1

APCD Advisory Group Meeting

Access Health CT

August 10 2017

2

Todayrsquos AgendaAPCD Advisory Group Meeting

Call To Order and Introductions (5 minutes)

Public Comments (10 minutes)

Approval of Minutes (10 minutes)

Updates amp Project Status Overview (15 minutes)

APCD Data Release Update (30 minutes)

CT APCD Data - Preliminary Analysis Examples amp Showcase (30 minutes)

Next Steps (5 minutes)

Future Meetings amp Adjournment (5 minutes)

3

Public Comments

(2 Minutes per Commenter)

4

Approval of Minutes

May 11 2017 Advisory Group Meeting

5

APCD Updates amp Project

Status Overview

6

Minnesota - Analysis of Low-Value Health Services inthe Minnesota All Payer Claims Database1

Virginia - VHI Five Most Common Avoidable ER Visits2

State APCD Activity

HealthCostcom latest publicly available transparency website released3

Cost Transparency Websites

SAMHSA - Confidentiality of Alcohol and Drug Abuse Patient Records 42 CFR Part 2

National Policy Update

Recent National DevelopmentsAPCD Updates and Project Status

1) httpwwwhealthstatemnushealthreformallpayerlvsissuebriefpdf2) httpwwwalexandrianewsorg201707virginias-five-most-common-avoidable-er-visits3) httpswwwhealthcostcomconsumer4) httpswwwcgactgov2017actpa2017PA-00154-R00SB-00546-PAhtm

PA 17-154 ndash An Act Concerning Participating Provider Directories4

State Policy Update

2

Todayrsquos AgendaAPCD Advisory Group Meeting

Call To Order and Introductions (5 minutes)

Public Comments (10 minutes)

Approval of Minutes (10 minutes)

Updates amp Project Status Overview (15 minutes)

APCD Data Release Update (30 minutes)

CT APCD Data - Preliminary Analysis Examples amp Showcase (30 minutes)

Next Steps (5 minutes)

Future Meetings amp Adjournment (5 minutes)

3

Public Comments

(2 Minutes per Commenter)

4

Approval of Minutes

May 11 2017 Advisory Group Meeting

5

APCD Updates amp Project

Status Overview

6

Minnesota - Analysis of Low-Value Health Services inthe Minnesota All Payer Claims Database1

Virginia - VHI Five Most Common Avoidable ER Visits2

State APCD Activity

HealthCostcom latest publicly available transparency website released3

Cost Transparency Websites

SAMHSA - Confidentiality of Alcohol and Drug Abuse Patient Records 42 CFR Part 2

National Policy Update

Recent National DevelopmentsAPCD Updates and Project Status

1) httpwwwhealthstatemnushealthreformallpayerlvsissuebriefpdf2) httpwwwalexandrianewsorg201707virginias-five-most-common-avoidable-er-visits3) httpswwwhealthcostcomconsumer4) httpswwwcgactgov2017actpa2017PA-00154-R00SB-00546-PAhtm

PA 17-154 ndash An Act Concerning Participating Provider Directories4

State Policy Update

3

Public Comments

(2 Minutes per Commenter)

4

Approval of Minutes

May 11 2017 Advisory Group Meeting

5

APCD Updates amp Project

Status Overview

6

Minnesota - Analysis of Low-Value Health Services inthe Minnesota All Payer Claims Database1

Virginia - VHI Five Most Common Avoidable ER Visits2

State APCD Activity

HealthCostcom latest publicly available transparency website released3

Cost Transparency Websites

SAMHSA - Confidentiality of Alcohol and Drug Abuse Patient Records 42 CFR Part 2

National Policy Update

Recent National DevelopmentsAPCD Updates and Project Status

1) httpwwwhealthstatemnushealthreformallpayerlvsissuebriefpdf2) httpwwwalexandrianewsorg201707virginias-five-most-common-avoidable-er-visits3) httpswwwhealthcostcomconsumer4) httpswwwcgactgov2017actpa2017PA-00154-R00SB-00546-PAhtm

PA 17-154 ndash An Act Concerning Participating Provider Directories4

State Policy Update

4

Approval of Minutes

May 11 2017 Advisory Group Meeting

5

APCD Updates amp Project

Status Overview

6

Minnesota - Analysis of Low-Value Health Services inthe Minnesota All Payer Claims Database1

