CT Scans 1108 824 938 844Primary Care Office Visits 15216 18755 16068 18628Psychiatric Visits 9864 9783 9783 11092Chiropractic Visits 3403 7808 3088 7913
Utilization measures are capped at the 99th percentile
33
Expenditure PMPY Diabetes Population
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$-
$5000
$10000
$15000
$20000
$25000
$30000
No Diabetes (n=730838) Diabetes amp no comorbidity (n=16419) Diabetes with comorbidity (n=12950)$0
No Diabetes (n = 730838)
Diabetes No Comorbidity(n = 16419)
Diabetes Comorbidity(n = 12950)
34
Vermont Blueprint for HealthDiabetes HbA1c Control amp Outcomes
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Measure HbA1c in Control HbA1c Not in Control
Members 5619 786
Average annual expenditures per capita
$15726 ($15219 $16233)
$17328 ($16110 $18546)
Inpatient hospitalizations per 1000 members
1897 (1782 2011)
2531 (2177 2886)
Inpatient days per 1000 members
8685 (8440 8930)
11561 (10804 12318)
Outpatient ED visits per 1000 members
6275 (6067 6483)
8011 (7381 8642)
Risk-adjusted rates and 95 confidence intervals 99th percentile outliers excluded HbA1c not in control gt9
35
Expenditures PMPY by County
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
County Average Members Expenditures PMPYExpenditures PMPY
(Risk Adjusted)Fairfield 223295 $5182 $5539 New London 44741 $5913 $5342 New Haven 161763 $5494 $5335 Middlesex 38531 $5359 $5184 Litchfield 43224 $5136 $5118 Tolland 36304 $5047 $5019 Hartford 191415 $4998 $4958 Windham 20934 $5539 $4950
Total 760207 $5255 $5255
36
Expenditures PMPY by HSA Risk Adjusted
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$0
$1000
$2000
$3000
$4000
$5000
$6000
$7000
37
EffectivePreventive Care
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
HEDIS MeasureCT APCD
CommercialNCQA
National HMONCQA
National PPOAvoidance of Antibiotic Treatment in Adults with Acute Bronchitis 268 276 258Anti-Depressant Medication Management 764 664 666Well-Child Visits 798 762 723Breast Cancer Screening 671 732 696
NCQA National HMO and NCQA National PPO benchmark metrics calculated for CY2015 Several other HEDIS measures can be run using the CT APCD data set and compared against the NCQA National HMO and PPO benchmarks Examples include Comprehensive Diabetes Care ndash HbA1C Testing Comprehensive Diabetes Care ndash Medical Attention for Nephrology Comprehensive Diabetes Care ndash Eye Exam Performed Adolescent Well-Care Visits Appropriate Treatment for Children with Upper Respiratory Infection etc
38
Breast Cancer Screening
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
60
62
64
66
68
70
72
Urban Centers (n=3369) Manufacturing Centers (n=10974) Diverse Suburbs (n=12206) Mill Towns (n=16281) Rural Towns (n=16789) Wealthy Suburbs (n=12266)
39
Vermont Blueprintrsquos Hub amp Spoke Model
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
bull Vermontrsquos ldquoHealth Homerdquo program designed to treat Vermonters with chronic opioid addiction
bull Hubs ndash designated providers ndash Provide coordinated care to patients through MAT services
ndash Coordinate referral to ongoing care
bull Spokes ndash teams of healthcare professionalsndash Blueprint Advanced Practice Medical Homes
ndash Federally-Qualified Health Centers
ndash Outpatient substance abuse and primary care providers
40copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Medication Assisted Treatment
bull Vermont Blueprint baseline study comparing medication-assisted treatment (MAT) population versus non-MAT population
bull Study published in the Journal of Substance Abuse Treatment (August 2016)
41
bull The CT APCD is a comparable resource to other statewide APCDs ndash A powerful tool that will only continue to grow with usendash Encompasses a robust set of information including
expenditures procedure codes diagnosis coding drug codes and enhanced value-adds (eg claim type master membermaster provider IDsNPIs MS-DRGs etc)
bull Future considerations to enhance the CT APCDndash Add Medicare and Medicaid claims datandash Continue to strengthen the completeness and validity of data
elements of importance to downstream analytic use cases (eg member race and ethnicity codes) in data collection
Lessons Learned
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
43
Next Steps
44
01Task
02Task
Ensure data quality issues are identified documented communicated and resolved
Data Quality
Continue building breadth of payer database amp complete enclave load
Data ETL
Finalize strategy to ensure site accomplishes PA 13-247 and PA 15-146 intent
Establish Strategy
05Task
Identify leading consumer information and price transparency tools available
Consumer Tool Evaluation04Task
Tasks Until Next Meeting (11917)APCD Development and Strategy Update
Distinguish Critical Paths Across and Within Strategic Priorities and Maintain Focus on ldquoMust Havesrdquo and ldquoQuick Winsrdquo
Ensure APCD staff can generate self-service extracts at little cost with minimal lead time
Deliver First DR Extract03Task
45
Future MeetingsAPCD Development and Strategy Update
November
9Legislative Office
Building Room 1D 300 Capitol Avenue
Hartford
All Payer Claims Database Advisory GroupMeeting
900ndash1100 AM
13
DR TableField Classification MatrixAPCD Data Release Update
Table Name
Field Classifications
Administrative
Enrollee Coverage
InformationEnrollee
DemographicsClaim
InformationDiagnosis
Information
Procedure Coding amp
DetailFinancial
InformationProvider
InformationPayer
InformationSafe Harbor
Variable Grand TotalEligibility 2 11 1 1 1 1 4 21
Eligibility Supplemental 2 13 9 4 28
Medical 2 3 13 2 7 8 4 1 6 46
Medical Claim Header 2 5 7
Medical Supplemental 4 6 3 11 1 6 31
Medical Claim Diagnosis 1 3 1 5
Medical Claim Icd Procedure 2 14 5 4 1 26
Pharmacy 3 3 11 2 9 2 1 3 34
Pharmacy Supplemental 2 8 4 1 15
Provider 3 2 1 6Grand Total 23 30 10 55 10 15 41 10 5 20 219
Data Release Dictionary Located httpagencyaccesshealthctcommeetings1485450397264-a8f3a430-837b
14
ProviderFacility Directory
512k Unique National Provider Identifiers
Pharmacy Claims
All claimsencounters paid by submitting carrier
Data includes info on Administrative Enrollee Coverage Claim Detail Diagnosis Codes Procedure Codes Financials Payers Providers Safe Harbor (12)
1273M Claims $125B
Medical Claims
All claimsencounters paid by submitting carrier
Data includes info on Administrative Enrollee Coverage Claim Detail Diagnosis Codes Procedure Codes Financials Payers Providers Safe Harbor (12)
747M Claims $304B
Enrollees
CY 2012 ndash Present (n- 1 month)
Data includes info on Administrative Enrollee Coverage Enrollee Demographics Financials Payers Providers Safe Harbor (2)Fully insuredNon-ERISA plans (~900k Lives)
Whatrsquos Available Through DRAPCD Data Release Update
Billing rendering prescribing pharmacy primary care provider IDs (varying completion rate)
Data includes info on Unblended and composite provider IDs and NPIs
15
ERISALives covered under self-
insured ERISA plans
Part 2 SUD claimsSUD claims provided by
Part 2 providers
Denied ClaimsFully denied claims not
collected
Test Result ValuesLab imaging biometrics
and physician derived data
Third Party Data Risk scoring social
determinants knowledge base etc
Dental ClaimsDental claims not required
for submission
Ancillary FinancialsPlan premiums capitation payments performance
payments administrative fees
Whatrsquos Not Available Through DRAPCD Data Release Update
HIPAA Safe Harbor Variables18 HIPAA identifiers
16
18 HIPAA identifiers removed from dataset
Identifiers removed as set forth in 45 CFR 164514
De-identification
De-Identified Data ReleaseAPCD Data Release Update
Age caps applied (over 89 less than 1) amp geography reduced to 3 digit zip
All dates related to service and payments masked
First three digits of zip codes only if the geographic area covered by all zip codes beginning with those three digits has a population greater than 20000 or the zip codes for those areas are changed to 000 in the data set
Supplementary safeguards imposed to reduce unique characteristics
17
Partnerships LicensingAccessibilityValue Add DataProcess
Improvement
Identify third party data that can supplement and enrich within release requirements
Third Party DataIdentify areas of process
improvement and automation
ScalabilityEstablish enclave capability
upon needdemand
Extract v EnclaveIdentify areas of opportunity for ongoing multiple use by
institutions
Engagement
Potential Future ImprovementsAPCD Data Release Update
18
AUGUST
16SEPTEMBER
7SEPTEMBER
15SEPTEMBER
22Committee review and
vote on first data request application
from UConn
DATA RELEASE COMMITTEE MEETING
To be canceled if no additional applications
submitted
DATA RELEASE COMMITTEE MEETING
Review and confirmation of de-
identification methods and implementation
EXTRACT AUDIT
Extract delivered and support channel
opened
DATA RELEASE
Data release activities within the next two months include
Open Action ItemsAPCD Data Release Update
Project Descriptions
bull State Innovation Modelndash Online dashboard of ~30 pace and performance measures
bull Used to monitor performance of SIM bull 12 measures use APCD databull Includes yearly targets for overall Connecticut
ndash Online Scorecard Online dashboard of FQHC and Advanced Network performancebull First health care performance scorecard in CTbull Provides transparency in provider performancebull Utilizes claims based measures from common scorecard and CAHPS surveys
bull Suicide Risk Identificationndash Improves identification of patients at risk of suicide
bull Utilizes APCD claims data EHR data from 5 health care providers and mortality databull Creation of phenotypic algorithm
19
APCD Based Dashboard Measures
Health Care DeliveryPercent of adults with regular source of careChildren well-child visits for at-risk popMammograms for women gt50 last 2 yearsOptimal diabetes care- 2+ annual A1c testsED use- asthma as primary dx (per 10k)
Percent of adults with HTN taking HTN medsFollow-Up after Discharge from the Emergency Department for Mental Health or Alcohol or other Drug
Follow-Up after Hospitalization for Mental Illness
Antidepressant Medication ManagementInitiation and Engagement of Alcohol and Other Drug Dependence Treatment
Health Care Costs
Cost of inpatient care PMPY
Cost of outpatient care PMPY
httpwwwpublichealthuconnedusim_dashhtmlohriNav=7C
Scorecard MeasuresReporting Only
Coordination of Care30 day readmission
PCPs that meet Meaningful Use
Prevention
Non-recommended Cervical Cancer Screening in Adolescent Female
Well-child visits in the third fourth fifth and sixth years of life (Medicaid only)
Frequency of Ongoing Prenatal Care (FPC)
Oral Evaluation Dental Services (Medicaid only)
Acute and Chronic Care
Cardiac strss img Testing in asymptomatic low risk patients
Behavioral HealthAdult major depressive disorder (MDD) Coordination of care of patients with specific co-morbid conditions
Anti-Depressant Medication Management
Initiation and Engagement of Alcohol and Other Drug Dependence Treatment
Follow up after hospitalization for mental illness 7 amp 30 days
21
Provisional Core Measure SetCare CoordinationPlan all-cause readmissionAnnual monitoring for persistent medications (roll-up)PreventionBreast cancer screeningCervical cancer screeningChlamydia screening in womenAdolescent female immunizations HPV
Weight assessment and counseling for nutrition and physical activity for childrenadolescents
Well-child visits in the first 15 months of lifeAdolescent well-care visitsBehavioral health screening (pediatric Medicaid only custom measure)
Acute amp Chronic Care
Medication management for people w asthma
DM HbA1c Testing
DM Diabetes medical attention for nephropathy
Use of imaging studies for low back pain
Avoidance of antibiotic treatment in adults with acute bronchitis
Appr treatment for children with upper respiratory infection
Behavioral Health
Follow-up care for children prescribed ADHD medicationMetabolic Monitoring for Children and Adolescents on Antipsychotics (pediatric Medicaid only custom measure)
Suicide Risk Identification
22
23
CT APCD Data -
Preliminary Analysis
Examples amp Showcase
Title XxSubtitle Xx
Presenter TitleDate
24Proprietary and Confidential 24
Connecticut APCDPreliminary Analysis Examples amp Showcase
CT APCD Advisory Group Meeting August 10 2017
25
bull Data source CY2016 commercial data from the CT APCDbull Focus commercial population-based reportingbull Considerations risk adjustment for age gender and health statusbull Areas of exploration
ndash Multiple views of the CT APCD population total members health exchange members members with diabetes
ndash Expenditures utilization and effective and preventive care ratesndash Analysis by multiple geographic units county Hospital Service
Area (HSA) and Health Reference Group (HRG) bull Conclusion Recap and lessons learned
Presentation Overview
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
26
bull Member Any person covered in a submitterrsquos eligibility databull Average Members Member months divided by 12 (months)bull Expenditures Allowed amount bull Capping Capped outliers in the data at the 99th percentilebull Clinical Risk Groups Individualsrsquo categorized health statusbull County Administrative focus areasbull Hospital Service Area Local hospital marketsbull Health Reference Group Community types bull Rates Expenditures by average membersbull Risk Adjustment Adjusting for differences between member
populations by considering membersrsquo age gender and health status
Key Terms
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
27
Population-Based Reporting
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
bull Reporting units county modified Hospital Service Area (HSA) and Health Reference Group (HRG)
bull Risk adjustment age gender and health status (3M CRGs)
28
CT APCD Population Overview
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Measure Count
Unique Members 875129
Total Member Months 9122482
Average Members 760207
Total Expenditures $40 Billion
Total Expenditures Per Member Per Year (PMPY) $5255
Total Expenditures Per Member Per Month (PMPM) $438
Total expenditures are capped at the 99th percentile
29
Expenditures PMPY by Age amp Gender
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$0
$1000
$2000
$3000
$4000
$5000
$6000
$7000
$8000
$9000
0-18 Female 0-18 Male 18-34 Female 18-34 Male 35-44 Female 35-44 Male 45-54 Female 45-54 Male 55-64 Female 55-64 Male
30
Expenditures PMPY by CRGs
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$-
$5000
$10000
$15000
$20000
$25000
$30000
$35000
$40000
Healthy Acute or Minor Chronic Moderate Chronic Significant Chronic Cancer or Catastrophic
$0
31
CT Health Exchange Population Overview
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
MeasureExchange Members
Non-Exchange Members
Average Members 86941 673266
Percentage of Members 55-64 Years of Age 31 20
Percentage of Members with Chronic Condition(s) 23 19
Expenditures PMPY $5378 $5239
Expenditures PMPY Risk Adjusted $4780 $5316 Expenditures PMPY for Members with Diabetes Risk-Adjusted $17561 $19291
32
CT Exchange vs Non-Exchange Rates
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Rate per 1000 Rate per 1000 (Risk Adj)
Measure Exchange Members
Non-Exchange Members
Exchange Members
Non-Exchange Members
Inpatient Acute Visits 390 328 339 335Medical 210 144 181 147Surgical 140 116 115 119Maternity 41 69 41 69
Outpatient Emergency Visits 1941 1924 1944 1923MRIs 920 803 810 817CT Scans 1108 824 938 844Primary Care Office Visits 15216 18755 16068 18628Psychiatric Visits 9864 9783 9783 11092Chiropractic Visits 3403 7808 3088 7913
Utilization measures are capped at the 99th percentile
33
Expenditure PMPY Diabetes Population
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$-
$5000
$10000
$15000
$20000
$25000
$30000
No Diabetes (n=730838) Diabetes amp no comorbidity (n=16419) Diabetes with comorbidity (n=12950)$0
No Diabetes (n = 730838)
Diabetes No Comorbidity(n = 16419)
Diabetes Comorbidity(n = 12950)
34
Vermont Blueprint for HealthDiabetes HbA1c Control amp Outcomes
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Measure HbA1c in Control HbA1c Not in Control
Members 5619 786
Average annual expenditures per capita
$15726 ($15219 $16233)
$17328 ($16110 $18546)
Inpatient hospitalizations per 1000 members
1897 (1782 2011)
2531 (2177 2886)
Inpatient days per 1000 members
8685 (8440 8930)
11561 (10804 12318)
Outpatient ED visits per 1000 members
6275 (6067 6483)
8011 (7381 8642)
Risk-adjusted rates and 95 confidence intervals 99th percentile outliers excluded HbA1c not in control gt9
35
Expenditures PMPY by County
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
County Average Members Expenditures PMPYExpenditures PMPY
(Risk Adjusted)Fairfield 223295 $5182 $5539 New London 44741 $5913 $5342 New Haven 161763 $5494 $5335 Middlesex 38531 $5359 $5184 Litchfield 43224 $5136 $5118 Tolland 36304 $5047 $5019 Hartford 191415 $4998 $4958 Windham 20934 $5539 $4950
Total 760207 $5255 $5255
36
Expenditures PMPY by HSA Risk Adjusted
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$0
$1000
$2000
$3000
$4000
$5000
$6000
$7000
37
EffectivePreventive Care
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
HEDIS MeasureCT APCD
CommercialNCQA
National HMONCQA
National PPOAvoidance of Antibiotic Treatment in Adults with Acute Bronchitis 268 276 258Anti-Depressant Medication Management 764 664 666Well-Child Visits 798 762 723Breast Cancer Screening 671 732 696
NCQA National HMO and NCQA National PPO benchmark metrics calculated for CY2015 Several other HEDIS measures can be run using the CT APCD data set and compared against the NCQA National HMO and PPO benchmarks Examples include Comprehensive Diabetes Care ndash HbA1C Testing Comprehensive Diabetes Care ndash Medical Attention for Nephrology Comprehensive Diabetes Care ndash Eye Exam Performed Adolescent Well-Care Visits Appropriate Treatment for Children with Upper Respiratory Infection etc
38
Breast Cancer Screening
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
60
62
64
66
68
70
72
Urban Centers (n=3369) Manufacturing Centers (n=10974) Diverse Suburbs (n=12206) Mill Towns (n=16281) Rural Towns (n=16789) Wealthy Suburbs (n=12266)
39
Vermont Blueprintrsquos Hub amp Spoke Model
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
bull Vermontrsquos ldquoHealth Homerdquo program designed to treat Vermonters with chronic opioid addiction
bull Hubs ndash designated providers ndash Provide coordinated care to patients through MAT services
ndash Coordinate referral to ongoing care
bull Spokes ndash teams of healthcare professionalsndash Blueprint Advanced Practice Medical Homes
ndash Federally-Qualified Health Centers
ndash Outpatient substance abuse and primary care providers
40copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Medication Assisted Treatment
bull Vermont Blueprint baseline study comparing medication-assisted treatment (MAT) population versus non-MAT population
bull Study published in the Journal of Substance Abuse Treatment (August 2016)
41
bull The CT APCD is a comparable resource to other statewide APCDs ndash A powerful tool that will only continue to grow with usendash Encompasses a robust set of information including
expenditures procedure codes diagnosis coding drug codes and enhanced value-adds (eg claim type master membermaster provider IDsNPIs MS-DRGs etc)
bull Future considerations to enhance the CT APCDndash Add Medicare and Medicaid claims datandash Continue to strengthen the completeness and validity of data
elements of importance to downstream analytic use cases (eg member race and ethnicity codes) in data collection
Lessons Learned
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
43
Next Steps
44
01Task
02Task
Ensure data quality issues are identified documented communicated and resolved
Data Quality
Continue building breadth of payer database amp complete enclave load
Data ETL
Finalize strategy to ensure site accomplishes PA 13-247 and PA 15-146 intent
Establish Strategy
05Task
Identify leading consumer information and price transparency tools available
Consumer Tool Evaluation04Task
Tasks Until Next Meeting (11917)APCD Development and Strategy Update
Distinguish Critical Paths Across and Within Strategic Priorities and Maintain Focus on ldquoMust Havesrdquo and ldquoQuick Winsrdquo
Ensure APCD staff can generate self-service extracts at little cost with minimal lead time
Deliver First DR Extract03Task
45
Future MeetingsAPCD Development and Strategy Update
November
9Legislative Office
Building Room 1D 300 Capitol Avenue
Hartford
All Payer Claims Database Advisory GroupMeeting
900ndash1100 AM
14
ProviderFacility Directory
512k Unique National Provider Identifiers
Pharmacy Claims
All claimsencounters paid by submitting carrier
Data includes info on Administrative Enrollee Coverage Claim Detail Diagnosis Codes Procedure Codes Financials Payers Providers Safe Harbor (12)
1273M Claims $125B
Medical Claims
All claimsencounters paid by submitting carrier
Data includes info on Administrative Enrollee Coverage Claim Detail Diagnosis Codes Procedure Codes Financials Payers Providers Safe Harbor (12)
747M Claims $304B
Enrollees
CY 2012 ndash Present (n- 1 month)
Data includes info on Administrative Enrollee Coverage Enrollee Demographics Financials Payers Providers Safe Harbor (2)Fully insuredNon-ERISA plans (~900k Lives)
Whatrsquos Available Through DRAPCD Data Release Update
Billing rendering prescribing pharmacy primary care provider IDs (varying completion rate)
Data includes info on Unblended and composite provider IDs and NPIs
15
ERISALives covered under self-
insured ERISA plans
Part 2 SUD claimsSUD claims provided by
Part 2 providers
Denied ClaimsFully denied claims not
collected
Test Result ValuesLab imaging biometrics
and physician derived data
Third Party Data Risk scoring social
determinants knowledge base etc
Dental ClaimsDental claims not required
for submission
Ancillary FinancialsPlan premiums capitation payments performance
payments administrative fees
Whatrsquos Not Available Through DRAPCD Data Release Update
HIPAA Safe Harbor Variables18 HIPAA identifiers
16
18 HIPAA identifiers removed from dataset
Identifiers removed as set forth in 45 CFR 164514
De-identification
De-Identified Data ReleaseAPCD Data Release Update
Age caps applied (over 89 less than 1) amp geography reduced to 3 digit zip
All dates related to service and payments masked
First three digits of zip codes only if the geographic area covered by all zip codes beginning with those three digits has a population greater than 20000 or the zip codes for those areas are changed to 000 in the data set
Supplementary safeguards imposed to reduce unique characteristics
17
Partnerships LicensingAccessibilityValue Add DataProcess
Improvement
Identify third party data that can supplement and enrich within release requirements
Third Party DataIdentify areas of process
improvement and automation
ScalabilityEstablish enclave capability
upon needdemand
Extract v EnclaveIdentify areas of opportunity for ongoing multiple use by
institutions
Engagement
Potential Future ImprovementsAPCD Data Release Update
18
AUGUST
16SEPTEMBER
7SEPTEMBER
15SEPTEMBER
22Committee review and
vote on first data request application
from UConn
DATA RELEASE COMMITTEE MEETING
To be canceled if no additional applications
submitted
DATA RELEASE COMMITTEE MEETING
Review and confirmation of de-
identification methods and implementation
EXTRACT AUDIT
Extract delivered and support channel
opened
DATA RELEASE
Data release activities within the next two months include
Open Action ItemsAPCD Data Release Update
Project Descriptions
bull State Innovation Modelndash Online dashboard of ~30 pace and performance measures
bull Used to monitor performance of SIM bull 12 measures use APCD databull Includes yearly targets for overall Connecticut
ndash Online Scorecard Online dashboard of FQHC and Advanced Network performancebull First health care performance scorecard in CTbull Provides transparency in provider performancebull Utilizes claims based measures from common scorecard and CAHPS surveys
bull Suicide Risk Identificationndash Improves identification of patients at risk of suicide
bull Utilizes APCD claims data EHR data from 5 health care providers and mortality databull Creation of phenotypic algorithm
19
APCD Based Dashboard Measures
Health Care DeliveryPercent of adults with regular source of careChildren well-child visits for at-risk popMammograms for women gt50 last 2 yearsOptimal diabetes care- 2+ annual A1c testsED use- asthma as primary dx (per 10k)
Percent of adults with HTN taking HTN medsFollow-Up after Discharge from the Emergency Department for Mental Health or Alcohol or other Drug
Follow-Up after Hospitalization for Mental Illness
Antidepressant Medication ManagementInitiation and Engagement of Alcohol and Other Drug Dependence Treatment
Health Care Costs
Cost of inpatient care PMPY
Cost of outpatient care PMPY
httpwwwpublichealthuconnedusim_dashhtmlohriNav=7C
Scorecard MeasuresReporting Only
Coordination of Care30 day readmission
PCPs that meet Meaningful Use
Prevention
Non-recommended Cervical Cancer Screening in Adolescent Female
Well-child visits in the third fourth fifth and sixth years of life (Medicaid only)
Frequency of Ongoing Prenatal Care (FPC)
Oral Evaluation Dental Services (Medicaid only)
Acute and Chronic Care
Cardiac strss img Testing in asymptomatic low risk patients
Behavioral HealthAdult major depressive disorder (MDD) Coordination of care of patients with specific co-morbid conditions
Anti-Depressant Medication Management
Initiation and Engagement of Alcohol and Other Drug Dependence Treatment
Follow up after hospitalization for mental illness 7 amp 30 days
21
Provisional Core Measure SetCare CoordinationPlan all-cause readmissionAnnual monitoring for persistent medications (roll-up)PreventionBreast cancer screeningCervical cancer screeningChlamydia screening in womenAdolescent female immunizations HPV
Weight assessment and counseling for nutrition and physical activity for childrenadolescents
Well-child visits in the first 15 months of lifeAdolescent well-care visitsBehavioral health screening (pediatric Medicaid only custom measure)
Acute amp Chronic Care
Medication management for people w asthma
DM HbA1c Testing
DM Diabetes medical attention for nephropathy
Use of imaging studies for low back pain
Avoidance of antibiotic treatment in adults with acute bronchitis
Appr treatment for children with upper respiratory infection
Behavioral Health
Follow-up care for children prescribed ADHD medicationMetabolic Monitoring for Children and Adolescents on Antipsychotics (pediatric Medicaid only custom measure)
Suicide Risk Identification
22
23
CT APCD Data -
Preliminary Analysis
Examples amp Showcase
Title XxSubtitle Xx
Presenter TitleDate
24Proprietary and Confidential 24
Connecticut APCDPreliminary Analysis Examples amp Showcase
CT APCD Advisory Group Meeting August 10 2017
25
bull Data source CY2016 commercial data from the CT APCDbull Focus commercial population-based reportingbull Considerations risk adjustment for age gender and health statusbull Areas of exploration
ndash Multiple views of the CT APCD population total members health exchange members members with diabetes
ndash Expenditures utilization and effective and preventive care ratesndash Analysis by multiple geographic units county Hospital Service
Area (HSA) and Health Reference Group (HRG) bull Conclusion Recap and lessons learned
Presentation Overview
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
26
bull Member Any person covered in a submitterrsquos eligibility databull Average Members Member months divided by 12 (months)bull Expenditures Allowed amount bull Capping Capped outliers in the data at the 99th percentilebull Clinical Risk Groups Individualsrsquo categorized health statusbull County Administrative focus areasbull Hospital Service Area Local hospital marketsbull Health Reference Group Community types bull Rates Expenditures by average membersbull Risk Adjustment Adjusting for differences between member
populations by considering membersrsquo age gender and health status
Key Terms
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
27
Population-Based Reporting
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
bull Reporting units county modified Hospital Service Area (HSA) and Health Reference Group (HRG)
bull Risk adjustment age gender and health status (3M CRGs)
28
CT APCD Population Overview
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Measure Count
Unique Members 875129
Total Member Months 9122482
Average Members 760207
Total Expenditures $40 Billion
Total Expenditures Per Member Per Year (PMPY) $5255
Total Expenditures Per Member Per Month (PMPM) $438
Total expenditures are capped at the 99th percentile
29
Expenditures PMPY by Age amp Gender
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$0
$1000
$2000
$3000
$4000
$5000
$6000
