Board Meeting May 11, 2016 PRELIMINARY PREDECISIONAL WORKING - PowerPoint PPT Presentation

Board Meeting May 11, 2016

PRELIMINARY PREDECISIONAL WORKING DOCUMENT: SUBJECT TO CHANGE Agenda Topic Call to order Status updates Access to claims data Executive Director update Board business Public comment 2 PROPRIETARY AND CONFIDENTIAL

PRELIMINARY PREDECISIONAL WORKING DOCUMENT: SUBJECT TO CHANGE Agenda Topic Call to order Status updates Access to claims data Executive Director update Board business Public comment 3 PROPRIETARY AND CONFIDENTIAL

PRELIMINARY PREDECISIONAL WORKING DOCUMENT: SUBJECT TO CHANGE Summary of April DCHI Board meeting ▪ Board voted to adopt 2016 Q1 financial statement ▪ Executive director updated Board on recruiting for Healthy Neighborhoods Director and administrative assistant ▪ Heard an update from each Committee on progress against Year 2 SIM goals ▪ Received an update on CMS’s launch of Comprehensive Primary Care Plus (CPC+) and the opportunity for Delaware to submit an application to participate ▪ Discussed Payment Committee’s draft consensus paper on access to claims data 4 PROPRIETARY AND CONFIDENTIAL

PRELIMINARY PREDECISIONAL WORKING DOCUMENT: SUBJECT TO CHANGE April committee updates (1/2) Committee Update Path forward ▪ Updated licensing and credentialing ▪ Finalize licensing and consensus paper with key survey findings credentialing consensus paper Workforce ▪ Conducted survey follow up interviews ▪ Begin drafting workforce capacity planning analysis ▪ Reviewed messaging concepts for the DCHI ▪ Finalize messaging and other Town Hall meetings programmatic details for the Town Hall meetings ▪ Developed a document to capture key Consumer ▪ Develop outline for consensus themes and best practices of previous presenters paper on consumer engagement best practices ▪ Reviewed progress on practice ▪ Prepare v2.0 release to testing transformation enrollment and discussed practices and determine most effective ways to support PCPs statewide goals ▪ Continue to refine approach to ▪ Shared update on emerging perspective of Clinical behavioral health integration approach to behavioral health integration ▪ Discussed the opportunity for Delaware to participate in CPC+ 5 PROPRIETARY AND CONFIDENTIAL

PRELIMINARY PREDECISIONAL WORKING DOCUMENT: SUBJECT TO CHANGE April committee updates (2/2) Committee Update Path forward ▪ Finalized outreach materials for ▪ Develop Local Council resource community leader meetings and began library meeting with potential Council members ▪ Continue outreach plan and Healthy ▪ Initiated outreach with community Neighborhoods selection of first local council leaders in Wilmington and West/Central Sussex ▪ Discussed feedback on draft of paper on ▪ Present revised draft of paper to access to claims data and recommended Board ▪ Continue to monitor progress on additions, including analysis of potential unintended consequences in similar Payment launch of outcomes-based states that have launched APCDs payment models ▪ Reviewed an update on the Scorecard ▪ Release v2.0 with attribution to including plans for a May release of v2.0 testing practices in May data to testing practices and a ▪ Complete data quality deep dive September release statewide TAG ▪ Discussed performance management for the Scorecard including key interdependencies and an escalation pathway 6 PROPRIETARY AND CONFIDENTIAL

PRELIMINARY PREDECISIONAL WORKING DOCUMENT: SUBJECT TO CHANGE Agenda Topic Call to order Status updates Access to claims data Executive Director update Board business Public comment 7 PROPRIETARY AND CONFIDENTIAL

PRELIMINARY PREDECISIONAL WORKING DOCUMENT: SUBJECT TO CHANGE DCHI draft paper on access to claims data Use cases ▪ 1 Population health improvement . Community leaders of population health and quality improvement initiatives may use claims data to understand the prevalence of illness and injury within the broader state population and specific communities ▪ Value-based purchasing. Purchasers may 2 benefit from analyses that provide insights into factors that contribute to cost, utilization and quality of care spanning populations ▪ Provider risk sharing . Providers benefit from 3 greater transparency on cost, utilization, and quality performance to identify drivers for improvement and to support entry into risk- sharing arrangements ▪ Consumer shopping for care. Access to 4 claims data allows consumers to determine what their share of the costs would be, often through “shopping tools” such as websites that provide information on the cost of care for a procedure 8 PROPRIETARY AND CONFIDENTIAL