Virginia - VHI Five Most Common Avoidable ER Visits2

State APCD Activity

HealthCostcom latest publicly available transparency website released3

Cost Transparency Websites

SAMHSA - Confidentiality of Alcohol and Drug Abuse Patient Records 42 CFR Part 2

National Policy Update

Recent National DevelopmentsAPCD Updates and Project Status

1) httpwwwhealthstatemnushealthreformallpayerlvsissuebriefpdf2) httpwwwalexandrianewsorg201707virginias-five-most-common-avoidable-er-visits3) httpswwwhealthcostcomconsumer4) httpswwwcgactgov2017actpa2017PA-00154-R00SB-00546-PAhtm

PA 17-154 ndash An Act Concerning Participating Provider Directories4

State Policy Update

5

APCD Updates amp Project

Status Overview

6

Minnesota - Analysis of Low-Value Health Services inthe Minnesota All Payer Claims Database1

Virginia - VHI Five Most Common Avoidable ER Visits2

State APCD Activity

HealthCostcom latest publicly available transparency website released3

Cost Transparency Websites

SAMHSA - Confidentiality of Alcohol and Drug Abuse Patient Records 42 CFR Part 2

National Policy Update

Recent National DevelopmentsAPCD Updates and Project Status

1) httpwwwhealthstatemnushealthreformallpayerlvsissuebriefpdf2) httpwwwalexandrianewsorg201707virginias-five-most-common-avoidable-er-visits3) httpswwwhealthcostcomconsumer4) httpswwwcgactgov2017actpa2017PA-00154-R00SB-00546-PAhtm

PA 17-154 ndash An Act Concerning Participating Provider Directories4

State Policy Update

6

Minnesota - Analysis of Low-Value Health Services inthe Minnesota All Payer Claims Database1

Virginia - VHI Five Most Common Avoidable ER Visits2

State APCD Activity

HealthCostcom latest publicly available transparency website released3

Cost Transparency Websites

SAMHSA - Confidentiality of Alcohol and Drug Abuse Patient Records 42 CFR Part 2

National Policy Update

Recent National DevelopmentsAPCD Updates and Project Status

1) httpwwwhealthstatemnushealthreformallpayerlvsissuebriefpdf2) httpwwwalexandrianewsorg201707virginias-five-most-common-avoidable-er-visits3) httpswwwhealthcostcomconsumer4) httpswwwcgactgov2017actpa2017PA-00154-R00SB-00546-PAhtm

PA 17-154 ndash An Act Concerning Participating Provider Directories4

State Policy Update

7

01Task

02Task

03Task

Ensure data quality issues are identified documented communicated and resolved

Data Quality

Promote data usage as a form of data QA

Preliminary Reporting

Continue building breadth of payer database amp complete enclave load

Data ETL

Identify leading consumer information and price transparency tools available

Consumer Tool Evaluation05Task

Finalize strategy to ensure site accomplishes PA 13-247 and PA 15-146 intent

Establish Strategy06Task

Ensure APCD staff can generate self-service extracts at little cost with minimal lead time

Extract Development04Task

Target Initiatives Since Last MeetingAPCD Development and Strategy Update

Distinguish Critical Paths Across and Within Strategic Priorities and Maintain Focus on ldquoMust Havesrdquo and ldquoQuick Winsrdquo

8

Accomplishments Since Last MeetingAPCD Updates and Project Status

Data Collection Status2016 Commercial data normalization and load into enclave to be completed by May 15th

Data Release Architecture CompletePreliminary data dictionary released Data release extract tool development nearly complete

Medicare Data ApprovedApplication for CMS Medicare data approved Data received and integration in progress

Data Release Training and CoordinationData Release Committee re-engaged and 1st release review scheduled August16th

Preliminary Analysis and End User FeedbackPopulation segmentation and profiling underway value added tables amp software in various phases of implementation (knowledge bases risk scoring software etc)

First Data Release Application1st completed data release application received

9

Data Collection Status UpdateAPCD Updates and Project Status

Eligibility Medical Pharmacy ProviderStatusNotesStart Date End Date Start Date End Date Start Date End Date Start Date End Date

AetnaAetna Health Insurance HMO FI 012012 062017 012012 062017 012012 062017 012012 062017 Submitter is current with file submissions to OnpointAetna Health Insurance HMO on ACAS FI 012012 062017 012012 062017 012012 062017 NA NA Submitter is current with file submissions to OnpointAetna Life Insurance Company Aetna Student Health 012012 062017 012012 062017 NA NA 012012 062017 Submitter is current with file submissions to OnpointAetna Life Insurance Company HMO Medicare 012012 062017 012012 062017 012012 062017 NA NA Submitter is current with file submissions to OnpointAetna Life Insurance Company Traditional 012012 062017 012012 062017 012012 062017 012012 062017 Submitter is current with file submissions to Onpoint