$7000
$8000
$9000
0-18 Female 0-18 Male 18-34 Female 18-34 Male 35-44 Female 35-44 Male 45-54 Female 45-54 Male 55-64 Female 55-64 Male
30
Expenditures PMPY by CRGs
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$-
$5000
$10000
$15000
$20000
$25000
$30000
$35000
$40000
Healthy Acute or Minor Chronic Moderate Chronic Significant Chronic Cancer or Catastrophic
$0
31
CT Health Exchange Population Overview
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
MeasureExchange Members
Non-Exchange Members
Average Members 86941 673266
Percentage of Members 55-64 Years of Age 31 20
Percentage of Members with Chronic Condition(s) 23 19
Expenditures PMPY $5378 $5239
Expenditures PMPY Risk Adjusted $4780 $5316 Expenditures PMPY for Members with Diabetes Risk-Adjusted $17561 $19291
32
CT Exchange vs Non-Exchange Rates
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Rate per 1000 Rate per 1000 (Risk Adj)
Measure Exchange Members
Non-Exchange Members
Exchange Members
Non-Exchange Members
Inpatient Acute Visits 390 328 339 335Medical 210 144 181 147Surgical 140 116 115 119Maternity 41 69 41 69
Outpatient Emergency Visits 1941 1924 1944 1923MRIs 920 803 810 817CT Scans 1108 824 938 844Primary Care Office Visits 15216 18755 16068 18628Psychiatric Visits 9864 9783 9783 11092Chiropractic Visits 3403 7808 3088 7913
Utilization measures are capped at the 99th percentile
33
Expenditure PMPY Diabetes Population
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$-
$5000
$10000
$15000
$20000
$25000
$30000
No Diabetes (n=730838) Diabetes amp no comorbidity (n=16419) Diabetes with comorbidity (n=12950)$0
No Diabetes (n = 730838)
Diabetes No Comorbidity(n = 16419)
Diabetes Comorbidity(n = 12950)
34
Vermont Blueprint for HealthDiabetes HbA1c Control amp Outcomes
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Measure HbA1c in Control HbA1c Not in Control
Members 5619 786
Average annual expenditures per capita
$15726 ($15219 $16233)
$17328 ($16110 $18546)
Inpatient hospitalizations per 1000 members
1897 (1782 2011)
2531 (2177 2886)
Inpatient days per 1000 members
8685 (8440 8930)
11561 (10804 12318)
Outpatient ED visits per 1000 members
6275 (6067 6483)
8011 (7381 8642)
Risk-adjusted rates and 95 confidence intervals 99th percentile outliers excluded HbA1c not in control gt9
35
Expenditures PMPY by County
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
County Average Members Expenditures PMPYExpenditures PMPY
(Risk Adjusted)Fairfield 223295 $5182 $5539 New London 44741 $5913 $5342 New Haven 161763 $5494 $5335 Middlesex 38531 $5359 $5184 Litchfield 43224 $5136 $5118 Tolland 36304 $5047 $5019 Hartford 191415 $4998 $4958 Windham 20934 $5539 $4950
Total 760207 $5255 $5255
36
Expenditures PMPY by HSA Risk Adjusted
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$0
$1000
$2000
$3000
$4000
$5000
$6000
$7000
37
EffectivePreventive Care
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
HEDIS MeasureCT APCD
CommercialNCQA
National HMONCQA
National PPOAvoidance of Antibiotic Treatment in Adults with Acute Bronchitis 268 276 258Anti-Depressant Medication Management 764 664 666Well-Child Visits 798 762 723Breast Cancer Screening 671 732 696
NCQA National HMO and NCQA National PPO benchmark metrics calculated for CY2015 Several other HEDIS measures can be run using the CT APCD data set and compared against the NCQA National HMO and PPO benchmarks Examples include Comprehensive Diabetes Care ndash HbA1C Testing Comprehensive Diabetes Care ndash Medical Attention for Nephrology Comprehensive Diabetes Care ndash Eye Exam Performed Adolescent Well-Care Visits Appropriate Treatment for Children with Upper Respiratory Infection etc
38
Breast Cancer Screening
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
60
62
64
66
68
70
72
Urban Centers (n=3369) Manufacturing Centers (n=10974) Diverse Suburbs (n=12206) Mill Towns (n=16281) Rural Towns (n=16789) Wealthy Suburbs (n=12266)
39
Vermont Blueprintrsquos Hub amp Spoke Model
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
bull Vermontrsquos ldquoHealth Homerdquo program designed to treat Vermonters with chronic opioid addiction
bull Hubs ndash designated providers ndash Provide coordinated care to patients through MAT services
ndash Coordinate referral to ongoing care
bull Spokes ndash teams of healthcare professionalsndash Blueprint Advanced Practice Medical Homes
ndash Federally-Qualified Health Centers
ndash Outpatient substance abuse and primary care providers
40copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Medication Assisted Treatment
bull Vermont Blueprint baseline study comparing medication-assisted treatment (MAT) population versus non-MAT population
bull Study published in the Journal of Substance Abuse Treatment (August 2016)
41
bull The CT APCD is a comparable resource to other statewide APCDs ndash A powerful tool that will only continue to grow with usendash Encompasses a robust set of information including
expenditures procedure codes diagnosis coding drug codes and enhanced value-adds (eg claim type master membermaster provider IDsNPIs MS-DRGs etc)
bull Future considerations to enhance the CT APCDndash Add Medicare and Medicaid claims datandash Continue to strengthen the completeness and validity of data
elements of importance to downstream analytic use cases (eg member race and ethnicity codes) in data collection
Lessons Learned
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
43
Next Steps
44
01Task
02Task
Ensure data quality issues are identified documented communicated and resolved
Data Quality
Continue building breadth of payer database amp complete enclave load
Data ETL
Finalize strategy to ensure site accomplishes PA 13-247 and PA 15-146 intent
Establish Strategy
05Task
Identify leading consumer information and price transparency tools available
Consumer Tool Evaluation04Task
Tasks Until Next Meeting (11917)APCD Development and Strategy Update
Distinguish Critical Paths Across and Within Strategic Priorities and Maintain Focus on ldquoMust Havesrdquo and ldquoQuick Winsrdquo
Ensure APCD staff can generate self-service extracts at little cost with minimal lead time
Deliver First DR Extract03Task
45
Future MeetingsAPCD Development and Strategy Update
November
9Legislative Office
Building Room 1D 300 Capitol Avenue
Hartford
All Payer Claims Database Advisory GroupMeeting
900ndash1100 AM
15
ERISALives covered under self-
insured ERISA plans
Part 2 SUD claimsSUD claims provided by
Part 2 providers
Denied ClaimsFully denied claims not
collected
Test Result ValuesLab imaging biometrics
and physician derived data
Third Party Data Risk scoring social
determinants knowledge base etc
Dental ClaimsDental claims not required
for submission
Ancillary FinancialsPlan premiums capitation payments performance
payments administrative fees
Whatrsquos Not Available Through DRAPCD Data Release Update
HIPAA Safe Harbor Variables18 HIPAA identifiers
16
18 HIPAA identifiers removed from dataset
Identifiers removed as set forth in 45 CFR 164514
De-identification
De-Identified Data ReleaseAPCD Data Release Update
Age caps applied (over 89 less than 1) amp geography reduced to 3 digit zip
All dates related to service and payments masked
First three digits of zip codes only if the geographic area covered by all zip codes beginning with those three digits has a population greater than 20000 or the zip codes for those areas are changed to 000 in the data set
Supplementary safeguards imposed to reduce unique characteristics
17
Partnerships LicensingAccessibilityValue Add DataProcess
Improvement
Identify third party data that can supplement and enrich within release requirements
Third Party DataIdentify areas of process
improvement and automation
ScalabilityEstablish enclave capability
upon needdemand
Extract v EnclaveIdentify areas of opportunity for ongoing multiple use by
institutions
Engagement
Potential Future ImprovementsAPCD Data Release Update
18
AUGUST
16SEPTEMBER
7SEPTEMBER
15SEPTEMBER
22Committee review and
vote on first data request application
from UConn
DATA RELEASE COMMITTEE MEETING
To be canceled if no additional applications
submitted
DATA RELEASE COMMITTEE MEETING
Review and confirmation of de-
identification methods and implementation
EXTRACT AUDIT
Extract delivered and support channel
opened
DATA RELEASE
Data release activities within the next two months include
Open Action ItemsAPCD Data Release Update
Project Descriptions
bull State Innovation Modelndash Online dashboard of ~30 pace and performance measures
bull Used to monitor performance of SIM bull 12 measures use APCD databull Includes yearly targets for overall Connecticut
ndash Online Scorecard Online dashboard of FQHC and Advanced Network performancebull First health care performance scorecard in CTbull Provides transparency in provider performancebull Utilizes claims based measures from common scorecard and CAHPS surveys
bull Suicide Risk Identificationndash Improves identification of patients at risk of suicide
bull Utilizes APCD claims data EHR data from 5 health care providers and mortality databull Creation of phenotypic algorithm
19
APCD Based Dashboard Measures
Health Care DeliveryPercent of adults with regular source of careChildren well-child visits for at-risk popMammograms for women gt50 last 2 yearsOptimal diabetes care- 2+ annual A1c testsED use- asthma as primary dx (per 10k)
Percent of adults with HTN taking HTN medsFollow-Up after Discharge from the Emergency Department for Mental Health or Alcohol or other Drug
Follow-Up after Hospitalization for Mental Illness
Antidepressant Medication ManagementInitiation and Engagement of Alcohol and Other Drug Dependence Treatment
Health Care Costs
Cost of inpatient care PMPY
Cost of outpatient care PMPY
httpwwwpublichealthuconnedusim_dashhtmlohriNav=7C
Scorecard MeasuresReporting Only
Coordination of Care30 day readmission
PCPs that meet Meaningful Use
Prevention
Non-recommended Cervical Cancer Screening in Adolescent Female
Well-child visits in the third fourth fifth and sixth years of life (Medicaid only)
Frequency of Ongoing Prenatal Care (FPC)
Oral Evaluation Dental Services (Medicaid only)
Acute and Chronic Care
Cardiac strss img Testing in asymptomatic low risk patients
Behavioral HealthAdult major depressive disorder (MDD) Coordination of care of patients with specific co-morbid conditions
Anti-Depressant Medication Management
Initiation and Engagement of Alcohol and Other Drug Dependence Treatment
Follow up after hospitalization for mental illness 7 amp 30 days
21
Provisional Core Measure SetCare CoordinationPlan all-cause readmissionAnnual monitoring for persistent medications (roll-up)PreventionBreast cancer screeningCervical cancer screeningChlamydia screening in womenAdolescent female immunizations HPV
Weight assessment and counseling for nutrition and physical activity for childrenadolescents
Well-child visits in the first 15 months of lifeAdolescent well-care visitsBehavioral health screening (pediatric Medicaid only custom measure)
Acute amp Chronic Care
Medication management for people w asthma
DM HbA1c Testing
DM Diabetes medical attention for nephropathy
Use of imaging studies for low back pain
Avoidance of antibiotic treatment in adults with acute bronchitis
Appr treatment for children with upper respiratory infection
Behavioral Health
Follow-up care for children prescribed ADHD medicationMetabolic Monitoring for Children and Adolescents on Antipsychotics (pediatric Medicaid only custom measure)
Suicide Risk Identification
22
23
CT APCD Data -
Preliminary Analysis
Examples amp Showcase
Title XxSubtitle Xx
Presenter TitleDate
24Proprietary and Confidential 24
Connecticut APCDPreliminary Analysis Examples amp Showcase
CT APCD Advisory Group Meeting August 10 2017
25
bull Data source CY2016 commercial data from the CT APCDbull Focus commercial population-based reportingbull Considerations risk adjustment for age gender and health statusbull Areas of exploration
ndash Multiple views of the CT APCD population total members health exchange members members with diabetes
ndash Expenditures utilization and effective and preventive care ratesndash Analysis by multiple geographic units county Hospital Service
Area (HSA) and Health Reference Group (HRG) bull Conclusion Recap and lessons learned
Presentation Overview
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
26
bull Member Any person covered in a submitterrsquos eligibility databull Average Members Member months divided by 12 (months)bull Expenditures Allowed amount bull Capping Capped outliers in the data at the 99th percentilebull Clinical Risk Groups Individualsrsquo categorized health statusbull County Administrative focus areasbull Hospital Service Area Local hospital marketsbull Health Reference Group Community types bull Rates Expenditures by average membersbull Risk Adjustment Adjusting for differences between member
populations by considering membersrsquo age gender and health status
Key Terms
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
27
Population-Based Reporting
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
bull Reporting units county modified Hospital Service Area (HSA) and Health Reference Group (HRG)
bull Risk adjustment age gender and health status (3M CRGs)
28
CT APCD Population Overview
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Measure Count
Unique Members 875129
Total Member Months 9122482
Average Members 760207
Total Expenditures $40 Billion
Total Expenditures Per Member Per Year (PMPY) $5255
Total Expenditures Per Member Per Month (PMPM) $438
Total expenditures are capped at the 99th percentile
29
Expenditures PMPY by Age amp Gender
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$0
$1000
$2000
$3000
$4000
$5000
$6000
$7000
$8000
$9000
0-18 Female 0-18 Male 18-34 Female 18-34 Male 35-44 Female 35-44 Male 45-54 Female 45-54 Male 55-64 Female 55-64 Male
30
Expenditures PMPY by CRGs
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$-
$5000
$10000
$15000
$20000
$25000
$30000
$35000
$40000
Healthy Acute or Minor Chronic Moderate Chronic Significant Chronic Cancer or Catastrophic
$0
31
CT Health Exchange Population Overview
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
MeasureExchange Members
Non-Exchange Members
Average Members 86941 673266
Percentage of Members 55-64 Years of Age 31 20
Percentage of Members with Chronic Condition(s) 23 19
Expenditures PMPY $5378 $5239
Expenditures PMPY Risk Adjusted $4780 $5316 Expenditures PMPY for Members with Diabetes Risk-Adjusted $17561 $19291
32
CT Exchange vs Non-Exchange Rates
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Rate per 1000 Rate per 1000 (Risk Adj)
Measure Exchange Members
Non-Exchange Members
Exchange Members
Non-Exchange Members
Inpatient Acute Visits 390 328 339 335Medical 210 144 181 147Surgical 140 116 115 119Maternity 41 69 41 69
Outpatient Emergency Visits 1941 1924 1944 1923MRIs 920 803 810 817CT Scans 1108 824 938 844Primary Care Office Visits 15216 18755 16068 18628Psychiatric Visits 9864 9783 9783 11092Chiropractic Visits 3403 7808 3088 7913
Utilization measures are capped at the 99th percentile
33
Expenditure PMPY Diabetes Population
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$-
$5000
$10000
$15000
$20000
$25000
$30000
No Diabetes (n=730838) Diabetes amp no comorbidity (n=16419) Diabetes with comorbidity (n=12950)$0
No Diabetes (n = 730838)
Diabetes No Comorbidity(n = 16419)
Diabetes Comorbidity(n = 12950)
34
Vermont Blueprint for HealthDiabetes HbA1c Control amp Outcomes
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Measure HbA1c in Control HbA1c Not in Control
Members 5619 786
Average annual expenditures per capita
$15726 ($15219 $16233)
$17328 ($16110 $18546)
Inpatient hospitalizations per 1000 members
1897 (1782 2011)
2531 (2177 2886)
Inpatient days per 1000 members
8685 (8440 8930)
11561 (10804 12318)
Outpatient ED visits per 1000 members
6275 (6067 6483)
8011 (7381 8642)
Risk-adjusted rates and 95 confidence intervals 99th percentile outliers excluded HbA1c not in control gt9
35
Expenditures PMPY by County
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
County Average Members Expenditures PMPYExpenditures PMPY
(Risk Adjusted)Fairfield 223295 $5182 $5539 New London 44741 $5913 $5342 New Haven 161763 $5494 $5335 Middlesex 38531 $5359 $5184 Litchfield 43224 $5136 $5118 Tolland 36304 $5047 $5019 Hartford 191415 $4998 $4958 Windham 20934 $5539 $4950
Total 760207 $5255 $5255
36
Expenditures PMPY by HSA Risk Adjusted
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$0
$1000
$2000
$3000
$4000
$5000
$6000
$7000
37
EffectivePreventive Care
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
HEDIS MeasureCT APCD
CommercialNCQA
National HMONCQA
National PPOAvoidance of Antibiotic Treatment in Adults with Acute Bronchitis 268 276 258Anti-Depressant Medication Management 764 664 666Well-Child Visits 798 762 723Breast Cancer Screening 671 732 696
NCQA National HMO and NCQA National PPO benchmark metrics calculated for CY2015 Several other HEDIS measures can be run using the CT APCD data set and compared against the NCQA National HMO and PPO benchmarks Examples include Comprehensive Diabetes Care ndash HbA1C Testing Comprehensive Diabetes Care ndash Medical Attention for Nephrology Comprehensive Diabetes Care ndash Eye Exam Performed Adolescent Well-Care Visits Appropriate Treatment for Children with Upper Respiratory Infection etc
38
Breast Cancer Screening
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
60
62
64
66
68
70
72
Urban Centers (n=3369) Manufacturing Centers (n=10974) Diverse Suburbs (n=12206) Mill Towns (n=16281) Rural Towns (n=16789) Wealthy Suburbs (n=12266)
39
Vermont Blueprintrsquos Hub amp Spoke Model
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
bull Vermontrsquos ldquoHealth Homerdquo program designed to treat Vermonters with chronic opioid addiction
bull Hubs ndash designated providers ndash Provide coordinated care to patients through MAT services
ndash Coordinate referral to ongoing care
bull Spokes ndash teams of healthcare professionalsndash Blueprint Advanced Practice Medical Homes
ndash Federally-Qualified Health Centers
ndash Outpatient substance abuse and primary care providers
40copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Medication Assisted Treatment
bull Vermont Blueprint baseline study comparing medication-assisted treatment (MAT) population versus non-MAT population
bull Study published in the Journal of Substance Abuse Treatment (August 2016)
41
bull The CT APCD is a comparable resource to other statewide APCDs ndash A powerful tool that will only continue to grow with usendash Encompasses a robust set of information including
expenditures procedure codes diagnosis coding drug codes and enhanced value-adds (eg claim type master membermaster provider IDsNPIs MS-DRGs etc)
bull Future considerations to enhance the CT APCDndash Add Medicare and Medicaid claims datandash Continue to strengthen the completeness and validity of data
elements of importance to downstream analytic use cases (eg member race and ethnicity codes) in data collection
Lessons Learned
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
43
Next Steps
44
01Task
02Task
Ensure data quality issues are identified documented communicated and resolved
Data Quality
Continue building breadth of payer database amp complete enclave load
Data ETL
Finalize strategy to ensure site accomplishes PA 13-247 and PA 15-146 intent
Establish Strategy
05Task
Identify leading consumer information and price transparency tools available
Consumer Tool Evaluation04Task
Tasks Until Next Meeting (11917)APCD Development and Strategy Update
Distinguish Critical Paths Across and Within Strategic Priorities and Maintain Focus on ldquoMust Havesrdquo and ldquoQuick Winsrdquo
Ensure APCD staff can generate self-service extracts at little cost with minimal lead time
Deliver First DR Extract03Task
45
Future MeetingsAPCD Development and Strategy Update
November
9Legislative Office
Building Room 1D 300 Capitol Avenue
Hartford
All Payer Claims Database Advisory GroupMeeting
900ndash1100 AM
16
18 HIPAA identifiers removed from dataset
Identifiers removed as set forth in 45 CFR 164514
De-identification
De-Identified Data ReleaseAPCD Data Release Update
Age caps applied (over 89 less than 1) amp geography reduced to 3 digit zip
All dates related to service and payments masked
First three digits of zip codes only if the geographic area covered by all zip codes beginning with those three digits has a population greater than 20000 or the zip codes for those areas are changed to 000 in the data set
Supplementary safeguards imposed to reduce unique characteristics
17
Partnerships LicensingAccessibilityValue Add DataProcess
Improvement
Identify third party data that can supplement and enrich within release requirements
Third Party DataIdentify areas of process
improvement and automation
ScalabilityEstablish enclave capability
upon needdemand
Extract v EnclaveIdentify areas of opportunity for ongoing multiple use by
institutions
Engagement
Potential Future ImprovementsAPCD Data Release Update
18
AUGUST
16SEPTEMBER
7SEPTEMBER
15SEPTEMBER
22Committee review and
vote on first data request application
from UConn
DATA RELEASE COMMITTEE MEETING
To be canceled if no additional applications
submitted
DATA RELEASE COMMITTEE MEETING
Review and confirmation of de-
identification methods and implementation
EXTRACT AUDIT
Extract delivered and support channel
opened
DATA RELEASE
Data release activities within the next two months include
Open Action ItemsAPCD Data Release Update
Project Descriptions
bull State Innovation Modelndash Online dashboard of ~30 pace and performance measures
bull Used to monitor performance of SIM bull 12 measures use APCD databull Includes yearly targets for overall Connecticut
ndash Online Scorecard Online dashboard of FQHC and Advanced Network performancebull First health care performance scorecard in CTbull Provides transparency in provider performancebull Utilizes claims based measures from common scorecard and CAHPS surveys
bull Suicide Risk Identificationndash Improves identification of patients at risk of suicide
bull Utilizes APCD claims data EHR data from 5 health care providers and mortality databull Creation of phenotypic algorithm
19
APCD Based Dashboard Measures
Health Care DeliveryPercent of adults with regular source of careChildren well-child visits for at-risk popMammograms for women gt50 last 2 yearsOptimal diabetes care- 2+ annual A1c testsED use- asthma as primary dx (per 10k)
Percent of adults with HTN taking HTN medsFollow-Up after Discharge from the Emergency Department for Mental Health or Alcohol or other Drug
Follow-Up after Hospitalization for Mental Illness
Antidepressant Medication ManagementInitiation and Engagement of Alcohol and Other Drug Dependence Treatment
Health Care Costs
Cost of inpatient care PMPY
Cost of outpatient care PMPY
httpwwwpublichealthuconnedusim_dashhtmlohriNav=7C
Scorecard MeasuresReporting Only
Coordination of Care30 day readmission
PCPs that meet Meaningful Use
Prevention
Non-recommended Cervical Cancer Screening in Adolescent Female
Well-child visits in the third fourth fifth and sixth years of life (Medicaid only)
Frequency of Ongoing Prenatal Care (FPC)
Oral Evaluation Dental Services (Medicaid only)
Acute and Chronic Care
Cardiac strss img Testing in asymptomatic low risk patients
Behavioral HealthAdult major depressive disorder (MDD) Coordination of care of patients with specific co-morbid conditions
Anti-Depressant Medication Management
Initiation and Engagement of Alcohol and Other Drug Dependence Treatment
Follow up after hospitalization for mental illness 7 amp 30 days
21
Provisional Core Measure SetCare CoordinationPlan all-cause readmissionAnnual monitoring for persistent medications (roll-up)PreventionBreast cancer screeningCervical cancer screeningChlamydia screening in womenAdolescent female immunizations HPV
Weight assessment and counseling for nutrition and physical activity for childrenadolescents
Well-child visits in the first 15 months of lifeAdolescent well-care visitsBehavioral health screening (pediatric Medicaid only custom measure)
Acute amp Chronic Care
Medication management for people w asthma
DM HbA1c Testing
DM Diabetes medical attention for nephropathy
Use of imaging studies for low back pain
Avoidance of antibiotic treatment in adults with acute bronchitis
Appr treatment for children with upper respiratory infection
Behavioral Health
Follow-up care for children prescribed ADHD medicationMetabolic Monitoring for Children and Adolescents on Antipsychotics (pediatric Medicaid only custom measure)
Suicide Risk Identification
22
23
CT APCD Data -
Preliminary Analysis
Examples amp Showcase
Title XxSubtitle Xx
Presenter TitleDate
24Proprietary and Confidential 24
Connecticut APCDPreliminary Analysis Examples amp Showcase
CT APCD Advisory Group Meeting August 10 2017
25
bull Data source CY2016 commercial data from the CT APCDbull Focus commercial population-based reportingbull Considerations risk adjustment for age gender and health statusbull Areas of exploration
ndash Multiple views of the CT APCD population total members health exchange members members with diabetes
ndash Expenditures utilization and effective and preventive care ratesndash Analysis by multiple geographic units county Hospital Service
Area (HSA) and Health Reference Group (HRG) bull Conclusion Recap and lessons learned
Presentation Overview
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
26
bull Member Any person covered in a submitterrsquos eligibility databull Average Members Member months divided by 12 (months)bull Expenditures Allowed amount bull Capping Capped outliers in the data at the 99th percentilebull Clinical Risk Groups Individualsrsquo categorized health statusbull County Administrative focus areasbull Hospital Service Area Local hospital marketsbull Health Reference Group Community types bull Rates Expenditures by average membersbull Risk Adjustment Adjusting for differences between member
populations by considering membersrsquo age gender and health status
Key Terms
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
27
Population-Based Reporting
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
bull Reporting units county modified Hospital Service Area (HSA) and Health Reference Group (HRG)
bull Risk adjustment age gender and health status (3M CRGs)
28
CT APCD Population Overview
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Measure Count
Unique Members 875129
Total Member Months 9122482
Average Members 760207
Total Expenditures $40 Billion
Total Expenditures Per Member Per Year (PMPY) $5255
Total Expenditures Per Member Per Month (PMPM) $438
Total expenditures are capped at the 99th percentile
29
Expenditures PMPY by Age amp Gender
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$0
$1000
$2000
$3000
$4000
$5000
$6000
$7000
$8000
$9000
0-18 Female 0-18 Male 18-34 Female 18-34 Male 35-44 Female 35-44 Male 45-54 Female 45-54 Male 55-64 Female 55-64 Male
30
Expenditures PMPY by CRGs
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$-
$5000
$10000
$15000
$20000
$25000
$30000
$35000
$40000
Healthy Acute or Minor Chronic Moderate Chronic Significant Chronic Cancer or Catastrophic
$0
31
CT Health Exchange Population Overview
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
MeasureExchange Members
Non-Exchange Members
Average Members 86941 673266
Percentage of Members 55-64 Years of Age 31 20
Percentage of Members with Chronic Condition(s) 23 19
Expenditures PMPY $5378 $5239
Expenditures PMPY Risk Adjusted $4780 $5316 Expenditures PMPY for Members with Diabetes Risk-Adjusted $17561 $19291
32
CT Exchange vs Non-Exchange Rates
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Rate per 1000 Rate per 1000 (Risk Adj)
Measure Exchange Members
Non-Exchange Members
Exchange Members
Non-Exchange Members
Inpatient Acute Visits 390 328 339 335Medical 210 144 181 147Surgical 140 116 115 119Maternity 41 69 41 69
Outpatient Emergency Visits 1941 1924 1944 1923MRIs 920 803 810 817CT Scans 1108 824 938 844Primary Care Office Visits 15216 18755 16068 18628Psychiatric Visits 9864 9783 9783 11092Chiropractic Visits 3403 7808 3088 7913
Utilization measures are capped at the 99th percentile
33
Expenditure PMPY Diabetes Population
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$-
$5000
$10000
$15000
$20000
$25000
$30000
No Diabetes (n=730838) Diabetes amp no comorbidity (n=16419) Diabetes with comorbidity (n=12950)$0
No Diabetes (n = 730838)
Diabetes No Comorbidity(n = 16419)
Diabetes Comorbidity(n = 12950)
34
Vermont Blueprint for HealthDiabetes HbA1c Control amp Outcomes
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Measure HbA1c in Control HbA1c Not in Control
Members 5619 786
Average annual expenditures per capita
$15726 ($15219 $16233)
$17328 ($16110 $18546)
Inpatient hospitalizations per 1000 members
1897 (1782 2011)
