Department of Financial Regulation
Vermont Healthcare Claims Uniform
Reporting & Evaluation System:
Evolving Analytical Applications for Claims Data
Presented at the 6th Annual All Payer Database Conference
National Association of Health Data Organizations
State Uses of APCDs for Policy, Healthcare Reform, and Reporting
October 25, 2012
Dian Kahn, B.S.N., M.P.A.
dian.kahn@state.vt.us
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Building the “RES” in VHCURES?
Vermont Healthcare Claims Uniform Reporting & Evaluation System
Broad State Mandate (18 V.S.A. §9410):
To the extent allowed by HIPAA, the data shall be available as a resource for insurers,
employers, providers, purchasers of health care and state agencies to continuously
review health care utilization, expenditures, and performance in Vermont.
Only a single specified mandated annual report of insurer paid claims amounts by
insurer is the basis for the calculation of two state assessments on insurers.
Who can use the data? Proposed use must meets statutory and regulatory criteria.
“Serves the needs of the State of Vermont and/or the public interest.” Not approved
for proprietary commercial use.
Analytical uses are evolving and expanding as Vermont’s health care reforms are
planned, implemented, monitored, and evaluated.
State Financing Model
Insurance Exchange Planning
Advanced Primary Care Medical Home
Payment Reform, etc.
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VHCURES Development Drives and Responds to Needs for Analytics
Phase 1: 2009- 2011 Commercial Insurers and Insured Population
•
Get the data! Start collecting the data, get reporting compliance, and achieve basic data
completeness/quality.
•
Report the basics! Commercial enrollment, expenditures, HEDIS process measures, instate geographic variation; test utility of APCD for enhancing insurance rate review.
Utilization and expenditures measures applied to subset of commercial insurers
participating in Blueprint primary care medical home program.
•
Start to think regional! Interstate agreement to support the Vermont Tri-state Report on
Variation in commercial insurance utilization and expenditures (VT, NH,ME).
Phase 2: 2011- 2012 Integration of Medicaid and Medicare
•
Increased demand ! Proliferation of data use agreements including 5 state agencies. 150
data user affidavits on file linked to 17 DUAs including state employees, state contractors,
and approved researchers. Some DUAs approved for both commercial and Medicaid data.
•
Medicare Use Limited ! Obtained through CMMI MAPCP grant with use limited to medical
home program evaluation and CMS conditions of use.
•
Deeper Analytics! Comparative cohort study for Blueprint medical home program.
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VHCURES Development Drives and Responds to Needs for Analytics
Phase 3: 2012 and Future: Informatics and Technology Convergence for Big Data
•
Continuous Data Quality Improvement! Data Users Group includes users, researchers,
and insurers to identify issues with current data- prioritization, points of accountability,
action plan; recommend future enhancements to reporting requirements- feasibility,
prioritization, action plan; and share knowledge about using claims data in health care
services, public health, and health policy research. Planning wiki site for information
sharing. Current distribution list for data users group= 150+ individuals.
•
Urge to Merge! Exploring legal and technical issues related to data linkage across
administrative, financial, clinical, registry, vital records data to support longitudinal and
comprehensive person-level records.
•
More Robust Analytics! “What if” modeling for predicting risk, utilization, cost, access to
services (provider and service detail); spatial analysis with richer geographic,
demographic, health status/risk, socioeconomic detail. Inclusion of both commercial and
Medicaid populations in standard report series and approved studies. Will seek CMS DUA
for broader use of Medicare data than currently authorized under MAPCP grant.
•
Comparative Benchmarks! Explore options for interstate data sharing agreements with
other APCD states and participate in CMS/ASPE MCDB as data submitter and user.
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Tri-State Variation in Health Services
Outpatient Use – Potentially Avoidable Outpatient ED Visits
Sore throat, strep
Viral infection, unspecified
Anxiety, unspecified or
generalized
Conjunctivitis, acute or
unspecified
External & middle ear
infections, acute or
unspecified
Upper respiratory infections,
acute or unspecified
Bronchitis, acute or
unspecified, & cough
Asthma
Dermatitis & rash
Joint pain
Lower/unspecified back pain
Muscle/soft tissue limb pain
Fatigue
Headache
Newport
(50.8)
Caribou
(136.3)
Burlington
(16.1)
Tri-State Variation in Health Services Utilization & Expenditures in Northern New England, June 2010
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SAMPLE MEASURE- Per Member Per Month Claims Expenditures
Comprehensive chart book of measures for health status, utilization, and expenditures to be released in November
2012 with commercial and Medicaid data for under 65 populations enrolled with comprehensive benefits spanning
incurred service period of January 1, 2007- December 31, 2011.
THIS IS A TEMPLATE AND DOES NOT INCLUDE ACTUAL DATA
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% of Each Vermont Town’s Primary Care Visits to Burlington
49.6% of Burlington member visits (05401 Zip Code) were to providers in the 05401 Zip Code.
These data (05401 to 05401) cannot be shown using a spider diagram.
Primary Care Service Area Study: Merges and
reconciles provider data from claims with primary
care practice roster, HIE practice registry, and
licensure data for physicians, ARNPs, and PAs.
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VHCURES program information including listing of reports:
http://www.dfr.vermont.gov/health-care/health-insurers/vermont-healthcareclaims-uniform-reporting-and-evaluation-system-vhcure
VHCURES Data Users Listing:
http://www.dfr.vermont.gov/sites/default/files/VHCURES-Data-User-09102012.pdf
Dian Kahn, Director of Analysis and Data Management
dian.kahn@state.vt.us or (802) 828-2906
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