Anthem012012 012017 012012 012017 012012 012017 012012 012017 Submitter to resume data submissions in October 2017

Caremark LLC012012 062017 NA NA 012012 062017 NA NA Submitter is current with file submissions to Onpoint

CignaCigna Health and Life Insurance Company Inc - West 012012 062017 012012 062017 012012 062017 012012 062017 Submitter is current with file submissions to OnpointCigna Health and Life Insurance Company Inc - East 012012 062017 012012 062017 012012 062017 012012 062017 Submitter is current with file submissions to Onpoint

ConnectiCareConnectiCare 012012 052017 012012 052017 012012 052017 012012 052017 Submitter has not yet supplied June 2017 file submissionsConnectiCare Inc - Medicare Advantage 012012 052017 012012 052017 012012 012017 012012 052017 Submitter has not yet supplied June 2017 file submissions

Express Scripts- - NA NA - - NA NA Submitter supplied January 2012 test files on 872017

First Health Life and Health Insurance Company012012 062017 NA NA 012012 062017 NA NA Submitter is current with file submissions to Onpoint

Harvard Pilgrim012012 062017 012012 062017 012012 062017 012012 062017 Submitter is current with file submissions to Onpoint

HealthyCT012014 122014 012014 122014 012014 122014 012014 122014 Submitter no longer active with the CT APCD

United Health GroupeviCore (UHC - Oxford) NA NA 012015 042017 - - 012012 042017 Submitter has not yet supplied May - June 2017 file submissionsOptumHealth Care Solutions Inc (Optum) NA NA 012012 062017 NA NA 012012 062017 Submitter is current with file submissions to OnpointOrthoNet NA NA 012012 062017 NA NA NA NA Submitter is current with file submissions to OnpointOxford Health Plans 012012 062017 012012 052017 012012 062017 012012 062017 Submitter has not yet supplied June 2017 medical claims fileUHC - Golden Rule 012012 062017 012012 062017 012012 062017 012012 062017 Submitter is current with file submissions to OnpointUnitedHealthcare Insurance - Medicare 012012 062017 012012 062017 012012 062017 012012 062017 Submitter is current with file submissions to OnpointUnitedHealthcare Insurance Company 012012 062017 012012 062017 012012 062017 012012 062017 Submitter is current with file submissions to Onpoint

WellCare Health Plans Inc012012 062017 012012 062017 012012 122015 012012 062017 Submitter is current with file submissions to Onpoint

Medicaid- - - - - - - -

Medicare- - - - - - - - Data received 82017

Submission D

elay lt 3 Months or Integration In Progress

Submission O

n Schedule

Submission N

ot Scheduled or ge 3 Months D

elayed

10

APCD Data Release

Update

11

Develop and implement core requirements to achieve DRcapabilities

Administration Data release application dictionary ampsupport materialsSoftwareTools Extract creation and delivery toolSupport Admin support and documentation

Phase 1 Develop DR Process Tools and CapabilitiesEngage potential requestors to ensurecapabilities opportunities and services arerecognized

Phase 2 Promotion and Delivery

Data Release (DR) RecapAPCD Data Release Update

Legislative Charge (PA 13-247) The exchange shall helliphellip and (B) make data in the all-payer claims database available to any state agency insurer employer health care provider consumer of health care services or researcher for the purpose of allowing such person or entity to review such data as it relates to health care utilization costs or quality of health care services

12

End to End application process can take between 17 to 40days depending on time of month an application issubmitted All requests must follow the data releaseprocess outlined by Privacy Policy amp Procedures

Data Release ApplicationRequestor general information project summary research details data selection and securityintegrity

Data Release CommitteeReview application alignment with objectives re-identification risk safeguard adequacy and research design

Data Use Agreement Fees amp ExtractUser agrees to fee schedule DUA requirements Standard extract creation within 5 business days (after 1st release)