2531 (2177 2886)
Inpatient days per 1000 members
8685 (8440 8930)
11561 (10804 12318)
Outpatient ED visits per 1000 members
6275 (6067 6483)
8011 (7381 8642)
Risk-adjusted rates and 95 confidence intervals 99th percentile outliers excluded HbA1c not in control gt9
35
Expenditures PMPY by County
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
County Average Members Expenditures PMPYExpenditures PMPY
(Risk Adjusted)Fairfield 223295 $5182 $5539 New London 44741 $5913 $5342 New Haven 161763 $5494 $5335 Middlesex 38531 $5359 $5184 Litchfield 43224 $5136 $5118 Tolland 36304 $5047 $5019 Hartford 191415 $4998 $4958 Windham 20934 $5539 $4950
Total 760207 $5255 $5255
36
Expenditures PMPY by HSA Risk Adjusted
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$0
$1000
$2000
$3000
$4000
$5000
$6000
$7000
37
EffectivePreventive Care
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
HEDIS MeasureCT APCD
CommercialNCQA
National HMONCQA
National PPOAvoidance of Antibiotic Treatment in Adults with Acute Bronchitis 268 276 258Anti-Depressant Medication Management 764 664 666Well-Child Visits 798 762 723Breast Cancer Screening 671 732 696
NCQA National HMO and NCQA National PPO benchmark metrics calculated for CY2015 Several other HEDIS measures can be run using the CT APCD data set and compared against the NCQA National HMO and PPO benchmarks Examples include Comprehensive Diabetes Care ndash HbA1C Testing Comprehensive Diabetes Care ndash Medical Attention for Nephrology Comprehensive Diabetes Care ndash Eye Exam Performed Adolescent Well-Care Visits Appropriate Treatment for Children with Upper Respiratory Infection etc
38
Breast Cancer Screening
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
60
62
64
66
68
70
72
Urban Centers (n=3369) Manufacturing Centers (n=10974) Diverse Suburbs (n=12206) Mill Towns (n=16281) Rural Towns (n=16789) Wealthy Suburbs (n=12266)
39
Vermont Blueprintrsquos Hub amp Spoke Model
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
bull Vermontrsquos ldquoHealth Homerdquo program designed to treat Vermonters with chronic opioid addiction
bull Hubs ndash designated providers ndash Provide coordinated care to patients through MAT services
ndash Coordinate referral to ongoing care
bull Spokes ndash teams of healthcare professionalsndash Blueprint Advanced Practice Medical Homes
ndash Federally-Qualified Health Centers
ndash Outpatient substance abuse and primary care providers
40copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Medication Assisted Treatment
bull Vermont Blueprint baseline study comparing medication-assisted treatment (MAT) population versus non-MAT population
bull Study published in the Journal of Substance Abuse Treatment (August 2016)
41
bull The CT APCD is a comparable resource to other statewide APCDs ndash A powerful tool that will only continue to grow with usendash Encompasses a robust set of information including
expenditures procedure codes diagnosis coding drug codes and enhanced value-adds (eg claim type master membermaster provider IDsNPIs MS-DRGs etc)
bull Future considerations to enhance the CT APCDndash Add Medicare and Medicaid claims datandash Continue to strengthen the completeness and validity of data
elements of importance to downstream analytic use cases (eg member race and ethnicity codes) in data collection
Lessons Learned
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
43
Next Steps
44
01Task
02Task
Ensure data quality issues are identified documented communicated and resolved
Data Quality
Continue building breadth of payer database amp complete enclave load
Data ETL
Finalize strategy to ensure site accomplishes PA 13-247 and PA 15-146 intent
Establish Strategy
05Task
Identify leading consumer information and price transparency tools available
Consumer Tool Evaluation04Task
Tasks Until Next Meeting (11917)APCD Development and Strategy Update
Distinguish Critical Paths Across and Within Strategic Priorities and Maintain Focus on ldquoMust Havesrdquo and ldquoQuick Winsrdquo
Ensure APCD staff can generate self-service extracts at little cost with minimal lead time
Deliver First DR Extract03Task
45
Future MeetingsAPCD Development and Strategy Update
November
9Legislative Office
Building Room 1D 300 Capitol Avenue
Hartford
All Payer Claims Database Advisory GroupMeeting
900ndash1100 AM
17
Partnerships LicensingAccessibilityValue Add DataProcess
Improvement
Identify third party data that can supplement and enrich within release requirements
Third Party DataIdentify areas of process
improvement and automation
ScalabilityEstablish enclave capability
upon needdemand
Extract v EnclaveIdentify areas of opportunity for ongoing multiple use by
institutions
Engagement
Potential Future ImprovementsAPCD Data Release Update
18
AUGUST
16SEPTEMBER
7SEPTEMBER
15SEPTEMBER
22Committee review and
vote on first data request application
from UConn
DATA RELEASE COMMITTEE MEETING
To be canceled if no additional applications
submitted
DATA RELEASE COMMITTEE MEETING
Review and confirmation of de-
identification methods and implementation
EXTRACT AUDIT
Extract delivered and support channel
opened
DATA RELEASE
Data release activities within the next two months include
Open Action ItemsAPCD Data Release Update
Project Descriptions
bull State Innovation Modelndash Online dashboard of ~30 pace and performance measures
bull Used to monitor performance of SIM bull 12 measures use APCD databull Includes yearly targets for overall Connecticut
ndash Online Scorecard Online dashboard of FQHC and Advanced Network performancebull First health care performance scorecard in CTbull Provides transparency in provider performancebull Utilizes claims based measures from common scorecard and CAHPS surveys
bull Suicide Risk Identificationndash Improves identification of patients at risk of suicide
bull Utilizes APCD claims data EHR data from 5 health care providers and mortality databull Creation of phenotypic algorithm
19
APCD Based Dashboard Measures
Health Care DeliveryPercent of adults with regular source of careChildren well-child visits for at-risk popMammograms for women gt50 last 2 yearsOptimal diabetes care- 2+ annual A1c testsED use- asthma as primary dx (per 10k)
Percent of adults with HTN taking HTN medsFollow-Up after Discharge from the Emergency Department for Mental Health or Alcohol or other Drug
Follow-Up after Hospitalization for Mental Illness
Antidepressant Medication ManagementInitiation and Engagement of Alcohol and Other Drug Dependence Treatment
Health Care Costs
Cost of inpatient care PMPY
Cost of outpatient care PMPY
httpwwwpublichealthuconnedusim_dashhtmlohriNav=7C
Scorecard MeasuresReporting Only
Coordination of Care30 day readmission
PCPs that meet Meaningful Use
Prevention
Non-recommended Cervical Cancer Screening in Adolescent Female
Well-child visits in the third fourth fifth and sixth years of life (Medicaid only)
Frequency of Ongoing Prenatal Care (FPC)
Oral Evaluation Dental Services (Medicaid only)
Acute and Chronic Care
Cardiac strss img Testing in asymptomatic low risk patients
Behavioral HealthAdult major depressive disorder (MDD) Coordination of care of patients with specific co-morbid conditions
Anti-Depressant Medication Management
Initiation and Engagement of Alcohol and Other Drug Dependence Treatment
Follow up after hospitalization for mental illness 7 amp 30 days
21
Provisional Core Measure SetCare CoordinationPlan all-cause readmissionAnnual monitoring for persistent medications (roll-up)PreventionBreast cancer screeningCervical cancer screeningChlamydia screening in womenAdolescent female immunizations HPV
Weight assessment and counseling for nutrition and physical activity for childrenadolescents
Well-child visits in the first 15 months of lifeAdolescent well-care visitsBehavioral health screening (pediatric Medicaid only custom measure)
Acute amp Chronic Care
Medication management for people w asthma
DM HbA1c Testing
DM Diabetes medical attention for nephropathy
Use of imaging studies for low back pain
Avoidance of antibiotic treatment in adults with acute bronchitis
Appr treatment for children with upper respiratory infection
Behavioral Health
Follow-up care for children prescribed ADHD medicationMetabolic Monitoring for Children and Adolescents on Antipsychotics (pediatric Medicaid only custom measure)
Suicide Risk Identification
22
23
CT APCD Data -
Preliminary Analysis
Examples amp Showcase
Title XxSubtitle Xx
Presenter TitleDate
24Proprietary and Confidential 24
Connecticut APCDPreliminary Analysis Examples amp Showcase
CT APCD Advisory Group Meeting August 10 2017
25
bull Data source CY2016 commercial data from the CT APCDbull Focus commercial population-based reportingbull Considerations risk adjustment for age gender and health statusbull Areas of exploration
ndash Multiple views of the CT APCD population total members health exchange members members with diabetes
ndash Expenditures utilization and effective and preventive care ratesndash Analysis by multiple geographic units county Hospital Service
Area (HSA) and Health Reference Group (HRG) bull Conclusion Recap and lessons learned
Presentation Overview
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
26
bull Member Any person covered in a submitterrsquos eligibility databull Average Members Member months divided by 12 (months)bull Expenditures Allowed amount bull Capping Capped outliers in the data at the 99th percentilebull Clinical Risk Groups Individualsrsquo categorized health statusbull County Administrative focus areasbull Hospital Service Area Local hospital marketsbull Health Reference Group Community types bull Rates Expenditures by average membersbull Risk Adjustment Adjusting for differences between member
populations by considering membersrsquo age gender and health status
Key Terms
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
27
Population-Based Reporting
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
bull Reporting units county modified Hospital Service Area (HSA) and Health Reference Group (HRG)
bull Risk adjustment age gender and health status (3M CRGs)
28
CT APCD Population Overview
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Measure Count
Unique Members 875129
Total Member Months 9122482
Average Members 760207
Total Expenditures $40 Billion
Total Expenditures Per Member Per Year (PMPY) $5255
Total Expenditures Per Member Per Month (PMPM) $438
Total expenditures are capped at the 99th percentile
29
Expenditures PMPY by Age amp Gender
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$0
$1000
$2000
$3000
$4000
$5000
$6000
$7000
$8000
$9000
0-18 Female 0-18 Male 18-34 Female 18-34 Male 35-44 Female 35-44 Male 45-54 Female 45-54 Male 55-64 Female 55-64 Male
30
Expenditures PMPY by CRGs
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$-
$5000
$10000
$15000
$20000
$25000
$30000
$35000
$40000
Healthy Acute or Minor Chronic Moderate Chronic Significant Chronic Cancer or Catastrophic
$0
31
CT Health Exchange Population Overview
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
MeasureExchange Members
Non-Exchange Members
Average Members 86941 673266
Percentage of Members 55-64 Years of Age 31 20
Percentage of Members with Chronic Condition(s) 23 19
Expenditures PMPY $5378 $5239
Expenditures PMPY Risk Adjusted $4780 $5316 Expenditures PMPY for Members with Diabetes Risk-Adjusted $17561 $19291
32
CT Exchange vs Non-Exchange Rates
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Rate per 1000 Rate per 1000 (Risk Adj)
Measure Exchange Members
Non-Exchange Members
Exchange Members
Non-Exchange Members
Inpatient Acute Visits 390 328 339 335Medical 210 144 181 147Surgical 140 116 115 119Maternity 41 69 41 69
Outpatient Emergency Visits 1941 1924 1944 1923MRIs 920 803 810 817CT Scans 1108 824 938 844Primary Care Office Visits 15216 18755 16068 18628Psychiatric Visits 9864 9783 9783 11092Chiropractic Visits 3403 7808 3088 7913
Utilization measures are capped at the 99th percentile
33
Expenditure PMPY Diabetes Population
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$-
$5000
$10000
$15000
$20000
$25000
$30000
No Diabetes (n=730838) Diabetes amp no comorbidity (n=16419) Diabetes with comorbidity (n=12950)$0
No Diabetes (n = 730838)
Diabetes No Comorbidity(n = 16419)
Diabetes Comorbidity(n = 12950)
34
Vermont Blueprint for HealthDiabetes HbA1c Control amp Outcomes
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Measure HbA1c in Control HbA1c Not in Control
Members 5619 786
Average annual expenditures per capita
$15726 ($15219 $16233)
$17328 ($16110 $18546)
Inpatient hospitalizations per 1000 members
1897 (1782 2011)
2531 (2177 2886)
Inpatient days per 1000 members
8685 (8440 8930)
11561 (10804 12318)
Outpatient ED visits per 1000 members
6275 (6067 6483)
8011 (7381 8642)
Risk-adjusted rates and 95 confidence intervals 99th percentile outliers excluded HbA1c not in control gt9
35
Expenditures PMPY by County
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
County Average Members Expenditures PMPYExpenditures PMPY
(Risk Adjusted)Fairfield 223295 $5182 $5539 New London 44741 $5913 $5342 New Haven 161763 $5494 $5335 Middlesex 38531 $5359 $5184 Litchfield 43224 $5136 $5118 Tolland 36304 $5047 $5019 Hartford 191415 $4998 $4958 Windham 20934 $5539 $4950
Total 760207 $5255 $5255
36
Expenditures PMPY by HSA Risk Adjusted
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$0
$1000
$2000
$3000
$4000
$5000
$6000
$7000
37
EffectivePreventive Care
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
HEDIS MeasureCT APCD
CommercialNCQA
National HMONCQA
National PPOAvoidance of Antibiotic Treatment in Adults with Acute Bronchitis 268 276 258Anti-Depressant Medication Management 764 664 666Well-Child Visits 798 762 723Breast Cancer Screening 671 732 696
NCQA National HMO and NCQA National PPO benchmark metrics calculated for CY2015 Several other HEDIS measures can be run using the CT APCD data set and compared against the NCQA National HMO and PPO benchmarks Examples include Comprehensive Diabetes Care ndash HbA1C Testing Comprehensive Diabetes Care ndash Medical Attention for Nephrology Comprehensive Diabetes Care ndash Eye Exam Performed Adolescent Well-Care Visits Appropriate Treatment for Children with Upper Respiratory Infection etc
38
Breast Cancer Screening
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
60
62
64
66
68
70
72
Urban Centers (n=3369) Manufacturing Centers (n=10974) Diverse Suburbs (n=12206) Mill Towns (n=16281) Rural Towns (n=16789) Wealthy Suburbs (n=12266)
39
Vermont Blueprintrsquos Hub amp Spoke Model
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
bull Vermontrsquos ldquoHealth Homerdquo program designed to treat Vermonters with chronic opioid addiction
bull Hubs ndash designated providers ndash Provide coordinated care to patients through MAT services
ndash Coordinate referral to ongoing care
bull Spokes ndash teams of healthcare professionalsndash Blueprint Advanced Practice Medical Homes
ndash Federally-Qualified Health Centers
ndash Outpatient substance abuse and primary care providers
40copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Medication Assisted Treatment
bull Vermont Blueprint baseline study comparing medication-assisted treatment (MAT) population versus non-MAT population
bull Study published in the Journal of Substance Abuse Treatment (August 2016)
41
bull The CT APCD is a comparable resource to other statewide APCDs ndash A powerful tool that will only continue to grow with usendash Encompasses a robust set of information including
expenditures procedure codes diagnosis coding drug codes and enhanced value-adds (eg claim type master membermaster provider IDsNPIs MS-DRGs etc)
bull Future considerations to enhance the CT APCDndash Add Medicare and Medicaid claims datandash Continue to strengthen the completeness and validity of data
elements of importance to downstream analytic use cases (eg member race and ethnicity codes) in data collection
Lessons Learned
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
43
Next Steps
44
01Task
02Task
Ensure data quality issues are identified documented communicated and resolved
Data Quality
Continue building breadth of payer database amp complete enclave load
Data ETL
Finalize strategy to ensure site accomplishes PA 13-247 and PA 15-146 intent
Establish Strategy
05Task
Identify leading consumer information and price transparency tools available
Consumer Tool Evaluation04Task
Tasks Until Next Meeting (11917)APCD Development and Strategy Update
Distinguish Critical Paths Across and Within Strategic Priorities and Maintain Focus on ldquoMust Havesrdquo and ldquoQuick Winsrdquo
Ensure APCD staff can generate self-service extracts at little cost with minimal lead time
Deliver First DR Extract03Task
45
Future MeetingsAPCD Development and Strategy Update
November
9Legislative Office
Building Room 1D 300 Capitol Avenue
Hartford
All Payer Claims Database Advisory GroupMeeting
900ndash1100 AM
18
AUGUST
16SEPTEMBER
7SEPTEMBER
15SEPTEMBER
22Committee review and
vote on first data request application
from UConn
DATA RELEASE COMMITTEE MEETING
To be canceled if no additional applications
submitted
DATA RELEASE COMMITTEE MEETING
Review and confirmation of de-
identification methods and implementation
EXTRACT AUDIT
Extract delivered and support channel
opened
DATA RELEASE
Data release activities within the next two months include
Open Action ItemsAPCD Data Release Update
Project Descriptions
bull State Innovation Modelndash Online dashboard of ~30 pace and performance measures
bull Used to monitor performance of SIM bull 12 measures use APCD databull Includes yearly targets for overall Connecticut
ndash Online Scorecard Online dashboard of FQHC and Advanced Network performancebull First health care performance scorecard in CTbull Provides transparency in provider performancebull Utilizes claims based measures from common scorecard and CAHPS surveys
bull Suicide Risk Identificationndash Improves identification of patients at risk of suicide
bull Utilizes APCD claims data EHR data from 5 health care providers and mortality databull Creation of phenotypic algorithm
19
APCD Based Dashboard Measures
Health Care DeliveryPercent of adults with regular source of careChildren well-child visits for at-risk popMammograms for women gt50 last 2 yearsOptimal diabetes care- 2+ annual A1c testsED use- asthma as primary dx (per 10k)
Percent of adults with HTN taking HTN medsFollow-Up after Discharge from the Emergency Department for Mental Health or Alcohol or other Drug
Follow-Up after Hospitalization for Mental Illness
Antidepressant Medication ManagementInitiation and Engagement of Alcohol and Other Drug Dependence Treatment
Health Care Costs
Cost of inpatient care PMPY
Cost of outpatient care PMPY
httpwwwpublichealthuconnedusim_dashhtmlohriNav=7C
Scorecard MeasuresReporting Only
Coordination of Care30 day readmission
PCPs that meet Meaningful Use
Prevention
Non-recommended Cervical Cancer Screening in Adolescent Female
Well-child visits in the third fourth fifth and sixth years of life (Medicaid only)
Frequency of Ongoing Prenatal Care (FPC)
Oral Evaluation Dental Services (Medicaid only)
Acute and Chronic Care
Cardiac strss img Testing in asymptomatic low risk patients
Behavioral HealthAdult major depressive disorder (MDD) Coordination of care of patients with specific co-morbid conditions
Anti-Depressant Medication Management
Initiation and Engagement of Alcohol and Other Drug Dependence Treatment
Follow up after hospitalization for mental illness 7 amp 30 days
21
Provisional Core Measure SetCare CoordinationPlan all-cause readmissionAnnual monitoring for persistent medications (roll-up)PreventionBreast cancer screeningCervical cancer screeningChlamydia screening in womenAdolescent female immunizations HPV
Weight assessment and counseling for nutrition and physical activity for childrenadolescents
Well-child visits in the first 15 months of lifeAdolescent well-care visitsBehavioral health screening (pediatric Medicaid only custom measure)
Acute amp Chronic Care
Medication management for people w asthma
DM HbA1c Testing
DM Diabetes medical attention for nephropathy
Use of imaging studies for low back pain
Avoidance of antibiotic treatment in adults with acute bronchitis
Appr treatment for children with upper respiratory infection
Behavioral Health
Follow-up care for children prescribed ADHD medicationMetabolic Monitoring for Children and Adolescents on Antipsychotics (pediatric Medicaid only custom measure)
Suicide Risk Identification
22
23
CT APCD Data -
Preliminary Analysis
Examples amp Showcase
Title XxSubtitle Xx
Presenter TitleDate
24Proprietary and Confidential 24
Connecticut APCDPreliminary Analysis Examples amp Showcase
CT APCD Advisory Group Meeting August 10 2017
25
bull Data source CY2016 commercial data from the CT APCDbull Focus commercial population-based reportingbull Considerations risk adjustment for age gender and health statusbull Areas of exploration
ndash Multiple views of the CT APCD population total members health exchange members members with diabetes
ndash Expenditures utilization and effective and preventive care ratesndash Analysis by multiple geographic units county Hospital Service
Area (HSA) and Health Reference Group (HRG) bull Conclusion Recap and lessons learned
Presentation Overview
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
26
bull Member Any person covered in a submitterrsquos eligibility databull Average Members Member months divided by 12 (months)bull Expenditures Allowed amount bull Capping Capped outliers in the data at the 99th percentilebull Clinical Risk Groups Individualsrsquo categorized health statusbull County Administrative focus areasbull Hospital Service Area Local hospital marketsbull Health Reference Group Community types bull Rates Expenditures by average membersbull Risk Adjustment Adjusting for differences between member
populations by considering membersrsquo age gender and health status
Key Terms
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
27
Population-Based Reporting
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
bull Reporting units county modified Hospital Service Area (HSA) and Health Reference Group (HRG)
bull Risk adjustment age gender and health status (3M CRGs)
28
CT APCD Population Overview
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Measure Count
Unique Members 875129
Total Member Months 9122482
Average Members 760207
Total Expenditures $40 Billion
Total Expenditures Per Member Per Year (PMPY) $5255
Total Expenditures Per Member Per Month (PMPM) $438
Total expenditures are capped at the 99th percentile
29
Expenditures PMPY by Age amp Gender
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$0
$1000
$2000
$3000
$4000
$5000
$6000
$7000
$8000
$9000
0-18 Female 0-18 Male 18-34 Female 18-34 Male 35-44 Female 35-44 Male 45-54 Female 45-54 Male 55-64 Female 55-64 Male
30
Expenditures PMPY by CRGs
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$-
$5000
$10000
$15000
$20000
$25000
$30000
$35000
$40000
Healthy Acute or Minor Chronic Moderate Chronic Significant Chronic Cancer or Catastrophic
$0
31
CT Health Exchange Population Overview
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
MeasureExchange Members
Non-Exchange Members
Average Members 86941 673266
Percentage of Members 55-64 Years of Age 31 20
Percentage of Members with Chronic Condition(s) 23 19
Expenditures PMPY $5378 $5239
Expenditures PMPY Risk Adjusted $4780 $5316 Expenditures PMPY for Members with Diabetes Risk-Adjusted $17561 $19291
32
CT Exchange vs Non-Exchange Rates
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Rate per 1000 Rate per 1000 (Risk Adj)
Measure Exchange Members
Non-Exchange Members
Exchange Members
Non-Exchange Members
Inpatient Acute Visits 390 328 339 335Medical 210 144 181 147Surgical 140 116 115 119Maternity 41 69 41 69
Outpatient Emergency Visits 1941 1924 1944 1923MRIs 920 803 810 817CT Scans 1108 824 938 844Primary Care Office Visits 15216 18755 16068 18628Psychiatric Visits 9864 9783 9783 11092Chiropractic Visits 3403 7808 3088 7913
Utilization measures are capped at the 99th percentile
33
Expenditure PMPY Diabetes Population
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$-
$5000
$10000
$15000
$20000
$25000
$30000
No Diabetes (n=730838) Diabetes amp no comorbidity (n=16419) Diabetes with comorbidity (n=12950)$0
No Diabetes (n = 730838)
Diabetes No Comorbidity(n = 16419)
Diabetes Comorbidity(n = 12950)
34
Vermont Blueprint for HealthDiabetes HbA1c Control amp Outcomes
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Measure HbA1c in Control HbA1c Not in Control
Members 5619 786
Average annual expenditures per capita
$15726 ($15219 $16233)
$17328 ($16110 $18546)
Inpatient hospitalizations per 1000 members
1897 (1782 2011)
2531 (2177 2886)
Inpatient days per 1000 members
8685 (8440 8930)
11561 (10804 12318)
Outpatient ED visits per 1000 members
6275 (6067 6483)
8011 (7381 8642)
Risk-adjusted rates and 95 confidence intervals 99th percentile outliers excluded HbA1c not in control gt9
35
Expenditures PMPY by County
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
County Average Members Expenditures PMPYExpenditures PMPY
(Risk Adjusted)Fairfield 223295 $5182 $5539 New London 44741 $5913 $5342 New Haven 161763 $5494 $5335 Middlesex 38531 $5359 $5184 Litchfield 43224 $5136 $5118 Tolland 36304 $5047 $5019 Hartford 191415 $4998 $4958 Windham 20934 $5539 $4950
Total 760207 $5255 $5255
36
Expenditures PMPY by HSA Risk Adjusted
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$0
$1000
$2000
$3000
$4000
$5000
$6000
$7000
37
EffectivePreventive Care
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
HEDIS MeasureCT APCD
CommercialNCQA
National HMONCQA
National PPOAvoidance of Antibiotic Treatment in Adults with Acute Bronchitis 268 276 258Anti-Depressant Medication Management 764 664 666Well-Child Visits 798 762 723Breast Cancer Screening 671 732 696
NCQA National HMO and NCQA National PPO benchmark metrics calculated for CY2015 Several other HEDIS measures can be run using the CT APCD data set and compared against the NCQA National HMO and PPO benchmarks Examples include Comprehensive Diabetes Care ndash HbA1C Testing Comprehensive Diabetes Care ndash Medical Attention for Nephrology Comprehensive Diabetes Care ndash Eye Exam Performed Adolescent Well-Care Visits Appropriate Treatment for Children with Upper Respiratory Infection etc
38
Breast Cancer Screening
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
60
62
64
66
68
70
72
Urban Centers (n=3369) Manufacturing Centers (n=10974) Diverse Suburbs (n=12206) Mill Towns (n=16281) Rural Towns (n=16789) Wealthy Suburbs (n=12266)
39
Vermont Blueprintrsquos Hub amp Spoke Model
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
bull Vermontrsquos ldquoHealth Homerdquo program designed to treat Vermonters with chronic opioid addiction
bull Hubs ndash designated providers ndash Provide coordinated care to patients through MAT services
ndash Coordinate referral to ongoing care
bull Spokes ndash teams of healthcare professionalsndash Blueprint Advanced Practice Medical Homes
ndash Federally-Qualified Health Centers
ndash Outpatient substance abuse and primary care providers
40copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Medication Assisted Treatment
bull Vermont Blueprint baseline study comparing medication-assisted treatment (MAT) population versus non-MAT population
bull Study published in the Journal of Substance Abuse Treatment (August 2016)
41
bull The CT APCD is a comparable resource to other statewide APCDs ndash A powerful tool that will only continue to grow with usendash Encompasses a robust set of information including
expenditures procedure codes diagnosis coding drug codes and enhanced value-adds (eg claim type master membermaster provider IDsNPIs MS-DRGs etc)
bull Future considerations to enhance the CT APCDndash Add Medicare and Medicaid claims datandash Continue to strengthen the completeness and validity of data
elements of importance to downstream analytic use cases (eg member race and ethnicity codes) in data collection
Lessons Learned
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
43
Next Steps
44
01Task
02Task
Ensure data quality issues are identified documented communicated and resolved
Data Quality
Continue building breadth of payer database amp complete enclave load
Data ETL
Finalize strategy to ensure site accomplishes PA 13-247 and PA 15-146 intent
Establish Strategy
05Task
Identify leading consumer information and price transparency tools available
Consumer Tool Evaluation04Task
Tasks Until Next Meeting (11917)APCD Development and Strategy Update
Distinguish Critical Paths Across and Within Strategic Priorities and Maintain Focus on ldquoMust Havesrdquo and ldquoQuick Winsrdquo
Ensure APCD staff can generate self-service extracts at little cost with minimal lead time
Deliver First DR Extract03Task
45
Future MeetingsAPCD Development and Strategy Update