PRELIMINARY PREDECISIONAL WORKING DOCUMENT: SUBJECT TO CHANGE Access to claims data: potential data flow ILLUSTRATIVE and operations Data suppliers Data users Governing Provider risk body Medicare sharing Claims data Medicaid MCO A Value-based APCD purchasing Medicaid Comparative MCO B analysis Population HIE Analytic health State engine improvement Employees Health Plan Commercial Consumer Payer XYZ shopping 9 PROPRIETARY AND CONFIDENTIAL

PRELIMINARY PREDECISIONAL WORKING DOCUMENT: SUBJECT TO CHANGE Potential implementation options 1 Population health improvement May be fully enabled 2 Value-based purchasing May be partially enabled 3 Provider risk sharing mapped to use cases Not possible to enable 4 Consumer shopping for care Use Cases 1 2 3 4 Description Considerations ▪ All payers submit post-adjudicated ▪ Access to data subject to specific authorized uses only ▪ Insights amplified by aggregation across payers and providers claims data to central database ▪ Centralized analysis or data extracts to ▪ Affords insight into all drivers of cost variation APCD with 3 rd parties for specific authorized uses ▪ Some use cases may allow for masking of proprietary A contracted ▪ Analysis/extract may either reflect unit information unit prices ▪ Consumer shopping may be better enabled by payers prices, or regional averages depending on specific use case themselves based on ability to estimate of out-of-pocket (OOP) liability ▪ All payers submit claims data without ▪ Access to data subject to specific authorized uses only ▪ Insights amplified by aggregation across payers and providers contracted prices to central hub APCD without ▪ Centralized analysis or data extracts to ▪ Affords insight into only select drivers of cost variation contracted B 3 rd parties for specific authorized uses unit price ▪ Analyses use Medicare rates or RVUs information in lieu of contracted unit prices ▪ Payers independently analyze claims ▪ Uses constrained to centrally defined analyses Centralized data to generate standardized outputs ▪ Multiple producers of data/ analytics require close monitoring reporting of ▪ Analytic outputs are aggregated C and clear formats to ensure consistent reporting payer-executed centrally, compiled for reporting analyses ▪ Risk-bearing providers receive claims ▪ Insights constrained by size of population included Data sharing ▪ Requires each risk-bearing provider to operationalize data information directly from payers D between payers ▪ Providers conduct analyses themselves extraction, transformation, and loading separately with each and providers or through 3 rd -party vendors payer ▪ Payers independently provide ▪ Consumer shopping enabled by payer estimate of OOP liability ▪ Other insights constrained by size of population included Payer-specific providers and/or consumers with ▪ Uses constrained to analyses as defined by payers E performance analytic reports or performance ▪ Providers may receive multiple reports from different payers reporting measures for quality, utilization, and cost complicating integration into their workflow 10 PROPRIETARY AND CONFIDENTIAL

PRELIMINARY PREDECISIONAL WORKING DOCUMENT: SUBJECT TO CHANGE Draft recommendations pending further input / discussion ▪ Legislation should be considered to allow for the creation of an APCD and to mandate 1 participation by all state-regulated insurers ▪ A governing body should be established with authority over the APCD, including 2 representation from all key stakeholders groups ▪ 3 The existing DHIN infrastructure should be leveraged to facilitate the formation of the APCD ▪ Data reported to payers should be post-adjudicated claims data for all types of providers, 4 and should be as up-to-date as possible ▪ APCD start-up costs and operational costs should be funded through a combination of 5 sources that maximize federal funding while asking institutional users to bear a reasonable share of costs to access data and reporting ▪ DCHI should work with the APCD operator to design and implement a robust standard 6 analytics package to support the work of Healthy Neighborhoods and other population health improvement initiatives ▪ 7 Delaware’s APCD should release data extracts to risk-bearing providers, with appropriate protections for patient confidentiality ▪ Standard reporting on the drivers of cost and affordability, across populations should be 8 made publicly available ▪ The state should encourage payers to improve availability of consumer shopping tools and 9 build capabilities for the future 11 PROPRIETARY AND CONFIDENTIAL

PRELIMINARY PREDECISIONAL WORKING DOCUMENT: SUBJECT TO CHANGE Agenda Topic Call to order Status updates Access to claims data Executive Director update Board business Public comment 12 PROPRIETARY AND CONFIDENTIAL