S M T W T F S

1 2 3 4 5

6 7 8 9 10 11 12

13 14 15 16 17 18 19

20 21 22 23 24 25 26

27 28 29 39 31

DR Process amp Turn-Around TimeAPCD Data Release Update

13

DR TableField Classification MatrixAPCD Data Release Update

Table Name

Field Classifications

Administrative

Enrollee Coverage

InformationEnrollee

DemographicsClaim

InformationDiagnosis

Information

Procedure Coding amp

DetailFinancial

InformationProvider

InformationPayer

InformationSafe Harbor

Variable Grand TotalEligibility 2 11 1 1 1 1 4 21

Eligibility Supplemental 2 13 9 4 28

Medical 2 3 13 2 7 8 4 1 6 46

Medical Claim Header 2 5 7

Medical Supplemental 4 6 3 11 1 6 31

Medical Claim Diagnosis 1 3 1 5

Medical Claim Icd Procedure 2 14 5 4 1 26

Pharmacy 3 3 11 2 9 2 1 3 34

Pharmacy Supplemental 2 8 4 1 15

Provider 3 2 1 6Grand Total 23 30 10 55 10 15 41 10 5 20 219

Data Release Dictionary Located httpagencyaccesshealthctcommeetings1485450397264-a8f3a430-837b

8

Accomplishments Since Last MeetingAPCD Updates and Project Status

Data Collection Status2016 Commercial data normalization and load into enclave to be completed by May 15th

Data Release Architecture CompletePreliminary data dictionary released Data release extract tool development nearly complete

Medicare Data ApprovedApplication for CMS Medicare data approved Data received and integration in progress

Data Release Training and CoordinationData Release Committee re-engaged and 1st release review scheduled August16th

Preliminary Analysis and End User FeedbackPopulation segmentation and profiling underway value added tables amp software in various phases of implementation (knowledge bases risk scoring software etc)

First Data Release Application1st completed data release application received

9

Data Collection Status UpdateAPCD Updates and Project Status

Eligibility Medical Pharmacy ProviderStatusNotesStart Date End Date Start Date End Date Start Date End Date Start Date End Date

AetnaAetna Health Insurance HMO FI 012012 062017 012012 062017 012012 062017 012012 062017 Submitter is current with file submissions to OnpointAetna Health Insurance HMO on ACAS FI 012012 062017 012012 062017 012012 062017 NA NA Submitter is current with file submissions to OnpointAetna Life Insurance Company Aetna Student Health 012012 062017 012012 062017 NA NA 012012 062017 Submitter is current with file submissions to OnpointAetna Life Insurance Company HMO Medicare 012012 062017 012012 062017 012012 062017 NA NA Submitter is current with file submissions to OnpointAetna Life Insurance Company Traditional 012012 062017 012012 062017 012012 062017 012012 062017 Submitter is current with file submissions to Onpoint

Anthem012012 012017 012012 012017 012012 012017 012012 012017 Submitter to resume data submissions in October 2017

Caremark LLC012012 062017 NA NA 012012 062017 NA NA Submitter is current with file submissions to Onpoint

CignaCigna Health and Life Insurance Company Inc - West 012012 062017 012012 062017 012012 062017 012012 062017 Submitter is current with file submissions to OnpointCigna Health and Life Insurance Company Inc - East 012012 062017 012012 062017 012012 062017 012012 062017 Submitter is current with file submissions to Onpoint

ConnectiCareConnectiCare 012012 052017 012012 052017 012012 052017 012012 052017 Submitter has not yet supplied June 2017 file submissionsConnectiCare Inc - Medicare Advantage 012012 052017 012012 052017 012012 012017 012012 052017 Submitter has not yet supplied June 2017 file submissions

Express Scripts- - NA NA - - NA NA Submitter supplied January 2012 test files on 872017

First Health Life and Health Insurance Company012012 062017 NA NA 012012 062017 NA NA Submitter is current with file submissions to Onpoint

Harvard Pilgrim012012 062017 012012 062017 012012 062017 012012 062017 Submitter is current with file submissions to Onpoint

HealthyCT012014 122014 012014 122014 012014 122014 012014 122014 Submitter no longer active with the CT APCD

United Health GroupeviCore (UHC - Oxford) NA NA 012015 042017 - - 012012 042017 Submitter has not yet supplied May - June 2017 file submissionsOptumHealth Care Solutions Inc (Optum) NA NA 012012 062017 NA NA 012012 062017 Submitter is current with file submissions to OnpointOrthoNet NA NA 012012 062017 NA NA NA NA Submitter is current with file submissions to OnpointOxford Health Plans 012012 062017 012012 052017 012012 062017 012012 062017 Submitter has not yet supplied June 2017 medical claims fileUHC - Golden Rule 012012 062017 012012 062017 012012 062017 012012 062017 Submitter is current with file submissions to OnpointUnitedHealthcare Insurance - Medicare 012012 062017 012012 062017 012012 062017 012012 062017 Submitter is current with file submissions to OnpointUnitedHealthcare Insurance Company 012012 062017 012012 062017 012012 062017 012012 062017 Submitter is current with file submissions to Onpoint