November
9Legislative Office
Building Room 1D 300 Capitol Avenue
Hartford
All Payer Claims Database Advisory GroupMeeting
900ndash1100 AM
Project Descriptions
bull State Innovation Modelndash Online dashboard of ~30 pace and performance measures
bull Used to monitor performance of SIM bull 12 measures use APCD databull Includes yearly targets for overall Connecticut
ndash Online Scorecard Online dashboard of FQHC and Advanced Network performancebull First health care performance scorecard in CTbull Provides transparency in provider performancebull Utilizes claims based measures from common scorecard and CAHPS surveys
bull Suicide Risk Identificationndash Improves identification of patients at risk of suicide
bull Utilizes APCD claims data EHR data from 5 health care providers and mortality databull Creation of phenotypic algorithm
19
APCD Based Dashboard Measures
Health Care DeliveryPercent of adults with regular source of careChildren well-child visits for at-risk popMammograms for women gt50 last 2 yearsOptimal diabetes care- 2+ annual A1c testsED use- asthma as primary dx (per 10k)
Percent of adults with HTN taking HTN medsFollow-Up after Discharge from the Emergency Department for Mental Health or Alcohol or other Drug
Follow-Up after Hospitalization for Mental Illness
Antidepressant Medication ManagementInitiation and Engagement of Alcohol and Other Drug Dependence Treatment
Health Care Costs
Cost of inpatient care PMPY
Cost of outpatient care PMPY
httpwwwpublichealthuconnedusim_dashhtmlohriNav=7C
Scorecard MeasuresReporting Only
Coordination of Care30 day readmission
PCPs that meet Meaningful Use
Prevention
Non-recommended Cervical Cancer Screening in Adolescent Female
Well-child visits in the third fourth fifth and sixth years of life (Medicaid only)
Frequency of Ongoing Prenatal Care (FPC)
Oral Evaluation Dental Services (Medicaid only)
Acute and Chronic Care
Cardiac strss img Testing in asymptomatic low risk patients
Behavioral HealthAdult major depressive disorder (MDD) Coordination of care of patients with specific co-morbid conditions
Anti-Depressant Medication Management
Initiation and Engagement of Alcohol and Other Drug Dependence Treatment
Follow up after hospitalization for mental illness 7 amp 30 days
21
Provisional Core Measure SetCare CoordinationPlan all-cause readmissionAnnual monitoring for persistent medications (roll-up)PreventionBreast cancer screeningCervical cancer screeningChlamydia screening in womenAdolescent female immunizations HPV
Weight assessment and counseling for nutrition and physical activity for childrenadolescents
Well-child visits in the first 15 months of lifeAdolescent well-care visitsBehavioral health screening (pediatric Medicaid only custom measure)
Acute amp Chronic Care
Medication management for people w asthma
DM HbA1c Testing
DM Diabetes medical attention for nephropathy
Use of imaging studies for low back pain
Avoidance of antibiotic treatment in adults with acute bronchitis
Appr treatment for children with upper respiratory infection
Behavioral Health
Follow-up care for children prescribed ADHD medicationMetabolic Monitoring for Children and Adolescents on Antipsychotics (pediatric Medicaid only custom measure)
Suicide Risk Identification
22
23
CT APCD Data -
Preliminary Analysis
Examples amp Showcase
Title XxSubtitle Xx
Presenter TitleDate
24Proprietary and Confidential 24
Connecticut APCDPreliminary Analysis Examples amp Showcase
CT APCD Advisory Group Meeting August 10 2017
25
bull Data source CY2016 commercial data from the CT APCDbull Focus commercial population-based reportingbull Considerations risk adjustment for age gender and health statusbull Areas of exploration
ndash Multiple views of the CT APCD population total members health exchange members members with diabetes
ndash Expenditures utilization and effective and preventive care ratesndash Analysis by multiple geographic units county Hospital Service
Area (HSA) and Health Reference Group (HRG) bull Conclusion Recap and lessons learned
Presentation Overview
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
26
bull Member Any person covered in a submitterrsquos eligibility databull Average Members Member months divided by 12 (months)bull Expenditures Allowed amount bull Capping Capped outliers in the data at the 99th percentilebull Clinical Risk Groups Individualsrsquo categorized health statusbull County Administrative focus areasbull Hospital Service Area Local hospital marketsbull Health Reference Group Community types bull Rates Expenditures by average membersbull Risk Adjustment Adjusting for differences between member
populations by considering membersrsquo age gender and health status
Key Terms
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
27
Population-Based Reporting
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
bull Reporting units county modified Hospital Service Area (HSA) and Health Reference Group (HRG)
bull Risk adjustment age gender and health status (3M CRGs)
28
CT APCD Population Overview
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Measure Count
Unique Members 875129
Total Member Months 9122482
Average Members 760207
Total Expenditures $40 Billion
Total Expenditures Per Member Per Year (PMPY) $5255
Total Expenditures Per Member Per Month (PMPM) $438
Total expenditures are capped at the 99th percentile
29
Expenditures PMPY by Age amp Gender
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$0
$1000
$2000
$3000
$4000
$5000
$6000
$7000
$8000
$9000
0-18 Female 0-18 Male 18-34 Female 18-34 Male 35-44 Female 35-44 Male 45-54 Female 45-54 Male 55-64 Female 55-64 Male
30
Expenditures PMPY by CRGs
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$-
$5000
$10000
$15000
$20000
$25000
$30000
$35000
$40000
Healthy Acute or Minor Chronic Moderate Chronic Significant Chronic Cancer or Catastrophic
$0
31
CT Health Exchange Population Overview
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
MeasureExchange Members
Non-Exchange Members
Average Members 86941 673266
Percentage of Members 55-64 Years of Age 31 20
Percentage of Members with Chronic Condition(s) 23 19
Expenditures PMPY $5378 $5239
Expenditures PMPY Risk Adjusted $4780 $5316 Expenditures PMPY for Members with Diabetes Risk-Adjusted $17561 $19291
32
CT Exchange vs Non-Exchange Rates
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Rate per 1000 Rate per 1000 (Risk Adj)
Measure Exchange Members
Non-Exchange Members
Exchange Members
Non-Exchange Members
Inpatient Acute Visits 390 328 339 335Medical 210 144 181 147Surgical 140 116 115 119Maternity 41 69 41 69
Outpatient Emergency Visits 1941 1924 1944 1923MRIs 920 803 810 817CT Scans 1108 824 938 844Primary Care Office Visits 15216 18755 16068 18628Psychiatric Visits 9864 9783 9783 11092Chiropractic Visits 3403 7808 3088 7913
Utilization measures are capped at the 99th percentile
33
Expenditure PMPY Diabetes Population
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$-
$5000
$10000
$15000
$20000
$25000
$30000
No Diabetes (n=730838) Diabetes amp no comorbidity (n=16419) Diabetes with comorbidity (n=12950)$0
No Diabetes (n = 730838)
Diabetes No Comorbidity(n = 16419)
Diabetes Comorbidity(n = 12950)
34
Vermont Blueprint for HealthDiabetes HbA1c Control amp Outcomes
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Measure HbA1c in Control HbA1c Not in Control
Members 5619 786
Average annual expenditures per capita
$15726 ($15219 $16233)
$17328 ($16110 $18546)
Inpatient hospitalizations per 1000 members
1897 (1782 2011)
2531 (2177 2886)
Inpatient days per 1000 members
8685 (8440 8930)
11561 (10804 12318)
Outpatient ED visits per 1000 members
6275 (6067 6483)
8011 (7381 8642)
Risk-adjusted rates and 95 confidence intervals 99th percentile outliers excluded HbA1c not in control gt9
35
Expenditures PMPY by County
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
County Average Members Expenditures PMPYExpenditures PMPY
(Risk Adjusted)Fairfield 223295 $5182 $5539 New London 44741 $5913 $5342 New Haven 161763 $5494 $5335 Middlesex 38531 $5359 $5184 Litchfield 43224 $5136 $5118 Tolland 36304 $5047 $5019 Hartford 191415 $4998 $4958 Windham 20934 $5539 $4950
Total 760207 $5255 $5255
36
Expenditures PMPY by HSA Risk Adjusted
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$0
$1000
$2000
$3000
$4000
$5000
$6000
$7000
37
EffectivePreventive Care
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
HEDIS MeasureCT APCD
CommercialNCQA
National HMONCQA
National PPOAvoidance of Antibiotic Treatment in Adults with Acute Bronchitis 268 276 258Anti-Depressant Medication Management 764 664 666Well-Child Visits 798 762 723Breast Cancer Screening 671 732 696
NCQA National HMO and NCQA National PPO benchmark metrics calculated for CY2015 Several other HEDIS measures can be run using the CT APCD data set and compared against the NCQA National HMO and PPO benchmarks Examples include Comprehensive Diabetes Care ndash HbA1C Testing Comprehensive Diabetes Care ndash Medical Attention for Nephrology Comprehensive Diabetes Care ndash Eye Exam Performed Adolescent Well-Care Visits Appropriate Treatment for Children with Upper Respiratory Infection etc
38
Breast Cancer Screening
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
60
62
64
66
68
70
72
Urban Centers (n=3369) Manufacturing Centers (n=10974) Diverse Suburbs (n=12206) Mill Towns (n=16281) Rural Towns (n=16789) Wealthy Suburbs (n=12266)
39
Vermont Blueprintrsquos Hub amp Spoke Model
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
bull Vermontrsquos ldquoHealth Homerdquo program designed to treat Vermonters with chronic opioid addiction
bull Hubs ndash designated providers ndash Provide coordinated care to patients through MAT services
ndash Coordinate referral to ongoing care
bull Spokes ndash teams of healthcare professionalsndash Blueprint Advanced Practice Medical Homes
ndash Federally-Qualified Health Centers
ndash Outpatient substance abuse and primary care providers
40copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Medication Assisted Treatment
bull Vermont Blueprint baseline study comparing medication-assisted treatment (MAT) population versus non-MAT population
bull Study published in the Journal of Substance Abuse Treatment (August 2016)
41
bull The CT APCD is a comparable resource to other statewide APCDs ndash A powerful tool that will only continue to grow with usendash Encompasses a robust set of information including
expenditures procedure codes diagnosis coding drug codes and enhanced value-adds (eg claim type master membermaster provider IDsNPIs MS-DRGs etc)
bull Future considerations to enhance the CT APCDndash Add Medicare and Medicaid claims datandash Continue to strengthen the completeness and validity of data
elements of importance to downstream analytic use cases (eg member race and ethnicity codes) in data collection
Lessons Learned
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
43
Next Steps
44
01Task
02Task
Ensure data quality issues are identified documented communicated and resolved
Data Quality
Continue building breadth of payer database amp complete enclave load
Data ETL
Finalize strategy to ensure site accomplishes PA 13-247 and PA 15-146 intent
Establish Strategy
05Task
Identify leading consumer information and price transparency tools available
Consumer Tool Evaluation04Task
Tasks Until Next Meeting (11917)APCD Development and Strategy Update
Distinguish Critical Paths Across and Within Strategic Priorities and Maintain Focus on ldquoMust Havesrdquo and ldquoQuick Winsrdquo
Ensure APCD staff can generate self-service extracts at little cost with minimal lead time
Deliver First DR Extract03Task
45
Future MeetingsAPCD Development and Strategy Update
November
9Legislative Office
Building Room 1D 300 Capitol Avenue
Hartford
All Payer Claims Database Advisory GroupMeeting
900ndash1100 AM
APCD Based Dashboard Measures
Health Care DeliveryPercent of adults with regular source of careChildren well-child visits for at-risk popMammograms for women gt50 last 2 yearsOptimal diabetes care- 2+ annual A1c testsED use- asthma as primary dx (per 10k)
Percent of adults with HTN taking HTN medsFollow-Up after Discharge from the Emergency Department for Mental Health or Alcohol or other Drug
Follow-Up after Hospitalization for Mental Illness
Antidepressant Medication ManagementInitiation and Engagement of Alcohol and Other Drug Dependence Treatment
Health Care Costs
Cost of inpatient care PMPY
Cost of outpatient care PMPY
httpwwwpublichealthuconnedusim_dashhtmlohriNav=7C
Scorecard MeasuresReporting Only
Coordination of Care30 day readmission
PCPs that meet Meaningful Use
Prevention
Non-recommended Cervical Cancer Screening in Adolescent Female
Well-child visits in the third fourth fifth and sixth years of life (Medicaid only)
Frequency of Ongoing Prenatal Care (FPC)
Oral Evaluation Dental Services (Medicaid only)
Acute and Chronic Care
Cardiac strss img Testing in asymptomatic low risk patients
Behavioral HealthAdult major depressive disorder (MDD) Coordination of care of patients with specific co-morbid conditions
Anti-Depressant Medication Management
Initiation and Engagement of Alcohol and Other Drug Dependence Treatment
Follow up after hospitalization for mental illness 7 amp 30 days
21
Provisional Core Measure SetCare CoordinationPlan all-cause readmissionAnnual monitoring for persistent medications (roll-up)PreventionBreast cancer screeningCervical cancer screeningChlamydia screening in womenAdolescent female immunizations HPV
Weight assessment and counseling for nutrition and physical activity for childrenadolescents
Well-child visits in the first 15 months of lifeAdolescent well-care visitsBehavioral health screening (pediatric Medicaid only custom measure)
Acute amp Chronic Care
Medication management for people w asthma
DM HbA1c Testing
DM Diabetes medical attention for nephropathy
Use of imaging studies for low back pain
Avoidance of antibiotic treatment in adults with acute bronchitis
Appr treatment for children with upper respiratory infection
Behavioral Health
Follow-up care for children prescribed ADHD medicationMetabolic Monitoring for Children and Adolescents on Antipsychotics (pediatric Medicaid only custom measure)
Suicide Risk Identification
22
23
CT APCD Data -
Preliminary Analysis
Examples amp Showcase
Title XxSubtitle Xx
Presenter TitleDate
24Proprietary and Confidential 24
Connecticut APCDPreliminary Analysis Examples amp Showcase
CT APCD Advisory Group Meeting August 10 2017
25
bull Data source CY2016 commercial data from the CT APCDbull Focus commercial population-based reportingbull Considerations risk adjustment for age gender and health statusbull Areas of exploration
ndash Multiple views of the CT APCD population total members health exchange members members with diabetes
ndash Expenditures utilization and effective and preventive care ratesndash Analysis by multiple geographic units county Hospital Service
Area (HSA) and Health Reference Group (HRG) bull Conclusion Recap and lessons learned
Presentation Overview
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
26
bull Member Any person covered in a submitterrsquos eligibility databull Average Members Member months divided by 12 (months)bull Expenditures Allowed amount bull Capping Capped outliers in the data at the 99th percentilebull Clinical Risk Groups Individualsrsquo categorized health statusbull County Administrative focus areasbull Hospital Service Area Local hospital marketsbull Health Reference Group Community types bull Rates Expenditures by average membersbull Risk Adjustment Adjusting for differences between member
populations by considering membersrsquo age gender and health status
Key Terms
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
27
Population-Based Reporting
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
bull Reporting units county modified Hospital Service Area (HSA) and Health Reference Group (HRG)
bull Risk adjustment age gender and health status (3M CRGs)
28
CT APCD Population Overview
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Measure Count
Unique Members 875129
Total Member Months 9122482
Average Members 760207
Total Expenditures $40 Billion
Total Expenditures Per Member Per Year (PMPY) $5255
Total Expenditures Per Member Per Month (PMPM) $438
Total expenditures are capped at the 99th percentile
29
Expenditures PMPY by Age amp Gender
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$0
$1000
$2000
$3000
$4000
$5000
$6000
$7000
$8000
$9000
0-18 Female 0-18 Male 18-34 Female 18-34 Male 35-44 Female 35-44 Male 45-54 Female 45-54 Male 55-64 Female 55-64 Male
30
Expenditures PMPY by CRGs
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$-
$5000
$10000
$15000
$20000
$25000
$30000
$35000
$40000
Healthy Acute or Minor Chronic Moderate Chronic Significant Chronic Cancer or Catastrophic
$0
31
CT Health Exchange Population Overview
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
MeasureExchange Members
Non-Exchange Members
Average Members 86941 673266
Percentage of Members 55-64 Years of Age 31 20
Percentage of Members with Chronic Condition(s) 23 19
Expenditures PMPY $5378 $5239
Expenditures PMPY Risk Adjusted $4780 $5316 Expenditures PMPY for Members with Diabetes Risk-Adjusted $17561 $19291
32
CT Exchange vs Non-Exchange Rates
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Rate per 1000 Rate per 1000 (Risk Adj)
Measure Exchange Members
Non-Exchange Members
Exchange Members
Non-Exchange Members
Inpatient Acute Visits 390 328 339 335Medical 210 144 181 147Surgical 140 116 115 119Maternity 41 69 41 69
Outpatient Emergency Visits 1941 1924 1944 1923MRIs 920 803 810 817CT Scans 1108 824 938 844Primary Care Office Visits 15216 18755 16068 18628Psychiatric Visits 9864 9783 9783 11092Chiropractic Visits 3403 7808 3088 7913
Utilization measures are capped at the 99th percentile
33
Expenditure PMPY Diabetes Population
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$-
$5000
$10000
$15000
$20000
$25000
$30000
No Diabetes (n=730838) Diabetes amp no comorbidity (n=16419) Diabetes with comorbidity (n=12950)$0
No Diabetes (n = 730838)
Diabetes No Comorbidity(n = 16419)
Diabetes Comorbidity(n = 12950)
34
Vermont Blueprint for HealthDiabetes HbA1c Control amp Outcomes
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Measure HbA1c in Control HbA1c Not in Control
Members 5619 786
Average annual expenditures per capita
$15726 ($15219 $16233)
$17328 ($16110 $18546)
Inpatient hospitalizations per 1000 members
1897 (1782 2011)
2531 (2177 2886)
Inpatient days per 1000 members
8685 (8440 8930)
11561 (10804 12318)
Outpatient ED visits per 1000 members
6275 (6067 6483)
8011 (7381 8642)
Risk-adjusted rates and 95 confidence intervals 99th percentile outliers excluded HbA1c not in control gt9
35
Expenditures PMPY by County
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
County Average Members Expenditures PMPYExpenditures PMPY
(Risk Adjusted)Fairfield 223295 $5182 $5539 New London 44741 $5913 $5342 New Haven 161763 $5494 $5335 Middlesex 38531 $5359 $5184 Litchfield 43224 $5136 $5118 Tolland 36304 $5047 $5019 Hartford 191415 $4998 $4958 Windham 20934 $5539 $4950
Total 760207 $5255 $5255
36
Expenditures PMPY by HSA Risk Adjusted
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$0
$1000
$2000
$3000
$4000
$5000
$6000
$7000
37
EffectivePreventive Care
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
HEDIS MeasureCT APCD
CommercialNCQA
National HMONCQA
National PPOAvoidance of Antibiotic Treatment in Adults with Acute Bronchitis 268 276 258Anti-Depressant Medication Management 764 664 666Well-Child Visits 798 762 723Breast Cancer Screening 671 732 696
NCQA National HMO and NCQA National PPO benchmark metrics calculated for CY2015 Several other HEDIS measures can be run using the CT APCD data set and compared against the NCQA National HMO and PPO benchmarks Examples include Comprehensive Diabetes Care ndash HbA1C Testing Comprehensive Diabetes Care ndash Medical Attention for Nephrology Comprehensive Diabetes Care ndash Eye Exam Performed Adolescent Well-Care Visits Appropriate Treatment for Children with Upper Respiratory Infection etc
38
Breast Cancer Screening
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
60
62
64
66
68
70
72
Urban Centers (n=3369) Manufacturing Centers (n=10974) Diverse Suburbs (n=12206) Mill Towns (n=16281) Rural Towns (n=16789) Wealthy Suburbs (n=12266)
39
Vermont Blueprintrsquos Hub amp Spoke Model
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
bull Vermontrsquos ldquoHealth Homerdquo program designed to treat Vermonters with chronic opioid addiction
bull Hubs ndash designated providers ndash Provide coordinated care to patients through MAT services
ndash Coordinate referral to ongoing care
bull Spokes ndash teams of healthcare professionalsndash Blueprint Advanced Practice Medical Homes
ndash Federally-Qualified Health Centers
ndash Outpatient substance abuse and primary care providers
40copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Medication Assisted Treatment
bull Vermont Blueprint baseline study comparing medication-assisted treatment (MAT) population versus non-MAT population
bull Study published in the Journal of Substance Abuse Treatment (August 2016)
41
bull The CT APCD is a comparable resource to other statewide APCDs ndash A powerful tool that will only continue to grow with usendash Encompasses a robust set of information including
expenditures procedure codes diagnosis coding drug codes and enhanced value-adds (eg claim type master membermaster provider IDsNPIs MS-DRGs etc)
bull Future considerations to enhance the CT APCDndash Add Medicare and Medicaid claims datandash Continue to strengthen the completeness and validity of data
elements of importance to downstream analytic use cases (eg member race and ethnicity codes) in data collection
Lessons Learned
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
43
Next Steps
44
01Task
02Task
Ensure data quality issues are identified documented communicated and resolved
Data Quality
Continue building breadth of payer database amp complete enclave load
Data ETL
Finalize strategy to ensure site accomplishes PA 13-247 and PA 15-146 intent
Establish Strategy
05Task
Identify leading consumer information and price transparency tools available
Consumer Tool Evaluation04Task
Tasks Until Next Meeting (11917)APCD Development and Strategy Update
Distinguish Critical Paths Across and Within Strategic Priorities and Maintain Focus on ldquoMust Havesrdquo and ldquoQuick Winsrdquo
Ensure APCD staff can generate self-service extracts at little cost with minimal lead time
Deliver First DR Extract03Task
45
Future MeetingsAPCD Development and Strategy Update
November
9Legislative Office
Building Room 1D 300 Capitol Avenue
Hartford
All Payer Claims Database Advisory GroupMeeting
900ndash1100 AM
Scorecard MeasuresReporting Only
Coordination of Care30 day readmission
PCPs that meet Meaningful Use
Prevention
Non-recommended Cervical Cancer Screening in Adolescent Female
Well-child visits in the third fourth fifth and sixth years of life (Medicaid only)
Frequency of Ongoing Prenatal Care (FPC)
Oral Evaluation Dental Services (Medicaid only)
Acute and Chronic Care
Cardiac strss img Testing in asymptomatic low risk patients
Behavioral HealthAdult major depressive disorder (MDD) Coordination of care of patients with specific co-morbid conditions
Anti-Depressant Medication Management
Initiation and Engagement of Alcohol and Other Drug Dependence Treatment
Follow up after hospitalization for mental illness 7 amp 30 days
21
Provisional Core Measure SetCare CoordinationPlan all-cause readmissionAnnual monitoring for persistent medications (roll-up)PreventionBreast cancer screeningCervical cancer screeningChlamydia screening in womenAdolescent female immunizations HPV
Weight assessment and counseling for nutrition and physical activity for childrenadolescents
Well-child visits in the first 15 months of lifeAdolescent well-care visitsBehavioral health screening (pediatric Medicaid only custom measure)
Acute amp Chronic Care
Medication management for people w asthma
DM HbA1c Testing
DM Diabetes medical attention for nephropathy
Use of imaging studies for low back pain
Avoidance of antibiotic treatment in adults with acute bronchitis
Appr treatment for children with upper respiratory infection
Behavioral Health
Follow-up care for children prescribed ADHD medicationMetabolic Monitoring for Children and Adolescents on Antipsychotics (pediatric Medicaid only custom measure)
Suicide Risk Identification
22
23
CT APCD Data -
Preliminary Analysis
Examples amp Showcase
Title XxSubtitle Xx
Presenter TitleDate
24Proprietary and Confidential 24
Connecticut APCDPreliminary Analysis Examples amp Showcase
CT APCD Advisory Group Meeting August 10 2017
25
bull Data source CY2016 commercial data from the CT APCDbull Focus commercial population-based reportingbull Considerations risk adjustment for age gender and health statusbull Areas of exploration
ndash Multiple views of the CT APCD population total members health exchange members members with diabetes
ndash Expenditures utilization and effective and preventive care ratesndash Analysis by multiple geographic units county Hospital Service
Area (HSA) and Health Reference Group (HRG) bull Conclusion Recap and lessons learned
Presentation Overview
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
26
bull Member Any person covered in a submitterrsquos eligibility databull Average Members Member months divided by 12 (months)bull Expenditures Allowed amount bull Capping Capped outliers in the data at the 99th percentilebull Clinical Risk Groups Individualsrsquo categorized health statusbull County Administrative focus areasbull Hospital Service Area Local hospital marketsbull Health Reference Group Community types bull Rates Expenditures by average membersbull Risk Adjustment Adjusting for differences between member
populations by considering membersrsquo age gender and health status
Key Terms
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
27
Population-Based Reporting
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
bull Reporting units county modified Hospital Service Area (HSA) and Health Reference Group (HRG)
bull Risk adjustment age gender and health status (3M CRGs)
28
CT APCD Population Overview
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Measure Count
Unique Members 875129
Total Member Months 9122482
Average Members 760207
Total Expenditures $40 Billion
Total Expenditures Per Member Per Year (PMPY) $5255
Total Expenditures Per Member Per Month (PMPM) $438
Total expenditures are capped at the 99th percentile
29
Expenditures PMPY by Age amp Gender
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$0
$1000
$2000
$3000
$4000
$5000
$6000
$7000
$8000
$9000
0-18 Female 0-18 Male 18-34 Female 18-34 Male 35-44 Female 35-44 Male 45-54 Female 45-54 Male 55-64 Female 55-64 Male
30
Expenditures PMPY by CRGs
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$-
$5000
$10000
$15000
$20000
$25000
$30000
$35000
$40000
Healthy Acute or Minor Chronic Moderate Chronic Significant Chronic Cancer or Catastrophic
$0
31
CT Health Exchange Population Overview
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
MeasureExchange Members
Non-Exchange Members
Average Members 86941 673266
Percentage of Members 55-64 Years of Age 31 20
Percentage of Members with Chronic Condition(s) 23 19
Expenditures PMPY $5378 $5239
Expenditures PMPY Risk Adjusted $4780 $5316 Expenditures PMPY for Members with Diabetes Risk-Adjusted $17561 $19291
32
CT Exchange vs Non-Exchange Rates
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Rate per 1000 Rate per 1000 (Risk Adj)
Measure Exchange Members
Non-Exchange Members
Exchange Members
Non-Exchange Members
Inpatient Acute Visits 390 328 339 335Medical 210 144 181 147Surgical 140 116 115 119Maternity 41 69 41 69
Outpatient Emergency Visits 1941 1924 1944 1923MRIs 920 803 810 817CT Scans 1108 824 938 844Primary Care Office Visits 15216 18755 16068 18628Psychiatric Visits 9864 9783 9783 11092Chiropractic Visits 3403 7808 3088 7913
Utilization measures are capped at the 99th percentile
33
Expenditure PMPY Diabetes Population
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$-
$5000
$10000
$15000
$20000
$25000
$30000
No Diabetes (n=730838) Diabetes amp no comorbidity (n=16419) Diabetes with comorbidity (n=12950)$0
No Diabetes (n = 730838)
Diabetes No Comorbidity(n = 16419)
Diabetes Comorbidity(n = 12950)
34
Vermont Blueprint for HealthDiabetes HbA1c Control amp Outcomes
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Measure HbA1c in Control HbA1c Not in Control
Members 5619 786
Average annual expenditures per capita
$15726 ($15219 $16233)
$17328 ($16110 $18546)
Inpatient hospitalizations per 1000 members
1897 (1782 2011)
2531 (2177 2886)
Inpatient days per 1000 members
8685 (8440 8930)
11561 (10804 12318)
Outpatient ED visits per 1000 members
6275 (6067 6483)
