DEVELOPING MEASURES AND ANALYTIC APPROACHES

Transcription

1 DEVELOPING MEASURES AND ANALYTIC APPROACHES State Health Reform Assistance Network APCD Small Group Convening New Orleans, LA January 23, 2014 Support for this resource provided through a grant from the Robert Wood Johnson Foundation s State Health Reform Assistance Network program.

2 Click Agenda to edit Master title style Click State to Experiences edit Master text Developing styles Analytics Goals and Constraints Infrastructure Vendor relationships Using APCDs to Understand $$$ Key definitions Challenges Tools 2

3 Click Analytic to edit Goals: Master Evolve title Over style Time Price Variation in utilization/costs Transparency Rate Setting Provider profiling Payment Reform DRIVE CHANGE 3

4 Analytic priorities also shaped by constraints Click to edit Master title style Click Statutory to edit Master text styles Second Can limit: level Third Who level has access to the data What Fourth types level of reports can be created When data and reports are released Where data are housed Budgetary Increased analytic sophistication increased cost Longer-term sustainability and all of the above can change over time 4

5 Infrastructure What to do In House Click to edit Master title style Intake Data cleaning Analytics Reporting Warehousing 5

6 Click State to APCD edit Models Master title style In House Outsourced 6

7 Click Example: to edit New Master York s title Solution style 7

8 Click Vendor to Relationships edit Master title style 8

9 Click Vendor to Relationships: edit Master title Considerations style Expertise Needed Proprietary Analytics Getting Started Adaptability and Responsiveness Opportunities to Integrate with Other Reporting Systems Evaluating Ongoing Relationships Difficult of Changing Vendors Downstream Increased Need for Localized and Ad Hoc reporting Capabilities Vendor s Willingness to Build Capacity 9

10 Click to edit Master title style 10

11 Click to edit Master title style 11

12 Click Using to APCDs edit Master for understanding title style 12

13 Click Goals to edit Master title style Price Variation in utilization/costs Transparency Rate Setting Provider profiling Payment Reform DRIVE CHANGE 13

14 Click Definitions to edit Master title style Click Price to edit to a Master payer: text the negotiated styles amount paid to a provider for a given service Price Third to level a patient: the amount paid out of pocket for a given service Charges: the amount a provider charges for a given service 14

15 Click Common to edit $$ Master APCD Fields title style 15

16 Click Dealing to with edit Master $$$ in APCDs title style.. some issues Consolidating data across payers Mix of FFS and capitated claims Claims run-out Risk sharing contract issues Standardizing Fifth data level definitions and formats Consistency and reliability within 1 payer s data Changes in processing policies and edits Carve-outs Risk sharing contracts 16

17 Click Making to Sense edit Master out of title $$ style Click Episodes: to edit One Master payment text styles to providers for multiple services associated with an episode of care. = Total Cost of Care: Annual total costs for similar cohorts of patients 17

18 Click Tools to edit help: Master Groupers title style Click Episodes: to edit Master text styles MS-DRGs ETGs MEGs APR-DRGs Total Cost of Care: CDPS ACGs CMS-HCCs HHS-HCCs DxCGs CRGs, ERGs 18

19 Click Considerations to edit Master title style Click Very to edit similar Master in logic, text data styles use, and predictive accuracy Some Third have level certain advantages for specific applications 19

20 Click to edit Master title style 20

21 Click Technical to edit Assistance Master title style Click SHADAC to edit Master available text to styles Second Talk level through analytic challenges, measurement approaches, etc. Review/provide feedback on analytic RFPs, deliverables, reporting formats, etc. Facilitate peer-to-peer learning on analytic challenges and strategies 21

22 Click to edit Contact Master Information title style Dave Knutson, MS Jennifer Ricards, MS Lacey Hartman, MPP