WellCare Health Plans Inc012012 062017 012012 062017 012012 122015 012012 062017 Submitter is current with file submissions to Onpoint

Medicaid- - - - - - - -

Medicare- - - - - - - - Data received 82017

Submission D

elay lt 3 Months or Integration In Progress

Submission O

n Schedule

Submission N

ot Scheduled or ge 3 Months D

elayed

10

APCD Data Release

Update

11

Develop and implement core requirements to achieve DRcapabilities

Administration Data release application dictionary ampsupport materialsSoftwareTools Extract creation and delivery toolSupport Admin support and documentation

Phase 1 Develop DR Process Tools and CapabilitiesEngage potential requestors to ensurecapabilities opportunities and services arerecognized

Phase 2 Promotion and Delivery

Data Release (DR) RecapAPCD Data Release Update

Legislative Charge (PA 13-247) The exchange shall helliphellip and (B) make data in the all-payer claims database available to any state agency insurer employer health care provider consumer of health care services or researcher for the purpose of allowing such person or entity to review such data as it relates to health care utilization costs or quality of health care services

12

End to End application process can take between 17 to 40days depending on time of month an application issubmitted All requests must follow the data releaseprocess outlined by Privacy Policy amp Procedures

Data Release ApplicationRequestor general information project summary research details data selection and securityintegrity

Data Release CommitteeReview application alignment with objectives re-identification risk safeguard adequacy and research design

Data Use Agreement Fees amp ExtractUser agrees to fee schedule DUA requirements Standard extract creation within 5 business days (after 1st release)

S M T W T F S

1 2 3 4 5

6 7 8 9 10 11 12

13 14 15 16 17 18 19

20 21 22 23 24 25 26

27 28 29 39 31

DR Process amp Turn-Around TimeAPCD Data Release Update

13

DR TableField Classification MatrixAPCD Data Release Update

Table Name

Field Classifications

Administrative

Enrollee Coverage

InformationEnrollee

DemographicsClaim

InformationDiagnosis

Information

Procedure Coding amp

DetailFinancial

InformationProvider

InformationPayer

InformationSafe Harbor

Variable Grand TotalEligibility 2 11 1 1 1 1 4 21

Eligibility Supplemental 2 13 9 4 28

Medical 2 3 13 2 7 8 4 1 6 46

Medical Claim Header 2 5 7

Medical Supplemental 4 6 3 11 1 6 31

Medical Claim Diagnosis 1 3 1 5

Medical Claim Icd Procedure 2 14 5 4 1 26

Pharmacy 3 3 11 2 9 2 1 3 34

Pharmacy Supplemental 2 8 4 1 15

Provider 3 2 1 6Grand Total 23 30 10 55 10 15 41 10 5 20 219

Data Release Dictionary Located httpagencyaccesshealthctcommeetings1485450397264-a8f3a430-837b

9

Data Collection Status UpdateAPCD Updates and Project Status

Eligibility Medical Pharmacy ProviderStatusNotesStart Date End Date Start Date End Date Start Date End Date Start Date End Date

AetnaAetna Health Insurance HMO FI 012012 062017 012012 062017 012012 062017 012012 062017 Submitter is current with file submissions to OnpointAetna Health Insurance HMO on ACAS FI 012012 062017 012012 062017 012012 062017 NA NA Submitter is current with file submissions to OnpointAetna Life Insurance Company Aetna Student Health 012012 062017 012012 062017 NA NA 012012 062017 Submitter is current with file submissions to OnpointAetna Life Insurance Company HMO Medicare 012012 062017 012012 062017 012012 062017 NA NA Submitter is current with file submissions to OnpointAetna Life Insurance Company Traditional 012012 062017 012012 062017 012012 062017 012012 062017 Submitter is current with file submissions to Onpoint

Anthem012012 012017 012012 012017 012012 012017 012012 012017 Submitter to resume data submissions in October 2017

Caremark LLC012012 062017 NA NA 012012 062017 NA NA Submitter is current with file submissions to Onpoint

CignaCigna Health and Life Insurance Company Inc - West 012012 062017 012012 062017 012012 062017 012012 062017 Submitter is current with file submissions to OnpointCigna Health and Life Insurance Company Inc - East 012012 062017 012012 062017 012012 062017 012012 062017 Submitter is current with file submissions to Onpoint