8011 (7381 8642)
Risk-adjusted rates and 95 confidence intervals 99th percentile outliers excluded HbA1c not in control gt9
35
Expenditures PMPY by County
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
County Average Members Expenditures PMPYExpenditures PMPY
(Risk Adjusted)Fairfield 223295 $5182 $5539 New London 44741 $5913 $5342 New Haven 161763 $5494 $5335 Middlesex 38531 $5359 $5184 Litchfield 43224 $5136 $5118 Tolland 36304 $5047 $5019 Hartford 191415 $4998 $4958 Windham 20934 $5539 $4950
Total 760207 $5255 $5255
36
Expenditures PMPY by HSA Risk Adjusted
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$0
$1000
$2000
$3000
$4000
$5000
$6000
$7000
37
EffectivePreventive Care
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
HEDIS MeasureCT APCD
CommercialNCQA
National HMONCQA
National PPOAvoidance of Antibiotic Treatment in Adults with Acute Bronchitis 268 276 258Anti-Depressant Medication Management 764 664 666Well-Child Visits 798 762 723Breast Cancer Screening 671 732 696
NCQA National HMO and NCQA National PPO benchmark metrics calculated for CY2015 Several other HEDIS measures can be run using the CT APCD data set and compared against the NCQA National HMO and PPO benchmarks Examples include Comprehensive Diabetes Care ndash HbA1C Testing Comprehensive Diabetes Care ndash Medical Attention for Nephrology Comprehensive Diabetes Care ndash Eye Exam Performed Adolescent Well-Care Visits Appropriate Treatment for Children with Upper Respiratory Infection etc
38
Breast Cancer Screening
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
60
62
64
66
68
70
72
Urban Centers (n=3369) Manufacturing Centers (n=10974) Diverse Suburbs (n=12206) Mill Towns (n=16281) Rural Towns (n=16789) Wealthy Suburbs (n=12266)
39
Vermont Blueprintrsquos Hub amp Spoke Model
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
bull Vermontrsquos ldquoHealth Homerdquo program designed to treat Vermonters with chronic opioid addiction
bull Hubs ndash designated providers ndash Provide coordinated care to patients through MAT services
ndash Coordinate referral to ongoing care
bull Spokes ndash teams of healthcare professionalsndash Blueprint Advanced Practice Medical Homes
ndash Federally-Qualified Health Centers
ndash Outpatient substance abuse and primary care providers
40copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Medication Assisted Treatment
bull Vermont Blueprint baseline study comparing medication-assisted treatment (MAT) population versus non-MAT population
bull Study published in the Journal of Substance Abuse Treatment (August 2016)
41
bull The CT APCD is a comparable resource to other statewide APCDs ndash A powerful tool that will only continue to grow with usendash Encompasses a robust set of information including
expenditures procedure codes diagnosis coding drug codes and enhanced value-adds (eg claim type master membermaster provider IDsNPIs MS-DRGs etc)
bull Future considerations to enhance the CT APCDndash Add Medicare and Medicaid claims datandash Continue to strengthen the completeness and validity of data
elements of importance to downstream analytic use cases (eg member race and ethnicity codes) in data collection
Lessons Learned
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
43
Next Steps
44
01Task
02Task
Ensure data quality issues are identified documented communicated and resolved
Data Quality
Continue building breadth of payer database amp complete enclave load
Data ETL
Finalize strategy to ensure site accomplishes PA 13-247 and PA 15-146 intent
Establish Strategy
05Task
Identify leading consumer information and price transparency tools available
Consumer Tool Evaluation04Task
Tasks Until Next Meeting (11917)APCD Development and Strategy Update
Distinguish Critical Paths Across and Within Strategic Priorities and Maintain Focus on ldquoMust Havesrdquo and ldquoQuick Winsrdquo
Ensure APCD staff can generate self-service extracts at little cost with minimal lead time
Deliver First DR Extract03Task
45
Future MeetingsAPCD Development and Strategy Update
November
9Legislative Office
Building Room 1D 300 Capitol Avenue
Hartford
All Payer Claims Database Advisory GroupMeeting
900ndash1100 AM
Suicide Risk Identification
22
23
CT APCD Data -
Preliminary Analysis
Examples amp Showcase
Title XxSubtitle Xx
Presenter TitleDate
24Proprietary and Confidential 24
Connecticut APCDPreliminary Analysis Examples amp Showcase
CT APCD Advisory Group Meeting August 10 2017
25
bull Data source CY2016 commercial data from the CT APCDbull Focus commercial population-based reportingbull Considerations risk adjustment for age gender and health statusbull Areas of exploration
ndash Multiple views of the CT APCD population total members health exchange members members with diabetes
ndash Expenditures utilization and effective and preventive care ratesndash Analysis by multiple geographic units county Hospital Service
Area (HSA) and Health Reference Group (HRG) bull Conclusion Recap and lessons learned
Presentation Overview
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
26
bull Member Any person covered in a submitterrsquos eligibility databull Average Members Member months divided by 12 (months)bull Expenditures Allowed amount bull Capping Capped outliers in the data at the 99th percentilebull Clinical Risk Groups Individualsrsquo categorized health statusbull County Administrative focus areasbull Hospital Service Area Local hospital marketsbull Health Reference Group Community types bull Rates Expenditures by average membersbull Risk Adjustment Adjusting for differences between member
populations by considering membersrsquo age gender and health status
Key Terms
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
27
Population-Based Reporting
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
bull Reporting units county modified Hospital Service Area (HSA) and Health Reference Group (HRG)
bull Risk adjustment age gender and health status (3M CRGs)
28
CT APCD Population Overview
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Measure Count
Unique Members 875129
Total Member Months 9122482
Average Members 760207
Total Expenditures $40 Billion
Total Expenditures Per Member Per Year (PMPY) $5255
Total Expenditures Per Member Per Month (PMPM) $438
Total expenditures are capped at the 99th percentile
29
Expenditures PMPY by Age amp Gender
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$0
$1000
$2000
$3000
$4000
$5000
$6000
$7000
$8000
$9000
0-18 Female 0-18 Male 18-34 Female 18-34 Male 35-44 Female 35-44 Male 45-54 Female 45-54 Male 55-64 Female 55-64 Male
30
Expenditures PMPY by CRGs
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$-
$5000
$10000
$15000
$20000
$25000
$30000
$35000
$40000
Healthy Acute or Minor Chronic Moderate Chronic Significant Chronic Cancer or Catastrophic
$0
31
CT Health Exchange Population Overview
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
MeasureExchange Members
Non-Exchange Members
Average Members 86941 673266
Percentage of Members 55-64 Years of Age 31 20
Percentage of Members with Chronic Condition(s) 23 19
Expenditures PMPY $5378 $5239
Expenditures PMPY Risk Adjusted $4780 $5316 Expenditures PMPY for Members with Diabetes Risk-Adjusted $17561 $19291
32
CT Exchange vs Non-Exchange Rates
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Rate per 1000 Rate per 1000 (Risk Adj)
Measure Exchange Members
Non-Exchange Members
Exchange Members
Non-Exchange Members
Inpatient Acute Visits 390 328 339 335Medical 210 144 181 147Surgical 140 116 115 119Maternity 41 69 41 69
Outpatient Emergency Visits 1941 1924 1944 1923MRIs 920 803 810 817CT Scans 1108 824 938 844Primary Care Office Visits 15216 18755 16068 18628Psychiatric Visits 9864 9783 9783 11092Chiropractic Visits 3403 7808 3088 7913
Utilization measures are capped at the 99th percentile
33
Expenditure PMPY Diabetes Population
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$-
$5000
$10000
$15000
$20000
$25000
$30000
No Diabetes (n=730838) Diabetes amp no comorbidity (n=16419) Diabetes with comorbidity (n=12950)$0
No Diabetes (n = 730838)
Diabetes No Comorbidity(n = 16419)
Diabetes Comorbidity(n = 12950)
34
Vermont Blueprint for HealthDiabetes HbA1c Control amp Outcomes
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Measure HbA1c in Control HbA1c Not in Control
Members 5619 786
Average annual expenditures per capita
$15726 ($15219 $16233)
$17328 ($16110 $18546)
Inpatient hospitalizations per 1000 members
1897 (1782 2011)
2531 (2177 2886)
Inpatient days per 1000 members
8685 (8440 8930)
11561 (10804 12318)
Outpatient ED visits per 1000 members
6275 (6067 6483)
8011 (7381 8642)
Risk-adjusted rates and 95 confidence intervals 99th percentile outliers excluded HbA1c not in control gt9
35
Expenditures PMPY by County
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
County Average Members Expenditures PMPYExpenditures PMPY
(Risk Adjusted)Fairfield 223295 $5182 $5539 New London 44741 $5913 $5342 New Haven 161763 $5494 $5335 Middlesex 38531 $5359 $5184 Litchfield 43224 $5136 $5118 Tolland 36304 $5047 $5019 Hartford 191415 $4998 $4958 Windham 20934 $5539 $4950
Total 760207 $5255 $5255
36
Expenditures PMPY by HSA Risk Adjusted
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$0
$1000
$2000
$3000
$4000
$5000
$6000
$7000
37
EffectivePreventive Care
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
HEDIS MeasureCT APCD
CommercialNCQA
National HMONCQA
National PPOAvoidance of Antibiotic Treatment in Adults with Acute Bronchitis 268 276 258Anti-Depressant Medication Management 764 664 666Well-Child Visits 798 762 723Breast Cancer Screening 671 732 696
NCQA National HMO and NCQA National PPO benchmark metrics calculated for CY2015 Several other HEDIS measures can be run using the CT APCD data set and compared against the NCQA National HMO and PPO benchmarks Examples include Comprehensive Diabetes Care ndash HbA1C Testing Comprehensive Diabetes Care ndash Medical Attention for Nephrology Comprehensive Diabetes Care ndash Eye Exam Performed Adolescent Well-Care Visits Appropriate Treatment for Children with Upper Respiratory Infection etc
38
Breast Cancer Screening
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
60
62
64
66
68
70
72
Urban Centers (n=3369) Manufacturing Centers (n=10974) Diverse Suburbs (n=12206) Mill Towns (n=16281) Rural Towns (n=16789) Wealthy Suburbs (n=12266)
39
Vermont Blueprintrsquos Hub amp Spoke Model
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
bull Vermontrsquos ldquoHealth Homerdquo program designed to treat Vermonters with chronic opioid addiction
bull Hubs ndash designated providers ndash Provide coordinated care to patients through MAT services
ndash Coordinate referral to ongoing care
bull Spokes ndash teams of healthcare professionalsndash Blueprint Advanced Practice Medical Homes
ndash Federally-Qualified Health Centers
ndash Outpatient substance abuse and primary care providers
40copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Medication Assisted Treatment
bull Vermont Blueprint baseline study comparing medication-assisted treatment (MAT) population versus non-MAT population
bull Study published in the Journal of Substance Abuse Treatment (August 2016)
41
bull The CT APCD is a comparable resource to other statewide APCDs ndash A powerful tool that will only continue to grow with usendash Encompasses a robust set of information including
expenditures procedure codes diagnosis coding drug codes and enhanced value-adds (eg claim type master membermaster provider IDsNPIs MS-DRGs etc)
bull Future considerations to enhance the CT APCDndash Add Medicare and Medicaid claims datandash Continue to strengthen the completeness and validity of data
elements of importance to downstream analytic use cases (eg member race and ethnicity codes) in data collection
Lessons Learned
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
43
Next Steps
44
01Task
02Task
Ensure data quality issues are identified documented communicated and resolved
Data Quality
Continue building breadth of payer database amp complete enclave load
Data ETL
Finalize strategy to ensure site accomplishes PA 13-247 and PA 15-146 intent
Establish Strategy
05Task
Identify leading consumer information and price transparency tools available
Consumer Tool Evaluation04Task
Tasks Until Next Meeting (11917)APCD Development and Strategy Update
Distinguish Critical Paths Across and Within Strategic Priorities and Maintain Focus on ldquoMust Havesrdquo and ldquoQuick Winsrdquo
Ensure APCD staff can generate self-service extracts at little cost with minimal lead time
Deliver First DR Extract03Task
45
Future MeetingsAPCD Development and Strategy Update
November
9Legislative Office
Building Room 1D 300 Capitol Avenue
Hartford
All Payer Claims Database Advisory GroupMeeting
900ndash1100 AM
23
CT APCD Data -
Preliminary Analysis
Examples amp Showcase
Title XxSubtitle Xx
Presenter TitleDate
24Proprietary and Confidential 24
Connecticut APCDPreliminary Analysis Examples amp Showcase
CT APCD Advisory Group Meeting August 10 2017
25
bull Data source CY2016 commercial data from the CT APCDbull Focus commercial population-based reportingbull Considerations risk adjustment for age gender and health statusbull Areas of exploration
ndash Multiple views of the CT APCD population total members health exchange members members with diabetes
ndash Expenditures utilization and effective and preventive care ratesndash Analysis by multiple geographic units county Hospital Service
Area (HSA) and Health Reference Group (HRG) bull Conclusion Recap and lessons learned
Presentation Overview
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
26
bull Member Any person covered in a submitterrsquos eligibility databull Average Members Member months divided by 12 (months)bull Expenditures Allowed amount bull Capping Capped outliers in the data at the 99th percentilebull Clinical Risk Groups Individualsrsquo categorized health statusbull County Administrative focus areasbull Hospital Service Area Local hospital marketsbull Health Reference Group Community types bull Rates Expenditures by average membersbull Risk Adjustment Adjusting for differences between member
populations by considering membersrsquo age gender and health status
Key Terms
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
27
Population-Based Reporting
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
bull Reporting units county modified Hospital Service Area (HSA) and Health Reference Group (HRG)
bull Risk adjustment age gender and health status (3M CRGs)
28
CT APCD Population Overview
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Measure Count
Unique Members 875129
Total Member Months 9122482
Average Members 760207
Total Expenditures $40 Billion
Total Expenditures Per Member Per Year (PMPY) $5255
Total Expenditures Per Member Per Month (PMPM) $438
Total expenditures are capped at the 99th percentile
29
Expenditures PMPY by Age amp Gender
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$0
$1000
$2000
$3000
$4000
$5000
$6000
$7000
$8000
$9000
0-18 Female 0-18 Male 18-34 Female 18-34 Male 35-44 Female 35-44 Male 45-54 Female 45-54 Male 55-64 Female 55-64 Male
30
Expenditures PMPY by CRGs
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$-
$5000
$10000
$15000
$20000
$25000
$30000
$35000
$40000
Healthy Acute or Minor Chronic Moderate Chronic Significant Chronic Cancer or Catastrophic
$0
31
CT Health Exchange Population Overview
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
MeasureExchange Members
Non-Exchange Members
Average Members 86941 673266
Percentage of Members 55-64 Years of Age 31 20
Percentage of Members with Chronic Condition(s) 23 19
Expenditures PMPY $5378 $5239
Expenditures PMPY Risk Adjusted $4780 $5316 Expenditures PMPY for Members with Diabetes Risk-Adjusted $17561 $19291
32
CT Exchange vs Non-Exchange Rates
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Rate per 1000 Rate per 1000 (Risk Adj)
Measure Exchange Members
Non-Exchange Members
Exchange Members
Non-Exchange Members
Inpatient Acute Visits 390 328 339 335Medical 210 144 181 147Surgical 140 116 115 119Maternity 41 69 41 69
Outpatient Emergency Visits 1941 1924 1944 1923MRIs 920 803 810 817CT Scans 1108 824 938 844Primary Care Office Visits 15216 18755 16068 18628Psychiatric Visits 9864 9783 9783 11092Chiropractic Visits 3403 7808 3088 7913
Utilization measures are capped at the 99th percentile
33
Expenditure PMPY Diabetes Population
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$-
$5000
$10000
$15000
$20000
$25000
$30000
No Diabetes (n=730838) Diabetes amp no comorbidity (n=16419) Diabetes with comorbidity (n=12950)$0
No Diabetes (n = 730838)
Diabetes No Comorbidity(n = 16419)
Diabetes Comorbidity(n = 12950)
34
Vermont Blueprint for HealthDiabetes HbA1c Control amp Outcomes
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Measure HbA1c in Control HbA1c Not in Control
Members 5619 786
Average annual expenditures per capita
$15726 ($15219 $16233)
$17328 ($16110 $18546)
Inpatient hospitalizations per 1000 members
1897 (1782 2011)
2531 (2177 2886)
Inpatient days per 1000 members
8685 (8440 8930)
11561 (10804 12318)
Outpatient ED visits per 1000 members
6275 (6067 6483)
8011 (7381 8642)
Risk-adjusted rates and 95 confidence intervals 99th percentile outliers excluded HbA1c not in control gt9
35
Expenditures PMPY by County
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
County Average Members Expenditures PMPYExpenditures PMPY
(Risk Adjusted)Fairfield 223295 $5182 $5539 New London 44741 $5913 $5342 New Haven 161763 $5494 $5335 Middlesex 38531 $5359 $5184 Litchfield 43224 $5136 $5118 Tolland 36304 $5047 $5019 Hartford 191415 $4998 $4958 Windham 20934 $5539 $4950
Total 760207 $5255 $5255
36
Expenditures PMPY by HSA Risk Adjusted
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$0
$1000
$2000
$3000
$4000
$5000
$6000
$7000
37
EffectivePreventive Care
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
HEDIS MeasureCT APCD
CommercialNCQA
National HMONCQA
National PPOAvoidance of Antibiotic Treatment in Adults with Acute Bronchitis 268 276 258Anti-Depressant Medication Management 764 664 666Well-Child Visits 798 762 723Breast Cancer Screening 671 732 696
NCQA National HMO and NCQA National PPO benchmark metrics calculated for CY2015 Several other HEDIS measures can be run using the CT APCD data set and compared against the NCQA National HMO and PPO benchmarks Examples include Comprehensive Diabetes Care ndash HbA1C Testing Comprehensive Diabetes Care ndash Medical Attention for Nephrology Comprehensive Diabetes Care ndash Eye Exam Performed Adolescent Well-Care Visits Appropriate Treatment for Children with Upper Respiratory Infection etc
38
Breast Cancer Screening
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
60
62
64
66
68
70
72
Urban Centers (n=3369) Manufacturing Centers (n=10974) Diverse Suburbs (n=12206) Mill Towns (n=16281) Rural Towns (n=16789) Wealthy Suburbs (n=12266)
39
Vermont Blueprintrsquos Hub amp Spoke Model
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
bull Vermontrsquos ldquoHealth Homerdquo program designed to treat Vermonters with chronic opioid addiction
bull Hubs ndash designated providers ndash Provide coordinated care to patients through MAT services
ndash Coordinate referral to ongoing care
bull Spokes ndash teams of healthcare professionalsndash Blueprint Advanced Practice Medical Homes
ndash Federally-Qualified Health Centers
ndash Outpatient substance abuse and primary care providers
40copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Medication Assisted Treatment
bull Vermont Blueprint baseline study comparing medication-assisted treatment (MAT) population versus non-MAT population
bull Study published in the Journal of Substance Abuse Treatment (August 2016)
41
bull The CT APCD is a comparable resource to other statewide APCDs ndash A powerful tool that will only continue to grow with usendash Encompasses a robust set of information including
expenditures procedure codes diagnosis coding drug codes and enhanced value-adds (eg claim type master membermaster provider IDsNPIs MS-DRGs etc)
bull Future considerations to enhance the CT APCDndash Add Medicare and Medicaid claims datandash Continue to strengthen the completeness and validity of data
elements of importance to downstream analytic use cases (eg member race and ethnicity codes) in data collection
Lessons Learned
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
43
Next Steps
44
01Task
02Task
Ensure data quality issues are identified documented communicated and resolved
Data Quality
Continue building breadth of payer database amp complete enclave load
Data ETL
Finalize strategy to ensure site accomplishes PA 13-247 and PA 15-146 intent
Establish Strategy
05Task
Identify leading consumer information and price transparency tools available
Consumer Tool Evaluation04Task
Tasks Until Next Meeting (11917)APCD Development and Strategy Update
Distinguish Critical Paths Across and Within Strategic Priorities and Maintain Focus on ldquoMust Havesrdquo and ldquoQuick Winsrdquo
Ensure APCD staff can generate self-service extracts at little cost with minimal lead time
Deliver First DR Extract03Task
45
Future MeetingsAPCD Development and Strategy Update
November
9Legislative Office
Building Room 1D 300 Capitol Avenue
Hartford
All Payer Claims Database Advisory GroupMeeting
900ndash1100 AM
Title XxSubtitle Xx
Presenter TitleDate
24Proprietary and Confidential 24
Connecticut APCDPreliminary Analysis Examples amp Showcase
CT APCD Advisory Group Meeting August 10 2017
25
bull Data source CY2016 commercial data from the CT APCDbull Focus commercial population-based reportingbull Considerations risk adjustment for age gender and health statusbull Areas of exploration
ndash Multiple views of the CT APCD population total members health exchange members members with diabetes
ndash Expenditures utilization and effective and preventive care ratesndash Analysis by multiple geographic units county Hospital Service
Area (HSA) and Health Reference Group (HRG) bull Conclusion Recap and lessons learned
Presentation Overview
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
26
bull Member Any person covered in a submitterrsquos eligibility databull Average Members Member months divided by 12 (months)bull Expenditures Allowed amount bull Capping Capped outliers in the data at the 99th percentilebull Clinical Risk Groups Individualsrsquo categorized health statusbull County Administrative focus areasbull Hospital Service Area Local hospital marketsbull Health Reference Group Community types bull Rates Expenditures by average membersbull Risk Adjustment Adjusting for differences between member
populations by considering membersrsquo age gender and health status
Key Terms
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
27
Population-Based Reporting
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
bull Reporting units county modified Hospital Service Area (HSA) and Health Reference Group (HRG)
bull Risk adjustment age gender and health status (3M CRGs)
28
CT APCD Population Overview
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Measure Count
Unique Members 875129
Total Member Months 9122482
Average Members 760207
Total Expenditures $40 Billion
Total Expenditures Per Member Per Year (PMPY) $5255
Total Expenditures Per Member Per Month (PMPM) $438
Total expenditures are capped at the 99th percentile
29
Expenditures PMPY by Age amp Gender
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$0
$1000
$2000
$3000
$4000
$5000
$6000
$7000
$8000
$9000
0-18 Female 0-18 Male 18-34 Female 18-34 Male 35-44 Female 35-44 Male 45-54 Female 45-54 Male 55-64 Female 55-64 Male
30
Expenditures PMPY by CRGs
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$-
$5000
$10000
$15000
$20000
$25000
$30000
$35000
$40000
Healthy Acute or Minor Chronic Moderate Chronic Significant Chronic Cancer or Catastrophic
$0
31
CT Health Exchange Population Overview
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
MeasureExchange Members
Non-Exchange Members
Average Members 86941 673266
Percentage of Members 55-64 Years of Age 31 20
Percentage of Members with Chronic Condition(s) 23 19
Expenditures PMPY $5378 $5239
Expenditures PMPY Risk Adjusted $4780 $5316 Expenditures PMPY for Members with Diabetes Risk-Adjusted $17561 $19291
32
CT Exchange vs Non-Exchange Rates
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Rate per 1000 Rate per 1000 (Risk Adj)
Measure Exchange Members
Non-Exchange Members
Exchange Members
Non-Exchange Members
Inpatient Acute Visits 390 328 339 335Medical 210 144 181 147Surgical 140 116 115 119Maternity 41 69 41 69
Outpatient Emergency Visits 1941 1924 1944 1923MRIs 920 803 810 817CT Scans 1108 824 938 844Primary Care Office Visits 15216 18755 16068 18628Psychiatric Visits 9864 9783 9783 11092Chiropractic Visits 3403 7808 3088 7913
Utilization measures are capped at the 99th percentile
33
Expenditure PMPY Diabetes Population
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$-
$5000
$10000
$15000
$20000
$25000
$30000
No Diabetes (n=730838) Diabetes amp no comorbidity (n=16419) Diabetes with comorbidity (n=12950)$0
No Diabetes (n = 730838)
Diabetes No Comorbidity(n = 16419)
Diabetes Comorbidity(n = 12950)
34
Vermont Blueprint for HealthDiabetes HbA1c Control amp Outcomes
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Measure HbA1c in Control HbA1c Not in Control
Members 5619 786
Average annual expenditures per capita
$15726 ($15219 $16233)
$17328 ($16110 $18546)
Inpatient hospitalizations per 1000 members
1897 (1782 2011)
2531 (2177 2886)
Inpatient days per 1000 members
8685 (8440 8930)
11561 (10804 12318)
Outpatient ED visits per 1000 members
6275 (6067 6483)
8011 (7381 8642)
Risk-adjusted rates and 95 confidence intervals 99th percentile outliers excluded HbA1c not in control gt9
35
Expenditures PMPY by County
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
County Average Members Expenditures PMPYExpenditures PMPY
(Risk Adjusted)Fairfield 223295 $5182 $5539 New London 44741 $5913 $5342 New Haven 161763 $5494 $5335 Middlesex 38531 $5359 $5184 Litchfield 43224 $5136 $5118 Tolland 36304 $5047 $5019 Hartford 191415 $4998 $4958 Windham 20934 $5539 $4950
Total 760207 $5255 $5255
36
Expenditures PMPY by HSA Risk Adjusted
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$0
$1000
$2000
$3000
$4000
$5000
$6000
$7000
37
EffectivePreventive Care
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
HEDIS MeasureCT APCD
CommercialNCQA
National HMONCQA
National PPOAvoidance of Antibiotic Treatment in Adults with Acute Bronchitis 268 276 258Anti-Depressant Medication Management 764 664 666Well-Child Visits 798 762 723Breast Cancer Screening 671 732 696
NCQA National HMO and NCQA National PPO benchmark metrics calculated for CY2015 Several other HEDIS measures can be run using the CT APCD data set and compared against the NCQA National HMO and PPO benchmarks Examples include Comprehensive Diabetes Care ndash HbA1C Testing Comprehensive Diabetes Care ndash Medical Attention for Nephrology Comprehensive Diabetes Care ndash Eye Exam Performed Adolescent Well-Care Visits Appropriate Treatment for Children with Upper Respiratory Infection etc
38
Breast Cancer Screening
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
60
62
64
66
68
70
72
Urban Centers (n=3369) Manufacturing Centers (n=10974) Diverse Suburbs (n=12206) Mill Towns (n=16281) Rural Towns (n=16789) Wealthy Suburbs (n=12266)
39
Vermont Blueprintrsquos Hub amp Spoke Model
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
bull Vermontrsquos ldquoHealth Homerdquo program designed to treat Vermonters with chronic opioid addiction
bull Hubs ndash designated providers ndash Provide coordinated care to patients through MAT services
ndash Coordinate referral to ongoing care
bull Spokes ndash teams of healthcare professionalsndash Blueprint Advanced Practice Medical Homes
ndash Federally-Qualified Health Centers
ndash Outpatient substance abuse and primary care providers
40copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Medication Assisted Treatment
bull Vermont Blueprint baseline study comparing medication-assisted treatment (MAT) population versus non-MAT population
bull Study published in the Journal of Substance Abuse Treatment (August 2016)
41
bull The CT APCD is a comparable resource to other statewide APCDs ndash A powerful tool that will only continue to grow with usendash Encompasses a robust set of information including
expenditures procedure codes diagnosis coding drug codes and enhanced value-adds (eg claim type master membermaster provider IDsNPIs MS-DRGs etc)
bull Future considerations to enhance the CT APCDndash Add Medicare and Medicaid claims datandash Continue to strengthen the completeness and validity of data
elements of importance to downstream analytic use cases (eg member race and ethnicity codes) in data collection
Lessons Learned
