Combining Clinical and Claims Data in a Multi-Payer Database: Lessons Learned EVENT NAHDO 30th Anniversary Conference October 28, 2015 BACKGROUND TIMELINE PRESENTER Myron Hepner Director, Michigan Data Collaborative, Information and Data Management, Medical Center Information Technology (MCIT), University of Michigan Health System LESSONS LEARNED FINDINGS
BACKGROUND PHYSICIAN PAYERS ORGANIZATIONS 1. Medicaid 2. Medicare 3. BCBSM EHR Data Claims Data 4. BCN 5. Priority Health = = Electr ctroni nic c Clini nica cal Qualit ity y Measur sures es (eCQ CQMs) ) 2
BACKGROUND Challenges Success Factors Obtained PO Support through MiPCT Incentive Program Original Dashboard contained claims data Leveraged existing processes for five Payers and formats Flexibility and support Combine clinical Phased approach with claims data Is a patient’s health getting better? Dedicated staff 3
TIMELINE JUNE FEBRUARY FEBRUARY POs began POs submit Incentive sending historic data Calculations monthly SPRING production files Dashboard Developed production for format Release data request files confirmation 12.0 .0 2012 2013 2014 2015 FALL NOVEMBER JUNE FUTURE SEPTEMBER Investigate Final layout Measures Incentives Incentive formats options Published to improve Calculations First implemented Dashboard patient Dashboard communication Data request Release Release health with POs spec 9.0 10.0 completed 2016 and beyond… Proof of Concept files received (2012 – 2013) 4
LESSONS LEARNED Varied content Incentives focused PO attention for each PO on open issues POs didn’t update patient list when sending monthly data Who owns the data? Help POs coordinate between IT, Quality Department, and Leadership Needed explicit communication and in-person support Demonstrating to POs how reporting is a better representation Claims and Clinical data are both of their patient population trusted sources of truth 5
FINDINGS 75% 80% Claims ms-based sed qu quality ty …plus measures supplemented measures… with th EHR-base ased d clini nical al data 6
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