ConnectiCareConnectiCare 012012 052017 012012 052017 012012 052017 012012 052017 Submitter has not yet supplied June 2017 file submissionsConnectiCare Inc - Medicare Advantage 012012 052017 012012 052017 012012 012017 012012 052017 Submitter has not yet supplied June 2017 file submissions

Express Scripts- - NA NA - - NA NA Submitter supplied January 2012 test files on 872017

First Health Life and Health Insurance Company012012 062017 NA NA 012012 062017 NA NA Submitter is current with file submissions to Onpoint

Harvard Pilgrim012012 062017 012012 062017 012012 062017 012012 062017 Submitter is current with file submissions to Onpoint

HealthyCT012014 122014 012014 122014 012014 122014 012014 122014 Submitter no longer active with the CT APCD

United Health GroupeviCore (UHC - Oxford) NA NA 012015 042017 - - 012012 042017 Submitter has not yet supplied May - June 2017 file submissionsOptumHealth Care Solutions Inc (Optum) NA NA 012012 062017 NA NA 012012 062017 Submitter is current with file submissions to OnpointOrthoNet NA NA 012012 062017 NA NA NA NA Submitter is current with file submissions to OnpointOxford Health Plans 012012 062017 012012 052017 012012 062017 012012 062017 Submitter has not yet supplied June 2017 medical claims fileUHC - Golden Rule 012012 062017 012012 062017 012012 062017 012012 062017 Submitter is current with file submissions to OnpointUnitedHealthcare Insurance - Medicare 012012 062017 012012 062017 012012 062017 012012 062017 Submitter is current with file submissions to OnpointUnitedHealthcare Insurance Company 012012 062017 012012 062017 012012 062017 012012 062017 Submitter is current with file submissions to Onpoint

WellCare Health Plans Inc012012 062017 012012 062017 012012 122015 012012 062017 Submitter is current with file submissions to Onpoint

Medicaid- - - - - - - -

Medicare- - - - - - - - Data received 82017

Submission D

elay lt 3 Months or Integration In Progress

Submission O

n Schedule

Submission N

ot Scheduled or ge 3 Months D

elayed

10

APCD Data Release

Update

11

Develop and implement core requirements to achieve DRcapabilities

Administration Data release application dictionary ampsupport materialsSoftwareTools Extract creation and delivery toolSupport Admin support and documentation

Phase 1 Develop DR Process Tools and CapabilitiesEngage potential requestors to ensurecapabilities opportunities and services arerecognized

Phase 2 Promotion and Delivery

Data Release (DR) RecapAPCD Data Release Update

Legislative Charge (PA 13-247) The exchange shall helliphellip and (B) make data in the all-payer claims database available to any state agency insurer employer health care provider consumer of health care services or researcher for the purpose of allowing such person or entity to review such data as it relates to health care utilization costs or quality of health care services

12

End to End application process can take between 17 to 40days depending on time of month an application issubmitted All requests must follow the data releaseprocess outlined by Privacy Policy amp Procedures

Data Release ApplicationRequestor general information project summary research details data selection and securityintegrity

Data Release CommitteeReview application alignment with objectives re-identification risk safeguard adequacy and research design

Data Use Agreement Fees amp ExtractUser agrees to fee schedule DUA requirements Standard extract creation within 5 business days (after 1st release)

S M T W T F S

1 2 3 4 5

6 7 8 9 10 11 12

13 14 15 16 17 18 19

20 21 22 23 24 25 26

27 28 29 39 31

DR Process amp Turn-Around TimeAPCD Data Release Update

13

DR TableField Classification MatrixAPCD Data Release Update

Table Name

Field Classifications

Administrative

Enrollee Coverage

InformationEnrollee

DemographicsClaim

InformationDiagnosis

Information

Procedure Coding amp

DetailFinancial

InformationProvider

InformationPayer

InformationSafe Harbor

Variable Grand TotalEligibility 2 11 1 1 1 1 4 21

Eligibility Supplemental 2 13 9 4 28

Medical 2 3 13 2 7 8 4 1 6 46

Medical Claim Header 2 5 7

Medical Supplemental 4 6 3 11 1 6 31

Medical Claim Diagnosis 1 3 1 5

Medical Claim Icd Procedure 2 14 5 4 1 26

Pharmacy 3 3 11 2 9 2 1 3 34

Pharmacy Supplemental 2 8 4 1 15

Provider 3 2 1 6Grand Total 23 30 10 55 10 15 41 10 5 20 219

Data Release Dictionary Located httpagencyaccesshealthctcommeetings1485450397264-a8f3a430-837b