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
43
Next Steps
44
01Task
02Task
Ensure data quality issues are identified documented communicated and resolved
Data Quality
Continue building breadth of payer database amp complete enclave load
Data ETL
Finalize strategy to ensure site accomplishes PA 13-247 and PA 15-146 intent
Establish Strategy
05Task
Identify leading consumer information and price transparency tools available
Consumer Tool Evaluation04Task
Tasks Until Next Meeting (11917)APCD Development and Strategy Update
Distinguish Critical Paths Across and Within Strategic Priorities and Maintain Focus on ldquoMust Havesrdquo and ldquoQuick Winsrdquo
Ensure APCD staff can generate self-service extracts at little cost with minimal lead time
Deliver First DR Extract03Task
45
Future MeetingsAPCD Development and Strategy Update
November
9Legislative Office
Building Room 1D 300 Capitol Avenue
Hartford
All Payer Claims Database Advisory GroupMeeting
900ndash1100 AM
25
bull Data source CY2016 commercial data from the CT APCDbull Focus commercial population-based reportingbull Considerations risk adjustment for age gender and health statusbull Areas of exploration
ndash Multiple views of the CT APCD population total members health exchange members members with diabetes
ndash Expenditures utilization and effective and preventive care ratesndash Analysis by multiple geographic units county Hospital Service
Area (HSA) and Health Reference Group (HRG) bull Conclusion Recap and lessons learned
Presentation Overview
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
26
bull Member Any person covered in a submitterrsquos eligibility databull Average Members Member months divided by 12 (months)bull Expenditures Allowed amount bull Capping Capped outliers in the data at the 99th percentilebull Clinical Risk Groups Individualsrsquo categorized health statusbull County Administrative focus areasbull Hospital Service Area Local hospital marketsbull Health Reference Group Community types bull Rates Expenditures by average membersbull Risk Adjustment Adjusting for differences between member
populations by considering membersrsquo age gender and health status
Key Terms
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
27
Population-Based Reporting
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
bull Reporting units county modified Hospital Service Area (HSA) and Health Reference Group (HRG)
bull Risk adjustment age gender and health status (3M CRGs)
28
CT APCD Population Overview
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Measure Count
Unique Members 875129
Total Member Months 9122482
Average Members 760207
Total Expenditures $40 Billion
Total Expenditures Per Member Per Year (PMPY) $5255
Total Expenditures Per Member Per Month (PMPM) $438
Total expenditures are capped at the 99th percentile
29
Expenditures PMPY by Age amp Gender
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$0
$1000
$2000
$3000
$4000
$5000
$6000
$7000
$8000
$9000
0-18 Female 0-18 Male 18-34 Female 18-34 Male 35-44 Female 35-44 Male 45-54 Female 45-54 Male 55-64 Female 55-64 Male
30
Expenditures PMPY by CRGs
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$-
$5000
$10000
$15000
$20000
$25000
$30000
$35000
$40000
Healthy Acute or Minor Chronic Moderate Chronic Significant Chronic Cancer or Catastrophic
$0
31
CT Health Exchange Population Overview
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
MeasureExchange Members
Non-Exchange Members
Average Members 86941 673266
Percentage of Members 55-64 Years of Age 31 20
Percentage of Members with Chronic Condition(s) 23 19
Expenditures PMPY $5378 $5239
Expenditures PMPY Risk Adjusted $4780 $5316 Expenditures PMPY for Members with Diabetes Risk-Adjusted $17561 $19291
32
CT Exchange vs Non-Exchange Rates
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Rate per 1000 Rate per 1000 (Risk Adj)
Measure Exchange Members
Non-Exchange Members
Exchange Members
Non-Exchange Members
Inpatient Acute Visits 390 328 339 335Medical 210 144 181 147Surgical 140 116 115 119Maternity 41 69 41 69
Outpatient Emergency Visits 1941 1924 1944 1923MRIs 920 803 810 817CT Scans 1108 824 938 844Primary Care Office Visits 15216 18755 16068 18628Psychiatric Visits 9864 9783 9783 11092Chiropractic Visits 3403 7808 3088 7913
Utilization measures are capped at the 99th percentile
33
Expenditure PMPY Diabetes Population
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$-
$5000
$10000
$15000
$20000
$25000
$30000
No Diabetes (n=730838) Diabetes amp no comorbidity (n=16419) Diabetes with comorbidity (n=12950)$0
No Diabetes (n = 730838)
Diabetes No Comorbidity(n = 16419)
Diabetes Comorbidity(n = 12950)
34
Vermont Blueprint for HealthDiabetes HbA1c Control amp Outcomes
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Measure HbA1c in Control HbA1c Not in Control
Members 5619 786
Average annual expenditures per capita
$15726 ($15219 $16233)
$17328 ($16110 $18546)
Inpatient hospitalizations per 1000 members
1897 (1782 2011)
2531 (2177 2886)
Inpatient days per 1000 members
8685 (8440 8930)
11561 (10804 12318)
Outpatient ED visits per 1000 members
6275 (6067 6483)
8011 (7381 8642)
Risk-adjusted rates and 95 confidence intervals 99th percentile outliers excluded HbA1c not in control gt9
35
Expenditures PMPY by County
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
County Average Members Expenditures PMPYExpenditures PMPY
(Risk Adjusted)Fairfield 223295 $5182 $5539 New London 44741 $5913 $5342 New Haven 161763 $5494 $5335 Middlesex 38531 $5359 $5184 Litchfield 43224 $5136 $5118 Tolland 36304 $5047 $5019 Hartford 191415 $4998 $4958 Windham 20934 $5539 $4950
Total 760207 $5255 $5255
36
Expenditures PMPY by HSA Risk Adjusted
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$0
$1000
$2000
$3000
$4000
$5000
$6000
$7000
37
EffectivePreventive Care
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
HEDIS MeasureCT APCD
CommercialNCQA
National HMONCQA
National PPOAvoidance of Antibiotic Treatment in Adults with Acute Bronchitis 268 276 258Anti-Depressant Medication Management 764 664 666Well-Child Visits 798 762 723Breast Cancer Screening 671 732 696
NCQA National HMO and NCQA National PPO benchmark metrics calculated for CY2015 Several other HEDIS measures can be run using the CT APCD data set and compared against the NCQA National HMO and PPO benchmarks Examples include Comprehensive Diabetes Care ndash HbA1C Testing Comprehensive Diabetes Care ndash Medical Attention for Nephrology Comprehensive Diabetes Care ndash Eye Exam Performed Adolescent Well-Care Visits Appropriate Treatment for Children with Upper Respiratory Infection etc
38
Breast Cancer Screening
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
60
62
64
66
68
70
72
Urban Centers (n=3369) Manufacturing Centers (n=10974) Diverse Suburbs (n=12206) Mill Towns (n=16281) Rural Towns (n=16789) Wealthy Suburbs (n=12266)
39
Vermont Blueprintrsquos Hub amp Spoke Model
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
bull Vermontrsquos ldquoHealth Homerdquo program designed to treat Vermonters with chronic opioid addiction
bull Hubs ndash designated providers ndash Provide coordinated care to patients through MAT services
ndash Coordinate referral to ongoing care
bull Spokes ndash teams of healthcare professionalsndash Blueprint Advanced Practice Medical Homes
ndash Federally-Qualified Health Centers
ndash Outpatient substance abuse and primary care providers
40copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Medication Assisted Treatment
bull Vermont Blueprint baseline study comparing medication-assisted treatment (MAT) population versus non-MAT population
bull Study published in the Journal of Substance Abuse Treatment (August 2016)
41
bull The CT APCD is a comparable resource to other statewide APCDs ndash A powerful tool that will only continue to grow with usendash Encompasses a robust set of information including
expenditures procedure codes diagnosis coding drug codes and enhanced value-adds (eg claim type master membermaster provider IDsNPIs MS-DRGs etc)
bull Future considerations to enhance the CT APCDndash Add Medicare and Medicaid claims datandash Continue to strengthen the completeness and validity of data
elements of importance to downstream analytic use cases (eg member race and ethnicity codes) in data collection
Lessons Learned
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
43
Next Steps
44
01Task
02Task
Ensure data quality issues are identified documented communicated and resolved
Data Quality
Continue building breadth of payer database amp complete enclave load
Data ETL
Finalize strategy to ensure site accomplishes PA 13-247 and PA 15-146 intent
Establish Strategy
05Task
Identify leading consumer information and price transparency tools available
Consumer Tool Evaluation04Task
Tasks Until Next Meeting (11917)APCD Development and Strategy Update
Distinguish Critical Paths Across and Within Strategic Priorities and Maintain Focus on ldquoMust Havesrdquo and ldquoQuick Winsrdquo
Ensure APCD staff can generate self-service extracts at little cost with minimal lead time
Deliver First DR Extract03Task
45
Future MeetingsAPCD Development and Strategy Update
November
9Legislative Office
Building Room 1D 300 Capitol Avenue
Hartford
All Payer Claims Database Advisory GroupMeeting
900ndash1100 AM
26
bull Member Any person covered in a submitterrsquos eligibility databull Average Members Member months divided by 12 (months)bull Expenditures Allowed amount bull Capping Capped outliers in the data at the 99th percentilebull Clinical Risk Groups Individualsrsquo categorized health statusbull County Administrative focus areasbull Hospital Service Area Local hospital marketsbull Health Reference Group Community types bull Rates Expenditures by average membersbull Risk Adjustment Adjusting for differences between member
populations by considering membersrsquo age gender and health status
Key Terms
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
27
Population-Based Reporting
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
bull Reporting units county modified Hospital Service Area (HSA) and Health Reference Group (HRG)
bull Risk adjustment age gender and health status (3M CRGs)
28
CT APCD Population Overview
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Measure Count
Unique Members 875129
Total Member Months 9122482
Average Members 760207
Total Expenditures $40 Billion
Total Expenditures Per Member Per Year (PMPY) $5255
Total Expenditures Per Member Per Month (PMPM) $438
Total expenditures are capped at the 99th percentile
29
Expenditures PMPY by Age amp Gender
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$0
$1000
$2000
$3000
$4000
$5000
$6000
$7000
$8000
$9000
0-18 Female 0-18 Male 18-34 Female 18-34 Male 35-44 Female 35-44 Male 45-54 Female 45-54 Male 55-64 Female 55-64 Male
30
Expenditures PMPY by CRGs
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$-
$5000
$10000
$15000
$20000
$25000
$30000
$35000
$40000
Healthy Acute or Minor Chronic Moderate Chronic Significant Chronic Cancer or Catastrophic
$0
31
CT Health Exchange Population Overview
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
MeasureExchange Members
Non-Exchange Members
Average Members 86941 673266
Percentage of Members 55-64 Years of Age 31 20
Percentage of Members with Chronic Condition(s) 23 19
Expenditures PMPY $5378 $5239
Expenditures PMPY Risk Adjusted $4780 $5316 Expenditures PMPY for Members with Diabetes Risk-Adjusted $17561 $19291
32
CT Exchange vs Non-Exchange Rates
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Rate per 1000 Rate per 1000 (Risk Adj)
Measure Exchange Members
Non-Exchange Members
Exchange Members
Non-Exchange Members
Inpatient Acute Visits 390 328 339 335Medical 210 144 181 147Surgical 140 116 115 119Maternity 41 69 41 69
Outpatient Emergency Visits 1941 1924 1944 1923MRIs 920 803 810 817CT Scans 1108 824 938 844Primary Care Office Visits 15216 18755 16068 18628Psychiatric Visits 9864 9783 9783 11092Chiropractic Visits 3403 7808 3088 7913
Utilization measures are capped at the 99th percentile
33
Expenditure PMPY Diabetes Population
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$-
$5000
$10000
$15000
$20000
$25000
$30000
No Diabetes (n=730838) Diabetes amp no comorbidity (n=16419) Diabetes with comorbidity (n=12950)$0
No Diabetes (n = 730838)
Diabetes No Comorbidity(n = 16419)
Diabetes Comorbidity(n = 12950)
34
Vermont Blueprint for HealthDiabetes HbA1c Control amp Outcomes
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Measure HbA1c in Control HbA1c Not in Control
Members 5619 786
Average annual expenditures per capita
$15726 ($15219 $16233)
$17328 ($16110 $18546)
Inpatient hospitalizations per 1000 members
1897 (1782 2011)
2531 (2177 2886)
Inpatient days per 1000 members
8685 (8440 8930)
11561 (10804 12318)
Outpatient ED visits per 1000 members
6275 (6067 6483)
8011 (7381 8642)
Risk-adjusted rates and 95 confidence intervals 99th percentile outliers excluded HbA1c not in control gt9
35
Expenditures PMPY by County
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
County Average Members Expenditures PMPYExpenditures PMPY
(Risk Adjusted)Fairfield 223295 $5182 $5539 New London 44741 $5913 $5342 New Haven 161763 $5494 $5335 Middlesex 38531 $5359 $5184 Litchfield 43224 $5136 $5118 Tolland 36304 $5047 $5019 Hartford 191415 $4998 $4958 Windham 20934 $5539 $4950
Total 760207 $5255 $5255
36
Expenditures PMPY by HSA Risk Adjusted
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$0
$1000
$2000
$3000
$4000
$5000
$6000
$7000
37
EffectivePreventive Care
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
HEDIS MeasureCT APCD
CommercialNCQA
National HMONCQA
National PPOAvoidance of Antibiotic Treatment in Adults with Acute Bronchitis 268 276 258Anti-Depressant Medication Management 764 664 666Well-Child Visits 798 762 723Breast Cancer Screening 671 732 696
NCQA National HMO and NCQA National PPO benchmark metrics calculated for CY2015 Several other HEDIS measures can be run using the CT APCD data set and compared against the NCQA National HMO and PPO benchmarks Examples include Comprehensive Diabetes Care ndash HbA1C Testing Comprehensive Diabetes Care ndash Medical Attention for Nephrology Comprehensive Diabetes Care ndash Eye Exam Performed Adolescent Well-Care Visits Appropriate Treatment for Children with Upper Respiratory Infection etc
38
Breast Cancer Screening
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
60
62
64
66
68
70
72
Urban Centers (n=3369) Manufacturing Centers (n=10974) Diverse Suburbs (n=12206) Mill Towns (n=16281) Rural Towns (n=16789) Wealthy Suburbs (n=12266)
39
Vermont Blueprintrsquos Hub amp Spoke Model
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
bull Vermontrsquos ldquoHealth Homerdquo program designed to treat Vermonters with chronic opioid addiction
bull Hubs ndash designated providers ndash Provide coordinated care to patients through MAT services
ndash Coordinate referral to ongoing care
bull Spokes ndash teams of healthcare professionalsndash Blueprint Advanced Practice Medical Homes
ndash Federally-Qualified Health Centers
ndash Outpatient substance abuse and primary care providers
40copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Medication Assisted Treatment
bull Vermont Blueprint baseline study comparing medication-assisted treatment (MAT) population versus non-MAT population
bull Study published in the Journal of Substance Abuse Treatment (August 2016)
41
bull The CT APCD is a comparable resource to other statewide APCDs ndash A powerful tool that will only continue to grow with usendash Encompasses a robust set of information including
expenditures procedure codes diagnosis coding drug codes and enhanced value-adds (eg claim type master membermaster provider IDsNPIs MS-DRGs etc)
bull Future considerations to enhance the CT APCDndash Add Medicare and Medicaid claims datandash Continue to strengthen the completeness and validity of data
elements of importance to downstream analytic use cases (eg member race and ethnicity codes) in data collection
Lessons Learned
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
43
Next Steps
44
01Task
02Task
Ensure data quality issues are identified documented communicated and resolved
Data Quality
Continue building breadth of payer database amp complete enclave load
Data ETL
Finalize strategy to ensure site accomplishes PA 13-247 and PA 15-146 intent
Establish Strategy
05Task
Identify leading consumer information and price transparency tools available
Consumer Tool Evaluation04Task
Tasks Until Next Meeting (11917)APCD Development and Strategy Update
Distinguish Critical Paths Across and Within Strategic Priorities and Maintain Focus on ldquoMust Havesrdquo and ldquoQuick Winsrdquo
Ensure APCD staff can generate self-service extracts at little cost with minimal lead time
Deliver First DR Extract03Task
45
Future MeetingsAPCD Development and Strategy Update
November
9Legislative Office
Building Room 1D 300 Capitol Avenue
Hartford
All Payer Claims Database Advisory GroupMeeting
900ndash1100 AM
27
Population-Based Reporting
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
bull Reporting units county modified Hospital Service Area (HSA) and Health Reference Group (HRG)
bull Risk adjustment age gender and health status (3M CRGs)
28
CT APCD Population Overview
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Measure Count
Unique Members 875129
Total Member Months 9122482
Average Members 760207
Total Expenditures $40 Billion
Total Expenditures Per Member Per Year (PMPY) $5255
Total Expenditures Per Member Per Month (PMPM) $438
Total expenditures are capped at the 99th percentile
29
Expenditures PMPY by Age amp Gender
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$0
$1000
$2000
$3000
$4000
$5000
$6000
$7000
$8000
$9000
0-18 Female 0-18 Male 18-34 Female 18-34 Male 35-44 Female 35-44 Male 45-54 Female 45-54 Male 55-64 Female 55-64 Male
30
Expenditures PMPY by CRGs
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$-
$5000
$10000
$15000
$20000
$25000
$30000
$35000
$40000
Healthy Acute or Minor Chronic Moderate Chronic Significant Chronic Cancer or Catastrophic
$0
31
CT Health Exchange Population Overview
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
MeasureExchange Members
Non-Exchange Members
Average Members 86941 673266
Percentage of Members 55-64 Years of Age 31 20
Percentage of Members with Chronic Condition(s) 23 19
Expenditures PMPY $5378 $5239
Expenditures PMPY Risk Adjusted $4780 $5316 Expenditures PMPY for Members with Diabetes Risk-Adjusted $17561 $19291
32
CT Exchange vs Non-Exchange Rates
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Rate per 1000 Rate per 1000 (Risk Adj)
Measure Exchange Members
Non-Exchange Members
Exchange Members
Non-Exchange Members
Inpatient Acute Visits 390 328 339 335Medical 210 144 181 147Surgical 140 116 115 119Maternity 41 69 41 69
Outpatient Emergency Visits 1941 1924 1944 1923MRIs 920 803 810 817CT Scans 1108 824 938 844Primary Care Office Visits 15216 18755 16068 18628Psychiatric Visits 9864 9783 9783 11092Chiropractic Visits 3403 7808 3088 7913
Utilization measures are capped at the 99th percentile
33
Expenditure PMPY Diabetes Population
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$-
$5000
$10000
$15000
$20000
$25000
$30000
No Diabetes (n=730838) Diabetes amp no comorbidity (n=16419) Diabetes with comorbidity (n=12950)$0
No Diabetes (n = 730838)
Diabetes No Comorbidity(n = 16419)
Diabetes Comorbidity(n = 12950)
34
Vermont Blueprint for HealthDiabetes HbA1c Control amp Outcomes
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Measure HbA1c in Control HbA1c Not in Control
Members 5619 786
Average annual expenditures per capita
$15726 ($15219 $16233)
$17328 ($16110 $18546)
Inpatient hospitalizations per 1000 members
1897 (1782 2011)
2531 (2177 2886)
Inpatient days per 1000 members
8685 (8440 8930)
11561 (10804 12318)
Outpatient ED visits per 1000 members
6275 (6067 6483)
8011 (7381 8642)
Risk-adjusted rates and 95 confidence intervals 99th percentile outliers excluded HbA1c not in control gt9
35
Expenditures PMPY by County
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
County Average Members Expenditures PMPYExpenditures PMPY
(Risk Adjusted)Fairfield 223295 $5182 $5539 New London 44741 $5913 $5342 New Haven 161763 $5494 $5335 Middlesex 38531 $5359 $5184 Litchfield 43224 $5136 $5118 Tolland 36304 $5047 $5019 Hartford 191415 $4998 $4958 Windham 20934 $5539 $4950
Total 760207 $5255 $5255
36
Expenditures PMPY by HSA Risk Adjusted
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$0
$1000
$2000
$3000
$4000
$5000
$6000
$7000
37
EffectivePreventive Care
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
HEDIS MeasureCT APCD
CommercialNCQA
National HMONCQA
National PPOAvoidance of Antibiotic Treatment in Adults with Acute Bronchitis 268 276 258Anti-Depressant Medication Management 764 664 666Well-Child Visits 798 762 723Breast Cancer Screening 671 732 696
NCQA National HMO and NCQA National PPO benchmark metrics calculated for CY2015 Several other HEDIS measures can be run using the CT APCD data set and compared against the NCQA National HMO and PPO benchmarks Examples include Comprehensive Diabetes Care ndash HbA1C Testing Comprehensive Diabetes Care ndash Medical Attention for Nephrology Comprehensive Diabetes Care ndash Eye Exam Performed Adolescent Well-Care Visits Appropriate Treatment for Children with Upper Respiratory Infection etc
38
Breast Cancer Screening
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
60
62
64
66
68
70
72
Urban Centers (n=3369) Manufacturing Centers (n=10974) Diverse Suburbs (n=12206) Mill Towns (n=16281) Rural Towns (n=16789) Wealthy Suburbs (n=12266)
39
Vermont Blueprintrsquos Hub amp Spoke Model
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
bull Vermontrsquos ldquoHealth Homerdquo program designed to treat Vermonters with chronic opioid addiction
bull Hubs ndash designated providers ndash Provide coordinated care to patients through MAT services
ndash Coordinate referral to ongoing care
bull Spokes ndash teams of healthcare professionalsndash Blueprint Advanced Practice Medical Homes
ndash Federally-Qualified Health Centers
ndash Outpatient substance abuse and primary care providers
40copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Medication Assisted Treatment
bull Vermont Blueprint baseline study comparing medication-assisted treatment (MAT) population versus non-MAT population
bull Study published in the Journal of Substance Abuse Treatment (August 2016)
41
bull The CT APCD is a comparable resource to other statewide APCDs ndash A powerful tool that will only continue to grow with usendash Encompasses a robust set of information including
expenditures procedure codes diagnosis coding drug codes and enhanced value-adds (eg claim type master membermaster provider IDsNPIs MS-DRGs etc)
bull Future considerations to enhance the CT APCDndash Add Medicare and Medicaid claims datandash Continue to strengthen the completeness and validity of data
elements of importance to downstream analytic use cases (eg member race and ethnicity codes) in data collection
Lessons Learned
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
43
Next Steps
44
01Task
02Task
Ensure data quality issues are identified documented communicated and resolved
Data Quality
Continue building breadth of payer database amp complete enclave load
Data ETL
Finalize strategy to ensure site accomplishes PA 13-247 and PA 15-146 intent
Establish Strategy
05Task
Identify leading consumer information and price transparency tools available
Consumer Tool Evaluation04Task
Tasks Until Next Meeting (11917)APCD Development and Strategy Update
Distinguish Critical Paths Across and Within Strategic Priorities and Maintain Focus on ldquoMust Havesrdquo and ldquoQuick Winsrdquo
Ensure APCD staff can generate self-service extracts at little cost with minimal lead time
Deliver First DR Extract03Task
45
Future MeetingsAPCD Development and Strategy Update
November
9Legislative Office
Building Room 1D 300 Capitol Avenue
Hartford
All Payer Claims Database Advisory GroupMeeting
900ndash1100 AM
28
CT APCD Population Overview
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Measure Count
Unique Members 875129
Total Member Months 9122482
Average Members 760207
Total Expenditures $40 Billion
Total Expenditures Per Member Per Year (PMPY) $5255
Total Expenditures Per Member Per Month (PMPM) $438
Total expenditures are capped at the 99th percentile
29
Expenditures PMPY by Age amp Gender
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$0
$1000
$2000
$3000
$4000
$5000
$6000
$7000
$8000
$9000
0-18 Female 0-18 Male 18-34 Female 18-34 Male 35-44 Female 35-44 Male 45-54 Female 45-54 Male 55-64 Female 55-64 Male
30
Expenditures PMPY by CRGs
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$-
$5000
$10000
$15000
$20000
$25000
$30000
$35000
$40000
Healthy Acute or Minor Chronic Moderate Chronic Significant Chronic Cancer or Catastrophic
$0
31
CT Health Exchange Population Overview
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
MeasureExchange Members
Non-Exchange Members
Average Members 86941 673266
Percentage of Members 55-64 Years of Age 31 20
Percentage of Members with Chronic Condition(s) 23 19
Expenditures PMPY $5378 $5239
Expenditures PMPY Risk Adjusted $4780 $5316 Expenditures PMPY for Members with Diabetes Risk-Adjusted $17561 $19291
32
CT Exchange vs Non-Exchange Rates
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Rate per 1000 Rate per 1000 (Risk Adj)
Measure Exchange Members
Non-Exchange Members
Exchange Members
Non-Exchange Members
Inpatient Acute Visits 390 328 339 335Medical 210 144 181 147Surgical 140 116 115 119Maternity 41 69 41 69
Outpatient Emergency Visits 1941 1924 1944 1923MRIs 920 803 810 817CT Scans 1108 824 938 844Primary Care Office Visits 15216 18755 16068 18628Psychiatric Visits 9864 9783 9783 11092Chiropractic Visits 3403 7808 3088 7913
Utilization measures are capped at the 99th percentile
33
Expenditure PMPY Diabetes Population
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$-
$5000
$10000
$15000
$20000
$25000
$30000
No Diabetes (n=730838) Diabetes amp no comorbidity (n=16419) Diabetes with comorbidity (n=12950)$0
No Diabetes (n = 730838)
Diabetes No Comorbidity(n = 16419)
Diabetes Comorbidity(n = 12950)
34
Vermont Blueprint for HealthDiabetes HbA1c Control amp Outcomes
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Measure HbA1c in Control HbA1c Not in Control
Members 5619 786
Average annual expenditures per capita
$15726 ($15219 $16233)
$17328 ($16110 $18546)
Inpatient hospitalizations per 1000 members
1897 (1782 2011)
2531 (2177 2886)
Inpatient days per 1000 members
8685 (8440 8930)
11561 (10804 12318)
Outpatient ED visits per 1000 members
6275 (6067 6483)
8011 (7381 8642)
Risk-adjusted rates and 95 confidence intervals 99th percentile outliers excluded HbA1c not in control gt9
35
Expenditures PMPY by County
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
County Average Members Expenditures PMPYExpenditures PMPY
(Risk Adjusted)Fairfield 223295 $5182 $5539 New London 44741 $5913 $5342 New Haven 161763 $5494 $5335 Middlesex 38531 $5359 $5184 Litchfield 43224 $5136 $5118 Tolland 36304 $5047 $5019 Hartford 191415 $4998 $4958 Windham 20934 $5539 $4950
Total 760207 $5255 $5255
36
Expenditures PMPY by HSA Risk Adjusted
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$0
$1000
$2000
$3000
$4000
$5000
$6000
$7000
37
EffectivePreventive Care
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
HEDIS MeasureCT APCD
CommercialNCQA
National HMONCQA
National PPOAvoidance of Antibiotic Treatment in Adults with Acute Bronchitis 268 276 258Anti-Depressant Medication Management 764 664 666Well-Child Visits 798 762 723Breast Cancer Screening 671 732 696
NCQA National HMO and NCQA National PPO benchmark metrics calculated for CY2015 Several other HEDIS measures can be run using the CT APCD data set and compared against the NCQA National HMO and PPO benchmarks Examples include Comprehensive Diabetes Care ndash HbA1C Testing Comprehensive Diabetes Care ndash Medical Attention for Nephrology Comprehensive Diabetes Care ndash Eye Exam Performed Adolescent Well-Care Visits Appropriate Treatment for Children with Upper Respiratory Infection etc
38
Breast Cancer Screening
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
60
62
64
66
68
70
72
Urban Centers (n=3369) Manufacturing Centers (n=10974) Diverse Suburbs (n=12206) Mill Towns (n=16281) Rural Towns (n=16789) Wealthy Suburbs (n=12266)
39
Vermont Blueprintrsquos Hub amp Spoke Model
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
bull Vermontrsquos ldquoHealth Homerdquo program designed to treat Vermonters with chronic opioid addiction
bull Hubs ndash designated providers ndash Provide coordinated care to patients through MAT services
ndash Coordinate referral to ongoing care
