Barbara Rudolph, PhD, MSSW
NAHDO Consultant
• To enhance the value of
statewide APCDs by
cataloging measures and
reporting practices
• To develop and disseminate
APCD reporting guidance
with considerations for state
APCD systems
• To facilitate APCD planning
and reporting activities
across states thus reducing
duplicative planning efforts
 Review APCD Council site
 Review individual state
APCD websites
 General Web Search
 Conference calls with
State Work Group
 Review of Reporting and
Measures Table by
workgroup
States with Public Reports
• Maryland
• New Hampshire
• Utah
• Vermont
• Colorado (Planned)
States with Websites
• Maine
• New Hampshire
• Massachusetts
• Washington
• Colorado (Planned)
Scope of Measurement
Utilization
Cost
Quality
Efficiency
Population
Health
Covered by all APCDs—using different types of measures
• Global—overall utilization, payer groups, health planning
areas, service lines
• Provider specific—Utilization of inpatient, outpatient, ED,
observation, specialty, primary care, chiropractic, osteopathic,
dental, pharmacy, imaging
• Payer type—Utilization by Medicaid, SCHIP, CHIP, Medicare,
Medicare Part D, Private payer, Employer
• Procedures/Conditions—Number of high cost procedures and
conditions, knee, lumbar, mental health, screenings (cholesterol,
diabetes, kidney disease), prescriptions for specific conditions
Most APCD’s address cost—(using different measures)
• Cost to Payer—PMPM costs, high cost area, profile reports on
medical, dental, pharmacy costs by payer, high cost distribution
by plan product type, plan payments, plan costs by procedure,
plan costs by health service area, aggregated costs for
commercial population, payments per day and per day’s supply
by major therapeutic categories of drugs
• Cost to Patient—Total out-of-pocket cost, co-pays, co-insurance,
deductible amounts, cost to uninsured vs insured, costs by
procedure and by provider
• Provider Cost—by specialty, standardized pricing, compared
for units of service and mix of service
• Cost by Procedure/Condition—measures for preventive health,
ED Visit, radiology, common surgical procedures, maternity
measures, CRG, Diagnosis, chronic conditions, pharmacy costs
• Episode Cost—Burden of illness by CRG, diabetes, asthma
depression
Some APCD’s are reporting limited quality measures:
• Use of tools like MONAHRQ for reporting quality measures
• Use of NCQA (HEDIS) measures—for mental health and
substance abuse, medical groups, hospitals
• Use of some process measures for medical groups (LDL_C,
HbA1C, eye exams, )
• Use of CMS measures for hospital care
• Use of HCAPHS patient experience of care
• Re-admission rates (both cost and quality)
Measures thought to address efficiency include:
• Admission rates for ambulatory sensitive conditions
• Rates for potentially avoidable ED visits
• Costs per procedure by provider
• Length of Stay
• 30-day Readmission Rates
• Variation in rates of imaging
• Pharmacy payments by hospital service area presented as
PMPM; payments per day’s supply by major therapeutic
categories of drugs by HAS
• Provider’s costs to others of the same specialty—costs by mix of
ETG’s using standardized pricing
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Prevalence of key chronic conditions
Admission rates for ambulatory care sensitive conditions
Geographic variations in utilization, cost and care
High Cost areas for Medicaid and Commercial populations
Trends in healthcare costs
Overall measures such as PMPM by geography
Percentage of total health care costs of the top five chronic conditions
Asthma billed medical costs and amounts paid by age group
Health screenings for chronic conditions in small areas
Variation in imaging rates across geography
Key contributors driving pharmacy payments
Provider access measures
Draft Table
• APCD’s that are most developed in terms of public reporting
are those that have had APCD systems longer…
• New APCD’s have public plans for reporting, but because of
data lag they are not yet reporting
• States with mandatory reporting tend to do more public
reporting
• Voluntary collections are less likely to report publicly and those
that do are more likely to use measures that do not distinguish
between providers (e.g., process measures with 99%
compliance)
• Wide variation in number of reports and, whether or not there
is a “choice” website for the public, and utility of reporting
• Large range of measures in use—when you see one of a kind
measures—it is likely due to particular stakeholders
• Population health measures are plentiful; mainly utilizing geographic
variation to examine prevalence of disease, access to care
• Certain types of measures are more expensive to produce—require
risk adjustment or diagnostic/episodic groupers ; episode
measurement very limited—due to complexity of decision rules,
software, provider push back and other factors
• Quality measures are also limited given the availability of hundreds
of endorsed measures—likely due to a focus on costs by stakeholders
• Some quality measures in use have little or no variation across
providers—and therefore, very little utility
• Because of limitation on quality measures and episode measures—
efficiency measures are also lean. No composite measures of
efficiency in use.
• At this time, it would be very difficult to create benchmarks or to do
regional/national analyses given the lack of consistency in measures
used by APCDs
• Transparency boundaries
for voluntary collections
• Complex analytic
boundaries for
established APCDs
• Standardization
Boundaries for all!
• Provide a guidance
document
• Provide a completed
Table of Measures
• Provide a Knowledge
Base Tool (when funding
is available)