10

APCD Data Release

Update

11

Develop and implement core requirements to achieve DRcapabilities

Administration Data release application dictionary ampsupport materialsSoftwareTools Extract creation and delivery toolSupport Admin support and documentation

Phase 1 Develop DR Process Tools and CapabilitiesEngage potential requestors to ensurecapabilities opportunities and services arerecognized

Phase 2 Promotion and Delivery

Data Release (DR) RecapAPCD Data Release Update

Legislative Charge (PA 13-247) The exchange shall helliphellip and (B) make data in the all-payer claims database available to any state agency insurer employer health care provider consumer of health care services or researcher for the purpose of allowing such person or entity to review such data as it relates to health care utilization costs or quality of health care services

12

End to End application process can take between 17 to 40days depending on time of month an application issubmitted All requests must follow the data releaseprocess outlined by Privacy Policy amp Procedures

Data Release ApplicationRequestor general information project summary research details data selection and securityintegrity

Data Release CommitteeReview application alignment with objectives re-identification risk safeguard adequacy and research design

Data Use Agreement Fees amp ExtractUser agrees to fee schedule DUA requirements Standard extract creation within 5 business days (after 1st release)

S M T W T F S

1 2 3 4 5

6 7 8 9 10 11 12

13 14 15 16 17 18 19

20 21 22 23 24 25 26

27 28 29 39 31

DR Process amp Turn-Around TimeAPCD Data Release Update

13

DR TableField Classification MatrixAPCD Data Release Update

Table Name

Field Classifications

Administrative

Enrollee Coverage

InformationEnrollee

DemographicsClaim

InformationDiagnosis

Information

Procedure Coding amp

DetailFinancial

InformationProvider

InformationPayer

InformationSafe Harbor

Variable Grand TotalEligibility 2 11 1 1 1 1 4 21

Eligibility Supplemental 2 13 9 4 28

Medical 2 3 13 2 7 8 4 1 6 46

Medical Claim Header 2 5 7

Medical Supplemental 4 6 3 11 1 6 31

Medical Claim Diagnosis 1 3 1 5

Medical Claim Icd Procedure 2 14 5 4 1 26

Pharmacy 3 3 11 2 9 2 1 3 34

Pharmacy Supplemental 2 8 4 1 15

Provider 3 2 1 6Grand Total 23 30 10 55 10 15 41 10 5 20 219

Data Release Dictionary Located httpagencyaccesshealthctcommeetings1485450397264-a8f3a430-837b

11

Develop and implement core requirements to achieve DRcapabilities

Administration Data release application dictionary ampsupport materialsSoftwareTools Extract creation and delivery toolSupport Admin support and documentation

Phase 1 Develop DR Process Tools and CapabilitiesEngage potential requestors to ensurecapabilities opportunities and services arerecognized

Phase 2 Promotion and Delivery

Data Release (DR) RecapAPCD Data Release Update

Legislative Charge (PA 13-247) The exchange shall helliphellip and (B) make data in the all-payer claims database available to any state agency insurer employer health care provider consumer of health care services or researcher for the purpose of allowing such person or entity to review such data as it relates to health care utilization costs or quality of health care services

12

End to End application process can take between 17 to 40days depending on time of month an application issubmitted All requests must follow the data releaseprocess outlined by Privacy Policy amp Procedures

Data Release ApplicationRequestor general information project summary research details data selection and securityintegrity

Data Release CommitteeReview application alignment with objectives re-identification risk safeguard adequacy and research design

Data Use Agreement Fees amp ExtractUser agrees to fee schedule DUA requirements Standard extract creation within 5 business days (after 1st release)