bull Spokes ndash teams of healthcare professionalsndash Blueprint Advanced Practice Medical Homes
ndash Federally-Qualified Health Centers
ndash Outpatient substance abuse and primary care providers
40copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Medication Assisted Treatment
bull Vermont Blueprint baseline study comparing medication-assisted treatment (MAT) population versus non-MAT population
bull Study published in the Journal of Substance Abuse Treatment (August 2016)
41
bull The CT APCD is a comparable resource to other statewide APCDs ndash A powerful tool that will only continue to grow with usendash Encompasses a robust set of information including
expenditures procedure codes diagnosis coding drug codes and enhanced value-adds (eg claim type master membermaster provider IDsNPIs MS-DRGs etc)
bull Future considerations to enhance the CT APCDndash Add Medicare and Medicaid claims datandash Continue to strengthen the completeness and validity of data
elements of importance to downstream analytic use cases (eg member race and ethnicity codes) in data collection
Lessons Learned
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
43
Next Steps
44
01Task
02Task
Ensure data quality issues are identified documented communicated and resolved
Data Quality
Continue building breadth of payer database amp complete enclave load
Data ETL
Finalize strategy to ensure site accomplishes PA 13-247 and PA 15-146 intent
Establish Strategy
05Task
Identify leading consumer information and price transparency tools available
Consumer Tool Evaluation04Task
Tasks Until Next Meeting (11917)APCD Development and Strategy Update
Distinguish Critical Paths Across and Within Strategic Priorities and Maintain Focus on ldquoMust Havesrdquo and ldquoQuick Winsrdquo
Ensure APCD staff can generate self-service extracts at little cost with minimal lead time
Deliver First DR Extract03Task
45
Future MeetingsAPCD Development and Strategy Update
November
9Legislative Office
Building Room 1D 300 Capitol Avenue
Hartford
All Payer Claims Database Advisory GroupMeeting
900ndash1100 AM
29
Expenditures PMPY by Age amp Gender
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$0
$1000
$2000
$3000
$4000
$5000
$6000
$7000
$8000
$9000
0-18 Female 0-18 Male 18-34 Female 18-34 Male 35-44 Female 35-44 Male 45-54 Female 45-54 Male 55-64 Female 55-64 Male
30
Expenditures PMPY by CRGs
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$-
$5000
$10000
$15000
$20000
$25000
$30000
$35000
$40000
Healthy Acute or Minor Chronic Moderate Chronic Significant Chronic Cancer or Catastrophic
$0
31
CT Health Exchange Population Overview
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
MeasureExchange Members
Non-Exchange Members
Average Members 86941 673266
Percentage of Members 55-64 Years of Age 31 20
Percentage of Members with Chronic Condition(s) 23 19
Expenditures PMPY $5378 $5239
Expenditures PMPY Risk Adjusted $4780 $5316 Expenditures PMPY for Members with Diabetes Risk-Adjusted $17561 $19291
32
CT Exchange vs Non-Exchange Rates
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Rate per 1000 Rate per 1000 (Risk Adj)
Measure Exchange Members
Non-Exchange Members
Exchange Members
Non-Exchange Members
Inpatient Acute Visits 390 328 339 335Medical 210 144 181 147Surgical 140 116 115 119Maternity 41 69 41 69
Outpatient Emergency Visits 1941 1924 1944 1923MRIs 920 803 810 817CT Scans 1108 824 938 844Primary Care Office Visits 15216 18755 16068 18628Psychiatric Visits 9864 9783 9783 11092Chiropractic Visits 3403 7808 3088 7913
Utilization measures are capped at the 99th percentile
33
Expenditure PMPY Diabetes Population
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$-
$5000
$10000
$15000
$20000
$25000
$30000
No Diabetes (n=730838) Diabetes amp no comorbidity (n=16419) Diabetes with comorbidity (n=12950)$0
No Diabetes (n = 730838)
Diabetes No Comorbidity(n = 16419)
Diabetes Comorbidity(n = 12950)
34
Vermont Blueprint for HealthDiabetes HbA1c Control amp Outcomes
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Measure HbA1c in Control HbA1c Not in Control
Members 5619 786
Average annual expenditures per capita
$15726 ($15219 $16233)
$17328 ($16110 $18546)
Inpatient hospitalizations per 1000 members
1897 (1782 2011)
2531 (2177 2886)
Inpatient days per 1000 members
8685 (8440 8930)
11561 (10804 12318)
Outpatient ED visits per 1000 members
6275 (6067 6483)
8011 (7381 8642)
Risk-adjusted rates and 95 confidence intervals 99th percentile outliers excluded HbA1c not in control gt9
35
Expenditures PMPY by County
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
County Average Members Expenditures PMPYExpenditures PMPY
(Risk Adjusted)Fairfield 223295 $5182 $5539 New London 44741 $5913 $5342 New Haven 161763 $5494 $5335 Middlesex 38531 $5359 $5184 Litchfield 43224 $5136 $5118 Tolland 36304 $5047 $5019 Hartford 191415 $4998 $4958 Windham 20934 $5539 $4950
Total 760207 $5255 $5255
36
Expenditures PMPY by HSA Risk Adjusted
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$0
$1000
$2000
$3000
$4000
$5000
$6000
$7000
37
EffectivePreventive Care
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
HEDIS MeasureCT APCD
CommercialNCQA
National HMONCQA
National PPOAvoidance of Antibiotic Treatment in Adults with Acute Bronchitis 268 276 258Anti-Depressant Medication Management 764 664 666Well-Child Visits 798 762 723Breast Cancer Screening 671 732 696
NCQA National HMO and NCQA National PPO benchmark metrics calculated for CY2015 Several other HEDIS measures can be run using the CT APCD data set and compared against the NCQA National HMO and PPO benchmarks Examples include Comprehensive Diabetes Care ndash HbA1C Testing Comprehensive Diabetes Care ndash Medical Attention for Nephrology Comprehensive Diabetes Care ndash Eye Exam Performed Adolescent Well-Care Visits Appropriate Treatment for Children with Upper Respiratory Infection etc
38
Breast Cancer Screening
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
60
62
64
66
68
70
72
Urban Centers (n=3369) Manufacturing Centers (n=10974) Diverse Suburbs (n=12206) Mill Towns (n=16281) Rural Towns (n=16789) Wealthy Suburbs (n=12266)
39
Vermont Blueprintrsquos Hub amp Spoke Model
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
bull Vermontrsquos ldquoHealth Homerdquo program designed to treat Vermonters with chronic opioid addiction
bull Hubs ndash designated providers ndash Provide coordinated care to patients through MAT services
ndash Coordinate referral to ongoing care
bull Spokes ndash teams of healthcare professionalsndash Blueprint Advanced Practice Medical Homes
ndash Federally-Qualified Health Centers
ndash Outpatient substance abuse and primary care providers
40copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Medication Assisted Treatment
bull Vermont Blueprint baseline study comparing medication-assisted treatment (MAT) population versus non-MAT population
bull Study published in the Journal of Substance Abuse Treatment (August 2016)
41
bull The CT APCD is a comparable resource to other statewide APCDs ndash A powerful tool that will only continue to grow with usendash Encompasses a robust set of information including
expenditures procedure codes diagnosis coding drug codes and enhanced value-adds (eg claim type master membermaster provider IDsNPIs MS-DRGs etc)
bull Future considerations to enhance the CT APCDndash Add Medicare and Medicaid claims datandash Continue to strengthen the completeness and validity of data
elements of importance to downstream analytic use cases (eg member race and ethnicity codes) in data collection
Lessons Learned
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
43
Next Steps
44
01Task
02Task
Ensure data quality issues are identified documented communicated and resolved
Data Quality
Continue building breadth of payer database amp complete enclave load
Data ETL
Finalize strategy to ensure site accomplishes PA 13-247 and PA 15-146 intent
Establish Strategy
05Task
Identify leading consumer information and price transparency tools available
Consumer Tool Evaluation04Task
Tasks Until Next Meeting (11917)APCD Development and Strategy Update
Distinguish Critical Paths Across and Within Strategic Priorities and Maintain Focus on ldquoMust Havesrdquo and ldquoQuick Winsrdquo
Ensure APCD staff can generate self-service extracts at little cost with minimal lead time
Deliver First DR Extract03Task
45
Future MeetingsAPCD Development and Strategy Update
November
9Legislative Office
Building Room 1D 300 Capitol Avenue
Hartford
All Payer Claims Database Advisory GroupMeeting
900ndash1100 AM
30
Expenditures PMPY by CRGs
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$-
$5000
$10000
$15000
$20000
$25000
$30000
$35000
$40000
Healthy Acute or Minor Chronic Moderate Chronic Significant Chronic Cancer or Catastrophic
$0
31
CT Health Exchange Population Overview
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
MeasureExchange Members
Non-Exchange Members
Average Members 86941 673266
Percentage of Members 55-64 Years of Age 31 20
Percentage of Members with Chronic Condition(s) 23 19
Expenditures PMPY $5378 $5239
Expenditures PMPY Risk Adjusted $4780 $5316 Expenditures PMPY for Members with Diabetes Risk-Adjusted $17561 $19291
32
CT Exchange vs Non-Exchange Rates
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Rate per 1000 Rate per 1000 (Risk Adj)
Measure Exchange Members
Non-Exchange Members
Exchange Members
Non-Exchange Members
Inpatient Acute Visits 390 328 339 335Medical 210 144 181 147Surgical 140 116 115 119Maternity 41 69 41 69
Outpatient Emergency Visits 1941 1924 1944 1923MRIs 920 803 810 817CT Scans 1108 824 938 844Primary Care Office Visits 15216 18755 16068 18628Psychiatric Visits 9864 9783 9783 11092Chiropractic Visits 3403 7808 3088 7913
Utilization measures are capped at the 99th percentile
33
Expenditure PMPY Diabetes Population
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$-
$5000
$10000
$15000
$20000
$25000
$30000
No Diabetes (n=730838) Diabetes amp no comorbidity (n=16419) Diabetes with comorbidity (n=12950)$0
No Diabetes (n = 730838)
Diabetes No Comorbidity(n = 16419)
Diabetes Comorbidity(n = 12950)
34
Vermont Blueprint for HealthDiabetes HbA1c Control amp Outcomes
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Measure HbA1c in Control HbA1c Not in Control
Members 5619 786
Average annual expenditures per capita
$15726 ($15219 $16233)
$17328 ($16110 $18546)
Inpatient hospitalizations per 1000 members
1897 (1782 2011)
2531 (2177 2886)
Inpatient days per 1000 members
8685 (8440 8930)
11561 (10804 12318)
Outpatient ED visits per 1000 members
6275 (6067 6483)
8011 (7381 8642)
Risk-adjusted rates and 95 confidence intervals 99th percentile outliers excluded HbA1c not in control gt9
35
Expenditures PMPY by County
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
County Average Members Expenditures PMPYExpenditures PMPY
(Risk Adjusted)Fairfield 223295 $5182 $5539 New London 44741 $5913 $5342 New Haven 161763 $5494 $5335 Middlesex 38531 $5359 $5184 Litchfield 43224 $5136 $5118 Tolland 36304 $5047 $5019 Hartford 191415 $4998 $4958 Windham 20934 $5539 $4950
Total 760207 $5255 $5255
36
Expenditures PMPY by HSA Risk Adjusted
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$0
$1000
$2000
$3000
$4000
$5000
$6000
$7000
37
EffectivePreventive Care
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
HEDIS MeasureCT APCD
CommercialNCQA
National HMONCQA
National PPOAvoidance of Antibiotic Treatment in Adults with Acute Bronchitis 268 276 258Anti-Depressant Medication Management 764 664 666Well-Child Visits 798 762 723Breast Cancer Screening 671 732 696
NCQA National HMO and NCQA National PPO benchmark metrics calculated for CY2015 Several other HEDIS measures can be run using the CT APCD data set and compared against the NCQA National HMO and PPO benchmarks Examples include Comprehensive Diabetes Care ndash HbA1C Testing Comprehensive Diabetes Care ndash Medical Attention for Nephrology Comprehensive Diabetes Care ndash Eye Exam Performed Adolescent Well-Care Visits Appropriate Treatment for Children with Upper Respiratory Infection etc
38
Breast Cancer Screening
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
60
62
64
66
68
70
72
Urban Centers (n=3369) Manufacturing Centers (n=10974) Diverse Suburbs (n=12206) Mill Towns (n=16281) Rural Towns (n=16789) Wealthy Suburbs (n=12266)
39
Vermont Blueprintrsquos Hub amp Spoke Model
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
bull Vermontrsquos ldquoHealth Homerdquo program designed to treat Vermonters with chronic opioid addiction
bull Hubs ndash designated providers ndash Provide coordinated care to patients through MAT services
ndash Coordinate referral to ongoing care
bull Spokes ndash teams of healthcare professionalsndash Blueprint Advanced Practice Medical Homes
ndash Federally-Qualified Health Centers
ndash Outpatient substance abuse and primary care providers
40copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Medication Assisted Treatment
bull Vermont Blueprint baseline study comparing medication-assisted treatment (MAT) population versus non-MAT population
bull Study published in the Journal of Substance Abuse Treatment (August 2016)
41
bull The CT APCD is a comparable resource to other statewide APCDs ndash A powerful tool that will only continue to grow with usendash Encompasses a robust set of information including
expenditures procedure codes diagnosis coding drug codes and enhanced value-adds (eg claim type master membermaster provider IDsNPIs MS-DRGs etc)
bull Future considerations to enhance the CT APCDndash Add Medicare and Medicaid claims datandash Continue to strengthen the completeness and validity of data
elements of importance to downstream analytic use cases (eg member race and ethnicity codes) in data collection
Lessons Learned
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
43
Next Steps
44
01Task
02Task
Ensure data quality issues are identified documented communicated and resolved
Data Quality
Continue building breadth of payer database amp complete enclave load
Data ETL
Finalize strategy to ensure site accomplishes PA 13-247 and PA 15-146 intent
Establish Strategy
05Task
Identify leading consumer information and price transparency tools available
Consumer Tool Evaluation04Task
Tasks Until Next Meeting (11917)APCD Development and Strategy Update
Distinguish Critical Paths Across and Within Strategic Priorities and Maintain Focus on ldquoMust Havesrdquo and ldquoQuick Winsrdquo
Ensure APCD staff can generate self-service extracts at little cost with minimal lead time
Deliver First DR Extract03Task
45
Future MeetingsAPCD Development and Strategy Update
November
9Legislative Office
Building Room 1D 300 Capitol Avenue
Hartford
All Payer Claims Database Advisory GroupMeeting
900ndash1100 AM
31
CT Health Exchange Population Overview
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
MeasureExchange Members
Non-Exchange Members
Average Members 86941 673266
Percentage of Members 55-64 Years of Age 31 20
Percentage of Members with Chronic Condition(s) 23 19
Expenditures PMPY $5378 $5239
Expenditures PMPY Risk Adjusted $4780 $5316 Expenditures PMPY for Members with Diabetes Risk-Adjusted $17561 $19291
32
CT Exchange vs Non-Exchange Rates
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Rate per 1000 Rate per 1000 (Risk Adj)
Measure Exchange Members
Non-Exchange Members
Exchange Members
Non-Exchange Members
Inpatient Acute Visits 390 328 339 335Medical 210 144 181 147Surgical 140 116 115 119Maternity 41 69 41 69
Outpatient Emergency Visits 1941 1924 1944 1923MRIs 920 803 810 817CT Scans 1108 824 938 844Primary Care Office Visits 15216 18755 16068 18628Psychiatric Visits 9864 9783 9783 11092Chiropractic Visits 3403 7808 3088 7913
Utilization measures are capped at the 99th percentile
33
Expenditure PMPY Diabetes Population
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$-
$5000
$10000
$15000
$20000
$25000
$30000
No Diabetes (n=730838) Diabetes amp no comorbidity (n=16419) Diabetes with comorbidity (n=12950)$0
No Diabetes (n = 730838)
Diabetes No Comorbidity(n = 16419)
Diabetes Comorbidity(n = 12950)
34
Vermont Blueprint for HealthDiabetes HbA1c Control amp Outcomes
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Measure HbA1c in Control HbA1c Not in Control
Members 5619 786
Average annual expenditures per capita
$15726 ($15219 $16233)
$17328 ($16110 $18546)
Inpatient hospitalizations per 1000 members
1897 (1782 2011)
2531 (2177 2886)
Inpatient days per 1000 members
8685 (8440 8930)
11561 (10804 12318)
Outpatient ED visits per 1000 members
6275 (6067 6483)
8011 (7381 8642)
Risk-adjusted rates and 95 confidence intervals 99th percentile outliers excluded HbA1c not in control gt9
35
Expenditures PMPY by County
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
County Average Members Expenditures PMPYExpenditures PMPY
(Risk Adjusted)Fairfield 223295 $5182 $5539 New London 44741 $5913 $5342 New Haven 161763 $5494 $5335 Middlesex 38531 $5359 $5184 Litchfield 43224 $5136 $5118 Tolland 36304 $5047 $5019 Hartford 191415 $4998 $4958 Windham 20934 $5539 $4950
Total 760207 $5255 $5255
36
Expenditures PMPY by HSA Risk Adjusted
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$0
$1000
$2000
$3000
$4000
$5000
$6000
$7000
37
EffectivePreventive Care
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
HEDIS MeasureCT APCD
CommercialNCQA
National HMONCQA
National PPOAvoidance of Antibiotic Treatment in Adults with Acute Bronchitis 268 276 258Anti-Depressant Medication Management 764 664 666Well-Child Visits 798 762 723Breast Cancer Screening 671 732 696
NCQA National HMO and NCQA National PPO benchmark metrics calculated for CY2015 Several other HEDIS measures can be run using the CT APCD data set and compared against the NCQA National HMO and PPO benchmarks Examples include Comprehensive Diabetes Care ndash HbA1C Testing Comprehensive Diabetes Care ndash Medical Attention for Nephrology Comprehensive Diabetes Care ndash Eye Exam Performed Adolescent Well-Care Visits Appropriate Treatment for Children with Upper Respiratory Infection etc
38
Breast Cancer Screening
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
60
62
64
66
68
70
72
Urban Centers (n=3369) Manufacturing Centers (n=10974) Diverse Suburbs (n=12206) Mill Towns (n=16281) Rural Towns (n=16789) Wealthy Suburbs (n=12266)
39
Vermont Blueprintrsquos Hub amp Spoke Model
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
bull Vermontrsquos ldquoHealth Homerdquo program designed to treat Vermonters with chronic opioid addiction
bull Hubs ndash designated providers ndash Provide coordinated care to patients through MAT services
ndash Coordinate referral to ongoing care
bull Spokes ndash teams of healthcare professionalsndash Blueprint Advanced Practice Medical Homes
ndash Federally-Qualified Health Centers
ndash Outpatient substance abuse and primary care providers
40copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Medication Assisted Treatment
bull Vermont Blueprint baseline study comparing medication-assisted treatment (MAT) population versus non-MAT population
bull Study published in the Journal of Substance Abuse Treatment (August 2016)
41
bull The CT APCD is a comparable resource to other statewide APCDs ndash A powerful tool that will only continue to grow with usendash Encompasses a robust set of information including
expenditures procedure codes diagnosis coding drug codes and enhanced value-adds (eg claim type master membermaster provider IDsNPIs MS-DRGs etc)
bull Future considerations to enhance the CT APCDndash Add Medicare and Medicaid claims datandash Continue to strengthen the completeness and validity of data
elements of importance to downstream analytic use cases (eg member race and ethnicity codes) in data collection
Lessons Learned
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
43
Next Steps
44
01Task
02Task
Ensure data quality issues are identified documented communicated and resolved
Data Quality
Continue building breadth of payer database amp complete enclave load
Data ETL
Finalize strategy to ensure site accomplishes PA 13-247 and PA 15-146 intent
Establish Strategy
05Task
Identify leading consumer information and price transparency tools available
Consumer Tool Evaluation04Task
Tasks Until Next Meeting (11917)APCD Development and Strategy Update
Distinguish Critical Paths Across and Within Strategic Priorities and Maintain Focus on ldquoMust Havesrdquo and ldquoQuick Winsrdquo
Ensure APCD staff can generate self-service extracts at little cost with minimal lead time
Deliver First DR Extract03Task
45
Future MeetingsAPCD Development and Strategy Update
November
9Legislative Office
Building Room 1D 300 Capitol Avenue
Hartford
All Payer Claims Database Advisory GroupMeeting
900ndash1100 AM
32
CT Exchange vs Non-Exchange Rates
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Rate per 1000 Rate per 1000 (Risk Adj)
Measure Exchange Members
Non-Exchange Members
Exchange Members
Non-Exchange Members
Inpatient Acute Visits 390 328 339 335Medical 210 144 181 147Surgical 140 116 115 119Maternity 41 69 41 69
Outpatient Emergency Visits 1941 1924 1944 1923MRIs 920 803 810 817CT Scans 1108 824 938 844Primary Care Office Visits 15216 18755 16068 18628Psychiatric Visits 9864 9783 9783 11092Chiropractic Visits 3403 7808 3088 7913
Utilization measures are capped at the 99th percentile
33
Expenditure PMPY Diabetes Population
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$-
$5000
$10000
$15000
$20000
$25000
$30000
No Diabetes (n=730838) Diabetes amp no comorbidity (n=16419) Diabetes with comorbidity (n=12950)$0
No Diabetes (n = 730838)
Diabetes No Comorbidity(n = 16419)
Diabetes Comorbidity(n = 12950)
34
Vermont Blueprint for HealthDiabetes HbA1c Control amp Outcomes
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Measure HbA1c in Control HbA1c Not in Control
Members 5619 786
Average annual expenditures per capita
$15726 ($15219 $16233)
$17328 ($16110 $18546)
Inpatient hospitalizations per 1000 members
1897 (1782 2011)
2531 (2177 2886)
Inpatient days per 1000 members
8685 (8440 8930)
11561 (10804 12318)
Outpatient ED visits per 1000 members
6275 (6067 6483)
8011 (7381 8642)
Risk-adjusted rates and 95 confidence intervals 99th percentile outliers excluded HbA1c not in control gt9
35
Expenditures PMPY by County
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
County Average Members Expenditures PMPYExpenditures PMPY
(Risk Adjusted)Fairfield 223295 $5182 $5539 New London 44741 $5913 $5342 New Haven 161763 $5494 $5335 Middlesex 38531 $5359 $5184 Litchfield 43224 $5136 $5118 Tolland 36304 $5047 $5019 Hartford 191415 $4998 $4958 Windham 20934 $5539 $4950
Total 760207 $5255 $5255
36
Expenditures PMPY by HSA Risk Adjusted
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$0
$1000
$2000
$3000
$4000
$5000
$6000
$7000
37
EffectivePreventive Care
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
HEDIS MeasureCT APCD
CommercialNCQA
National HMONCQA
National PPOAvoidance of Antibiotic Treatment in Adults with Acute Bronchitis 268 276 258Anti-Depressant Medication Management 764 664 666Well-Child Visits 798 762 723Breast Cancer Screening 671 732 696
NCQA National HMO and NCQA National PPO benchmark metrics calculated for CY2015 Several other HEDIS measures can be run using the CT APCD data set and compared against the NCQA National HMO and PPO benchmarks Examples include Comprehensive Diabetes Care ndash HbA1C Testing Comprehensive Diabetes Care ndash Medical Attention for Nephrology Comprehensive Diabetes Care ndash Eye Exam Performed Adolescent Well-Care Visits Appropriate Treatment for Children with Upper Respiratory Infection etc
38
Breast Cancer Screening
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
60
62
64
66
68
70
72
Urban Centers (n=3369) Manufacturing Centers (n=10974) Diverse Suburbs (n=12206) Mill Towns (n=16281) Rural Towns (n=16789) Wealthy Suburbs (n=12266)
39
Vermont Blueprintrsquos Hub amp Spoke Model
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
bull Vermontrsquos ldquoHealth Homerdquo program designed to treat Vermonters with chronic opioid addiction
bull Hubs ndash designated providers ndash Provide coordinated care to patients through MAT services
ndash Coordinate referral to ongoing care
bull Spokes ndash teams of healthcare professionalsndash Blueprint Advanced Practice Medical Homes
ndash Federally-Qualified Health Centers
ndash Outpatient substance abuse and primary care providers
40copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Medication Assisted Treatment
bull Vermont Blueprint baseline study comparing medication-assisted treatment (MAT) population versus non-MAT population
bull Study published in the Journal of Substance Abuse Treatment (August 2016)
41
bull The CT APCD is a comparable resource to other statewide APCDs ndash A powerful tool that will only continue to grow with usendash Encompasses a robust set of information including
expenditures procedure codes diagnosis coding drug codes and enhanced value-adds (eg claim type master membermaster provider IDsNPIs MS-DRGs etc)
bull Future considerations to enhance the CT APCDndash Add Medicare and Medicaid claims datandash Continue to strengthen the completeness and validity of data
elements of importance to downstream analytic use cases (eg member race and ethnicity codes) in data collection
Lessons Learned
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
43
Next Steps
44
01Task
02Task
Ensure data quality issues are identified documented communicated and resolved
Data Quality
Continue building breadth of payer database amp complete enclave load
Data ETL
Finalize strategy to ensure site accomplishes PA 13-247 and PA 15-146 intent
Establish Strategy
05Task
Identify leading consumer information and price transparency tools available
Consumer Tool Evaluation04Task
Tasks Until Next Meeting (11917)APCD Development and Strategy Update
Distinguish Critical Paths Across and Within Strategic Priorities and Maintain Focus on ldquoMust Havesrdquo and ldquoQuick Winsrdquo
Ensure APCD staff can generate self-service extracts at little cost with minimal lead time
Deliver First DR Extract03Task
45
Future MeetingsAPCD Development and Strategy Update
November
9Legislative Office
Building Room 1D 300 Capitol Avenue
Hartford
All Payer Claims Database Advisory GroupMeeting
900ndash1100 AM
33
Expenditure PMPY Diabetes Population
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$-
$5000
$10000
$15000
$20000
$25000
$30000
No Diabetes (n=730838) Diabetes amp no comorbidity (n=16419) Diabetes with comorbidity (n=12950)$0
No Diabetes (n = 730838)
Diabetes No Comorbidity(n = 16419)
Diabetes Comorbidity(n = 12950)
34
Vermont Blueprint for HealthDiabetes HbA1c Control amp Outcomes
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Measure HbA1c in Control HbA1c Not in Control
Members 5619 786
Average annual expenditures per capita
$15726 ($15219 $16233)
$17328 ($16110 $18546)
Inpatient hospitalizations per 1000 members
1897 (1782 2011)
2531 (2177 2886)
Inpatient days per 1000 members
8685 (8440 8930)
11561 (10804 12318)
Outpatient ED visits per 1000 members
6275 (6067 6483)
8011 (7381 8642)
Risk-adjusted rates and 95 confidence intervals 99th percentile outliers excluded HbA1c not in control gt9
35
Expenditures PMPY by County
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
County Average Members Expenditures PMPYExpenditures PMPY
(Risk Adjusted)Fairfield 223295 $5182 $5539 New London 44741 $5913 $5342 New Haven 161763 $5494 $5335 Middlesex 38531 $5359 $5184 Litchfield 43224 $5136 $5118 Tolland 36304 $5047 $5019 Hartford 191415 $4998 $4958 Windham 20934 $5539 $4950
Total 760207 $5255 $5255
36
Expenditures PMPY by HSA Risk Adjusted
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$0
$1000
$2000
$3000
$4000
$5000
$6000
$7000
37
EffectivePreventive Care
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
HEDIS MeasureCT APCD
CommercialNCQA
National HMONCQA
National PPOAvoidance of Antibiotic Treatment in Adults with Acute Bronchitis 268 276 258Anti-Depressant Medication Management 764 664 666Well-Child Visits 798 762 723Breast Cancer Screening 671 732 696
NCQA National HMO and NCQA National PPO benchmark metrics calculated for CY2015 Several other HEDIS measures can be run using the CT APCD data set and compared against the NCQA National HMO and PPO benchmarks Examples include Comprehensive Diabetes Care ndash HbA1C Testing Comprehensive Diabetes Care ndash Medical Attention for Nephrology Comprehensive Diabetes Care ndash Eye Exam Performed Adolescent Well-Care Visits Appropriate Treatment for Children with Upper Respiratory Infection etc
38
Breast Cancer Screening
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
60
62
64
66
68
70
72
Urban Centers (n=3369) Manufacturing Centers (n=10974) Diverse Suburbs (n=12206) Mill Towns (n=16281) Rural Towns (n=16789) Wealthy Suburbs (n=12266)
39
Vermont Blueprintrsquos Hub amp Spoke Model
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
bull Vermontrsquos ldquoHealth Homerdquo program designed to treat Vermonters with chronic opioid addiction
bull Hubs ndash designated providers ndash Provide coordinated care to patients through MAT services
ndash Coordinate referral to ongoing care
bull Spokes ndash teams of healthcare professionalsndash Blueprint Advanced Practice Medical Homes
ndash Federally-Qualified Health Centers
ndash Outpatient substance abuse and primary care providers
40copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Medication Assisted Treatment
bull Vermont Blueprint baseline study comparing medication-assisted treatment (MAT) population versus non-MAT population
bull Study published in the Journal of Substance Abuse Treatment (August 2016)
41
bull The CT APCD is a comparable resource to other statewide APCDs ndash A powerful tool that will only continue to grow with usendash Encompasses a robust set of information including
expenditures procedure codes diagnosis coding drug codes and enhanced value-adds (eg claim type master membermaster provider IDsNPIs MS-DRGs etc)
bull Future considerations to enhance the CT APCDndash Add Medicare and Medicaid claims datandash Continue to strengthen the completeness and validity of data
elements of importance to downstream analytic use cases (eg member race and ethnicity codes) in data collection
Lessons Learned
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
43
Next Steps
44
01Task
02Task
Ensure data quality issues are identified documented communicated and resolved
Data Quality
Continue building breadth of payer database amp complete enclave load
Data ETL
Finalize strategy to ensure site accomplishes PA 13-247 and PA 15-146 intent
Establish Strategy
05Task
Identify leading consumer information and price transparency tools available
Consumer Tool Evaluation04Task
Tasks Until Next Meeting (11917)APCD Development and Strategy Update
Distinguish Critical Paths Across and Within Strategic Priorities and Maintain Focus on ldquoMust Havesrdquo and ldquoQuick Winsrdquo
Ensure APCD staff can generate self-service extracts at little cost with minimal lead time
Deliver First DR Extract03Task
45
Future MeetingsAPCD Development and Strategy Update
November
9Legislative Office
Building Room 1D 300 Capitol Avenue
Hartford
All Payer Claims Database Advisory GroupMeeting
900ndash1100 AM
34
Vermont Blueprint for HealthDiabetes HbA1c Control amp Outcomes
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Measure HbA1c in Control HbA1c Not in Control
Members 5619 786
Average annual expenditures per capita
$15726 ($15219 $16233)
$17328 ($16110 $18546)
Inpatient hospitalizations per 1000 members
1897 (1782 2011)
2531 (2177 2886)
Inpatient days per 1000 members
8685 (8440 8930)
11561 (10804 12318)
Outpatient ED visits per 1000 members
6275 (6067 6483)
8011 (7381 8642)
Risk-adjusted rates and 95 confidence intervals 99th percentile outliers excluded HbA1c not in control gt9
35
Expenditures PMPY by County
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
County Average Members Expenditures PMPYExpenditures PMPY
(Risk Adjusted)Fairfield 223295 $5182 $5539 New London 44741 $5913 $5342 New Haven 161763 $5494 $5335 Middlesex 38531 $5359 $5184 Litchfield 43224 $5136 $5118 Tolland 36304 $5047 $5019 Hartford 191415 $4998 $4958 Windham 20934 $5539 $4950
Total 760207 $5255 $5255
36
Expenditures PMPY by HSA Risk Adjusted
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$0
$1000
$2000
$3000
$4000
$5000
$6000
$7000
37
EffectivePreventive Care
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
HEDIS MeasureCT APCD
CommercialNCQA
National HMONCQA
National PPOAvoidance of Antibiotic Treatment in Adults with Acute Bronchitis 268 276 258Anti-Depressant Medication Management 764 664 666Well-Child Visits 798 762 723Breast Cancer Screening 671 732 696
NCQA National HMO and NCQA National PPO benchmark metrics calculated for CY2015 Several other HEDIS measures can be run using the CT APCD data set and compared against the NCQA National HMO and PPO benchmarks Examples include Comprehensive Diabetes Care ndash HbA1C Testing Comprehensive Diabetes Care ndash Medical Attention for Nephrology Comprehensive Diabetes Care ndash Eye Exam Performed Adolescent Well-Care Visits Appropriate Treatment for Children with Upper Respiratory Infection etc
38
Breast Cancer Screening
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
60
62
64
66
68
70
72
Urban Centers (n=3369) Manufacturing Centers (n=10974) Diverse Suburbs (n=12206) Mill Towns (n=16281) Rural Towns (n=16789) Wealthy Suburbs (n=12266)
39
Vermont Blueprintrsquos Hub amp Spoke Model
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
bull Vermontrsquos ldquoHealth Homerdquo program designed to treat Vermonters with chronic opioid addiction
bull Hubs ndash designated providers ndash Provide coordinated care to patients through MAT services
ndash Coordinate referral to ongoing care
bull Spokes ndash teams of healthcare professionalsndash Blueprint Advanced Practice Medical Homes
ndash Federally-Qualified Health Centers
ndash Outpatient substance abuse and primary care providers
40copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Medication Assisted Treatment
bull Vermont Blueprint baseline study comparing medication-assisted treatment (MAT) population versus non-MAT population
bull Study published in the Journal of Substance Abuse Treatment (August 2016)
41
bull The CT APCD is a comparable resource to other statewide APCDs ndash A powerful tool that will only continue to grow with usendash Encompasses a robust set of information including
expenditures procedure codes diagnosis coding drug codes and enhanced value-adds (eg claim type master membermaster provider IDsNPIs MS-DRGs etc)
bull Future considerations to enhance the CT APCDndash Add Medicare and Medicaid claims datandash Continue to strengthen the completeness and validity of data
elements of importance to downstream analytic use cases (eg member race and ethnicity codes) in data collection
Lessons Learned
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
43
Next Steps
44
01Task
02Task
Ensure data quality issues are identified documented communicated and resolved
Data Quality
Continue building breadth of payer database amp complete enclave load
Data ETL
Finalize strategy to ensure site accomplishes PA 13-247 and PA 15-146 intent
Establish Strategy
05Task
Identify leading consumer information and price transparency tools available
Consumer Tool Evaluation04Task
Tasks Until Next Meeting (11917)APCD Development and Strategy Update
Distinguish Critical Paths Across and Within Strategic Priorities and Maintain Focus on ldquoMust Havesrdquo and ldquoQuick Winsrdquo
Ensure APCD staff can generate self-service extracts at little cost with minimal lead time
Deliver First DR Extract03Task
45
Future MeetingsAPCD Development and Strategy Update
November
9Legislative Office
Building Room 1D 300 Capitol Avenue
Hartford
All Payer Claims Database Advisory GroupMeeting
900ndash1100 AM
35
Expenditures PMPY by County
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
County Average Members Expenditures PMPYExpenditures PMPY
(Risk Adjusted)Fairfield 223295 $5182 $5539 New London 44741 $5913 $5342 New Haven 161763 $5494 $5335 Middlesex 38531 $5359 $5184 Litchfield 43224 $5136 $5118 Tolland 36304 $5047 $5019 Hartford 191415 $4998 $4958 Windham 20934 $5539 $4950
Total 760207 $5255 $5255
36
Expenditures PMPY by HSA Risk Adjusted
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$0
$1000
$2000
$3000
$4000
$5000
$6000
$7000
37
EffectivePreventive Care
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
HEDIS MeasureCT APCD
CommercialNCQA
National HMONCQA
National PPOAvoidance of Antibiotic Treatment in Adults with Acute Bronchitis 268 276 258Anti-Depressant Medication Management 764 664 666Well-Child Visits 798 762 723Breast Cancer Screening 671 732 696
NCQA National HMO and NCQA National PPO benchmark metrics calculated for CY2015 Several other HEDIS measures can be run using the CT APCD data set and compared against the NCQA National HMO and PPO benchmarks Examples include Comprehensive Diabetes Care ndash HbA1C Testing Comprehensive Diabetes Care ndash Medical Attention for Nephrology Comprehensive Diabetes Care ndash Eye Exam Performed Adolescent Well-Care Visits Appropriate Treatment for Children with Upper Respiratory Infection etc
38
Breast Cancer Screening
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
60
62
64
66
68
70
72
Urban Centers (n=3369) Manufacturing Centers (n=10974) Diverse Suburbs (n=12206) Mill Towns (n=16281) Rural Towns (n=16789) Wealthy Suburbs (n=12266)
39
Vermont Blueprintrsquos Hub amp Spoke Model
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
bull Vermontrsquos ldquoHealth Homerdquo program designed to treat Vermonters with chronic opioid addiction
bull Hubs ndash designated providers ndash Provide coordinated care to patients through MAT services
ndash Coordinate referral to ongoing care
bull Spokes ndash teams of healthcare professionalsndash Blueprint Advanced Practice Medical Homes
ndash Federally-Qualified Health Centers
ndash Outpatient substance abuse and primary care providers
40copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Medication Assisted Treatment
bull Vermont Blueprint baseline study comparing medication-assisted treatment (MAT) population versus non-MAT population
bull Study published in the Journal of Substance Abuse Treatment (August 2016)
41
bull The CT APCD is a comparable resource to other statewide APCDs ndash A powerful tool that will only continue to grow with usendash Encompasses a robust set of information including
expenditures procedure codes diagnosis coding drug codes and enhanced value-adds (eg claim type master membermaster provider IDsNPIs MS-DRGs etc)
bull Future considerations to enhance the CT APCDndash Add Medicare and Medicaid claims datandash Continue to strengthen the completeness and validity of data
elements of importance to downstream analytic use cases (eg member race and ethnicity codes) in data collection
Lessons Learned
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
43
Next Steps
44
01Task
02Task
Ensure data quality issues are identified documented communicated and resolved
Data Quality
Continue building breadth of payer database amp complete enclave load
Data ETL
Finalize strategy to ensure site accomplishes PA 13-247 and PA 15-146 intent
Establish Strategy
05Task
Identify leading consumer information and price transparency tools available
Consumer Tool Evaluation04Task
Tasks Until Next Meeting (11917)APCD Development and Strategy Update
Distinguish Critical Paths Across and Within Strategic Priorities and Maintain Focus on ldquoMust Havesrdquo and ldquoQuick Winsrdquo
Ensure APCD staff can generate self-service extracts at little cost with minimal lead time
Deliver First DR Extract03Task
45
Future MeetingsAPCD Development and Strategy Update
November
9Legislative Office
Building Room 1D 300 Capitol Avenue
Hartford
All Payer Claims Database Advisory GroupMeeting
900ndash1100 AM
36
Expenditures PMPY by HSA Risk Adjusted
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
$0
$1000
$2000
$3000
$4000
$5000
$6000
$7000
37
EffectivePreventive Care
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
HEDIS MeasureCT APCD
CommercialNCQA
National HMONCQA
National PPOAvoidance of Antibiotic Treatment in Adults with Acute Bronchitis 268 276 258Anti-Depressant Medication Management 764 664 666Well-Child Visits 798 762 723Breast Cancer Screening 671 732 696
NCQA National HMO and NCQA National PPO benchmark metrics calculated for CY2015 Several other HEDIS measures can be run using the CT APCD data set and compared against the NCQA National HMO and PPO benchmarks Examples include Comprehensive Diabetes Care ndash HbA1C Testing Comprehensive Diabetes Care ndash Medical Attention for Nephrology Comprehensive Diabetes Care ndash Eye Exam Performed Adolescent Well-Care Visits Appropriate Treatment for Children with Upper Respiratory Infection etc
38
Breast Cancer Screening
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
60
62
64
66
68
70
72
Urban Centers (n=3369) Manufacturing Centers (n=10974) Diverse Suburbs (n=12206) Mill Towns (n=16281) Rural Towns (n=16789) Wealthy Suburbs (n=12266)
39
Vermont Blueprintrsquos Hub amp Spoke Model
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
bull Vermontrsquos ldquoHealth Homerdquo program designed to treat Vermonters with chronic opioid addiction
bull Hubs ndash designated providers ndash Provide coordinated care to patients through MAT services
ndash Coordinate referral to ongoing care
bull Spokes ndash teams of healthcare professionalsndash Blueprint Advanced Practice Medical Homes
ndash Federally-Qualified Health Centers
ndash Outpatient substance abuse and primary care providers
40copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Medication Assisted Treatment
bull Vermont Blueprint baseline study comparing medication-assisted treatment (MAT) population versus non-MAT population
bull Study published in the Journal of Substance Abuse Treatment (August 2016)
41
bull The CT APCD is a comparable resource to other statewide APCDs ndash A powerful tool that will only continue to grow with usendash Encompasses a robust set of information including
expenditures procedure codes diagnosis coding drug codes and enhanced value-adds (eg claim type master membermaster provider IDsNPIs MS-DRGs etc)
bull Future considerations to enhance the CT APCDndash Add Medicare and Medicaid claims datandash Continue to strengthen the completeness and validity of data
elements of importance to downstream analytic use cases (eg member race and ethnicity codes) in data collection
Lessons Learned
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
43
Next Steps
44
01Task
02Task
Ensure data quality issues are identified documented communicated and resolved
Data Quality
Continue building breadth of payer database amp complete enclave load
Data ETL
Finalize strategy to ensure site accomplishes PA 13-247 and PA 15-146 intent
Establish Strategy
05Task
Identify leading consumer information and price transparency tools available
Consumer Tool Evaluation04Task
Tasks Until Next Meeting (11917)APCD Development and Strategy Update
Distinguish Critical Paths Across and Within Strategic Priorities and Maintain Focus on ldquoMust Havesrdquo and ldquoQuick Winsrdquo
Ensure APCD staff can generate self-service extracts at little cost with minimal lead time
Deliver First DR Extract03Task
45
Future MeetingsAPCD Development and Strategy Update
November
9Legislative Office
Building Room 1D 300 Capitol Avenue
Hartford
All Payer Claims Database Advisory GroupMeeting
900ndash1100 AM
37
EffectivePreventive Care
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
HEDIS MeasureCT APCD
CommercialNCQA
National HMONCQA
National PPOAvoidance of Antibiotic Treatment in Adults with Acute Bronchitis 268 276 258Anti-Depressant Medication Management 764 664 666Well-Child Visits 798 762 723Breast Cancer Screening 671 732 696
NCQA National HMO and NCQA National PPO benchmark metrics calculated for CY2015 Several other HEDIS measures can be run using the CT APCD data set and compared against the NCQA National HMO and PPO benchmarks Examples include Comprehensive Diabetes Care ndash HbA1C Testing Comprehensive Diabetes Care ndash Medical Attention for Nephrology Comprehensive Diabetes Care ndash Eye Exam Performed Adolescent Well-Care Visits Appropriate Treatment for Children with Upper Respiratory Infection etc
38
Breast Cancer Screening
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
60
62
64
66
68
70
72
Urban Centers (n=3369) Manufacturing Centers (n=10974) Diverse Suburbs (n=12206) Mill Towns (n=16281) Rural Towns (n=16789) Wealthy Suburbs (n=12266)
39
Vermont Blueprintrsquos Hub amp Spoke Model
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
bull Vermontrsquos ldquoHealth Homerdquo program designed to treat Vermonters with chronic opioid addiction
bull Hubs ndash designated providers ndash Provide coordinated care to patients through MAT services
ndash Coordinate referral to ongoing care
bull Spokes ndash teams of healthcare professionalsndash Blueprint Advanced Practice Medical Homes
ndash Federally-Qualified Health Centers
ndash Outpatient substance abuse and primary care providers
40copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Medication Assisted Treatment
bull Vermont Blueprint baseline study comparing medication-assisted treatment (MAT) population versus non-MAT population
bull Study published in the Journal of Substance Abuse Treatment (August 2016)
41
bull The CT APCD is a comparable resource to other statewide APCDs ndash A powerful tool that will only continue to grow with usendash Encompasses a robust set of information including
expenditures procedure codes diagnosis coding drug codes and enhanced value-adds (eg claim type master membermaster provider IDsNPIs MS-DRGs etc)
bull Future considerations to enhance the CT APCDndash Add Medicare and Medicaid claims datandash Continue to strengthen the completeness and validity of data
elements of importance to downstream analytic use cases (eg member race and ethnicity codes) in data collection
Lessons Learned
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
43
Next Steps
44
01Task
02Task
Ensure data quality issues are identified documented communicated and resolved
Data Quality
Continue building breadth of payer database amp complete enclave load
Data ETL
Finalize strategy to ensure site accomplishes PA 13-247 and PA 15-146 intent
Establish Strategy
05Task
Identify leading consumer information and price transparency tools available
Consumer Tool Evaluation04Task
Tasks Until Next Meeting (11917)APCD Development and Strategy Update
Distinguish Critical Paths Across and Within Strategic Priorities and Maintain Focus on ldquoMust Havesrdquo and ldquoQuick Winsrdquo
Ensure APCD staff can generate self-service extracts at little cost with minimal lead time
Deliver First DR Extract03Task
45
Future MeetingsAPCD Development and Strategy Update
November
9Legislative Office
Building Room 1D 300 Capitol Avenue
Hartford
All Payer Claims Database Advisory GroupMeeting
900ndash1100 AM
38
Breast Cancer Screening
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
60
62
64
66
68
70
72
Urban Centers (n=3369) Manufacturing Centers (n=10974) Diverse Suburbs (n=12206) Mill Towns (n=16281) Rural Towns (n=16789) Wealthy Suburbs (n=12266)
39
Vermont Blueprintrsquos Hub amp Spoke Model
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
bull Vermontrsquos ldquoHealth Homerdquo program designed to treat Vermonters with chronic opioid addiction
bull Hubs ndash designated providers ndash Provide coordinated care to patients through MAT services
ndash Coordinate referral to ongoing care
bull Spokes ndash teams of healthcare professionalsndash Blueprint Advanced Practice Medical Homes
ndash Federally-Qualified Health Centers
ndash Outpatient substance abuse and primary care providers
40copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Medication Assisted Treatment
bull Vermont Blueprint baseline study comparing medication-assisted treatment (MAT) population versus non-MAT population
bull Study published in the Journal of Substance Abuse Treatment (August 2016)
41
bull The CT APCD is a comparable resource to other statewide APCDs ndash A powerful tool that will only continue to grow with usendash Encompasses a robust set of information including
expenditures procedure codes diagnosis coding drug codes and enhanced value-adds (eg claim type master membermaster provider IDsNPIs MS-DRGs etc)
bull Future considerations to enhance the CT APCDndash Add Medicare and Medicaid claims datandash Continue to strengthen the completeness and validity of data
elements of importance to downstream analytic use cases (eg member race and ethnicity codes) in data collection
Lessons Learned
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
43
Next Steps
44
01Task
02Task
Ensure data quality issues are identified documented communicated and resolved
Data Quality
Continue building breadth of payer database amp complete enclave load
Data ETL
Finalize strategy to ensure site accomplishes PA 13-247 and PA 15-146 intent
Establish Strategy
05Task
Identify leading consumer information and price transparency tools available
Consumer Tool Evaluation04Task
Tasks Until Next Meeting (11917)APCD Development and Strategy Update
Distinguish Critical Paths Across and Within Strategic Priorities and Maintain Focus on ldquoMust Havesrdquo and ldquoQuick Winsrdquo
Ensure APCD staff can generate self-service extracts at little cost with minimal lead time
Deliver First DR Extract03Task
45
Future MeetingsAPCD Development and Strategy Update
November
9Legislative Office
Building Room 1D 300 Capitol Avenue
Hartford
All Payer Claims Database Advisory GroupMeeting
900ndash1100 AM
39
Vermont Blueprintrsquos Hub amp Spoke Model
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
bull Vermontrsquos ldquoHealth Homerdquo program designed to treat Vermonters with chronic opioid addiction
bull Hubs ndash designated providers ndash Provide coordinated care to patients through MAT services
ndash Coordinate referral to ongoing care
bull Spokes ndash teams of healthcare professionalsndash Blueprint Advanced Practice Medical Homes
ndash Federally-Qualified Health Centers
ndash Outpatient substance abuse and primary care providers
40copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Medication Assisted Treatment
bull Vermont Blueprint baseline study comparing medication-assisted treatment (MAT) population versus non-MAT population
bull Study published in the Journal of Substance Abuse Treatment (August 2016)
41
bull The CT APCD is a comparable resource to other statewide APCDs ndash A powerful tool that will only continue to grow with usendash Encompasses a robust set of information including
expenditures procedure codes diagnosis coding drug codes and enhanced value-adds (eg claim type master membermaster provider IDsNPIs MS-DRGs etc)
bull Future considerations to enhance the CT APCDndash Add Medicare and Medicaid claims datandash Continue to strengthen the completeness and validity of data
elements of importance to downstream analytic use cases (eg member race and ethnicity codes) in data collection
Lessons Learned
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
43
Next Steps
44
01Task
02Task
Ensure data quality issues are identified documented communicated and resolved
Data Quality
Continue building breadth of payer database amp complete enclave load
Data ETL
Finalize strategy to ensure site accomplishes PA 13-247 and PA 15-146 intent
Establish Strategy
05Task
Identify leading consumer information and price transparency tools available
Consumer Tool Evaluation04Task
Tasks Until Next Meeting (11917)APCD Development and Strategy Update
Distinguish Critical Paths Across and Within Strategic Priorities and Maintain Focus on ldquoMust Havesrdquo and ldquoQuick Winsrdquo
Ensure APCD staff can generate self-service extracts at little cost with minimal lead time
Deliver First DR Extract03Task
45
Future MeetingsAPCD Development and Strategy Update
November
9Legislative Office
Building Room 1D 300 Capitol Avenue
Hartford
All Payer Claims Database Advisory GroupMeeting
900ndash1100 AM
40copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
Medication Assisted Treatment
bull Vermont Blueprint baseline study comparing medication-assisted treatment (MAT) population versus non-MAT population
bull Study published in the Journal of Substance Abuse Treatment (August 2016)
41
bull The CT APCD is a comparable resource to other statewide APCDs ndash A powerful tool that will only continue to grow with usendash Encompasses a robust set of information including
expenditures procedure codes diagnosis coding drug codes and enhanced value-adds (eg claim type master membermaster provider IDsNPIs MS-DRGs etc)
bull Future considerations to enhance the CT APCDndash Add Medicare and Medicaid claims datandash Continue to strengthen the completeness and validity of data
elements of importance to downstream analytic use cases (eg member race and ethnicity codes) in data collection
Lessons Learned
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
43
Next Steps
44
01Task
02Task
Ensure data quality issues are identified documented communicated and resolved
Data Quality
Continue building breadth of payer database amp complete enclave load
Data ETL
Finalize strategy to ensure site accomplishes PA 13-247 and PA 15-146 intent
Establish Strategy
05Task
Identify leading consumer information and price transparency tools available
Consumer Tool Evaluation04Task
Tasks Until Next Meeting (11917)APCD Development and Strategy Update
Distinguish Critical Paths Across and Within Strategic Priorities and Maintain Focus on ldquoMust Havesrdquo and ldquoQuick Winsrdquo
Ensure APCD staff can generate self-service extracts at little cost with minimal lead time
Deliver First DR Extract03Task
45
Future MeetingsAPCD Development and Strategy Update
November
9Legislative Office
Building Room 1D 300 Capitol Avenue
Hartford
All Payer Claims Database Advisory GroupMeeting
900ndash1100 AM
41
bull The CT APCD is a comparable resource to other statewide APCDs ndash A powerful tool that will only continue to grow with usendash Encompasses a robust set of information including
expenditures procedure codes diagnosis coding drug codes and enhanced value-adds (eg claim type master membermaster provider IDsNPIs MS-DRGs etc)
bull Future considerations to enhance the CT APCDndash Add Medicare and Medicaid claims datandash Continue to strengthen the completeness and validity of data
elements of importance to downstream analytic use cases (eg member race and ethnicity codes) in data collection
Lessons Learned
copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution
43
Next Steps
44
01Task
02Task
Ensure data quality issues are identified documented communicated and resolved
Data Quality
Continue building breadth of payer database amp complete enclave load
Data ETL
Finalize strategy to ensure site accomplishes PA 13-247 and PA 15-146 intent
Establish Strategy
05Task
Identify leading consumer information and price transparency tools available
Consumer Tool Evaluation04Task
Tasks Until Next Meeting (11917)APCD Development and Strategy Update
Distinguish Critical Paths Across and Within Strategic Priorities and Maintain Focus on ldquoMust Havesrdquo and ldquoQuick Winsrdquo
Ensure APCD staff can generate self-service extracts at little cost with minimal lead time
Deliver First DR Extract03Task
45
Future MeetingsAPCD Development and Strategy Update
November
9Legislative Office
Building Room 1D 300 Capitol Avenue
Hartford
All Payer Claims Database Advisory GroupMeeting
900ndash1100 AM
43
Next Steps
44
01Task
02Task
Ensure data quality issues are identified documented communicated and resolved
Data Quality
Continue building breadth of payer database amp complete enclave load
Data ETL
Finalize strategy to ensure site accomplishes PA 13-247 and PA 15-146 intent
Establish Strategy
05Task
Identify leading consumer information and price transparency tools available
Consumer Tool Evaluation04Task
Tasks Until Next Meeting (11917)APCD Development and Strategy Update
Distinguish Critical Paths Across and Within Strategic Priorities and Maintain Focus on ldquoMust Havesrdquo and ldquoQuick Winsrdquo
Ensure APCD staff can generate self-service extracts at little cost with minimal lead time
Deliver First DR Extract03Task
45
Future MeetingsAPCD Development and Strategy Update
November
9Legislative Office
Building Room 1D 300 Capitol Avenue
Hartford
All Payer Claims Database Advisory GroupMeeting
900ndash1100 AM
44
01Task
02Task
Ensure data quality issues are identified documented communicated and resolved
Data Quality
Continue building breadth of payer database amp complete enclave load
Data ETL
Finalize strategy to ensure site accomplishes PA 13-247 and PA 15-146 intent
Establish Strategy
05Task
Identify leading consumer information and price transparency tools available
Consumer Tool Evaluation04Task
Tasks Until Next Meeting (11917)APCD Development and Strategy Update
Distinguish Critical Paths Across and Within Strategic Priorities and Maintain Focus on ldquoMust Havesrdquo and ldquoQuick Winsrdquo
Ensure APCD staff can generate self-service extracts at little cost with minimal lead time
Deliver First DR Extract03Task
45
Future MeetingsAPCD Development and Strategy Update
November
9Legislative Office
Building Room 1D 300 Capitol Avenue
Hartford
All Payer Claims Database Advisory GroupMeeting
900ndash1100 AM
45
Future MeetingsAPCD Development and Strategy Update
November
9Legislative Office
Building Room 1D 300 Capitol Avenue
Hartford
All Payer Claims Database Advisory GroupMeeting
900ndash1100 AM
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