S M T W T F S

1 2 3 4 5

6 7 8 9 10 11 12

13 14 15 16 17 18 19

20 21 22 23 24 25 26

27 28 29 39 31

DR Process amp Turn-Around TimeAPCD Data Release Update

13

DR TableField Classification MatrixAPCD Data Release Update

Table Name

Field Classifications

Administrative

Enrollee Coverage

InformationEnrollee

DemographicsClaim

InformationDiagnosis

Information

Procedure Coding amp

DetailFinancial

InformationProvider

InformationPayer

InformationSafe Harbor

Variable Grand TotalEligibility 2 11 1 1 1 1 4 21

Eligibility Supplemental 2 13 9 4 28

Medical 2 3 13 2 7 8 4 1 6 46

Medical Claim Header 2 5 7

Medical Supplemental 4 6 3 11 1 6 31

Medical Claim Diagnosis 1 3 1 5

Medical Claim Icd Procedure 2 14 5 4 1 26

Pharmacy 3 3 11 2 9 2 1 3 34

Pharmacy Supplemental 2 8 4 1 15

Provider 3 2 1 6Grand Total 23 30 10 55 10 15 41 10 5 20 219

Data Release Dictionary Located httpagencyaccesshealthctcommeetings1485450397264-a8f3a430-837b

12

End to End application process can take between 17 to 40days depending on time of month an application issubmitted All requests must follow the data releaseprocess outlined by Privacy Policy amp Procedures

Data Release ApplicationRequestor general information project summary research details data selection and securityintegrity

Data Release CommitteeReview application alignment with objectives re-identification risk safeguard adequacy and research design

Data Use Agreement Fees amp ExtractUser agrees to fee schedule DUA requirements Standard extract creation within 5 business days (after 1st release)

S M T W T F S

1 2 3 4 5

6 7 8 9 10 11 12

13 14 15 16 17 18 19

20 21 22 23 24 25 26

27 28 29 39 31

DR Process amp Turn-Around TimeAPCD Data Release Update

13

DR TableField Classification MatrixAPCD Data Release Update

Table Name

Field Classifications

Administrative

Enrollee Coverage

InformationEnrollee

DemographicsClaim

InformationDiagnosis

Information

Procedure Coding amp

DetailFinancial

InformationProvider

InformationPayer

InformationSafe Harbor

Variable Grand TotalEligibility 2 11 1 1 1 1 4 21

Eligibility Supplemental 2 13 9 4 28

Medical 2 3 13 2 7 8 4 1 6 46

Medical Claim Header 2 5 7

Medical Supplemental 4 6 3 11 1 6 31

Medical Claim Diagnosis 1 3 1 5

Medical Claim Icd Procedure 2 14 5 4 1 26

Pharmacy 3 3 11 2 9 2 1 3 34

Pharmacy Supplemental 2 8 4 1 15

Provider 3 2 1 6Grand Total 23 30 10 55 10 15 41 10 5 20 219

Data Release Dictionary Located httpagencyaccesshealthctcommeetings1485450397264-a8f3a430-837b

13

DR TableField Classification MatrixAPCD Data Release Update

Table Name

Field Classifications

Administrative

Enrollee Coverage

InformationEnrollee

DemographicsClaim

InformationDiagnosis

Information

Procedure Coding amp

DetailFinancial

InformationProvider

InformationPayer

InformationSafe Harbor

Variable Grand TotalEligibility 2 11 1 1 1 1 4 21

Eligibility Supplemental 2 13 9 4 28

Medical 2 3 13 2 7 8 4 1 6 46

Medical Claim Header 2 5 7

Medical Supplemental 4 6 3 11 1 6 31

Medical Claim Diagnosis 1 3 1 5

Medical Claim Icd Procedure 2 14 5 4 1 26

Pharmacy 3 3 11 2 9 2 1 3 34

Pharmacy Supplemental 2 8 4 1 15

Provider 3 2 1 6Grand Total 23 30 10 55 10 15 41 10 5 20 219

Data Release Dictionary Located httpagencyaccesshealthctcommeetings1485450397264-a8f3a430-837b

14

ProviderFacility Directory

512k Unique National Provider Identifiers

Pharmacy Claims

All claimsencounters paid by submitting carrier

Data includes info on Administrative Enrollee Coverage Claim Detail Diagnosis Codes Procedure Codes Financials Payers Providers Safe Harbor (12)

1273M Claims $125B

Medical Claims

All claimsencounters paid by submitting carrier

Data includes info on Administrative Enrollee Coverage Claim Detail Diagnosis Codes Procedure Codes Financials Payers Providers Safe Harbor (12)

747M Claims $304B

Enrollees

CY 2012 ndash Present (n- 1 month)

Data includes info on Administrative Enrollee Coverage Enrollee Demographics Financials Payers Providers Safe Harbor (2)Fully insuredNon-ERISA plans (~900k Lives)

Whatrsquos Available Through DRAPCD Data Release Update

Billing rendering prescribing pharmacy primary care provider IDs (varying completion rate)

Data includes info on Unblended and composite provider IDs and NPIs

15

ERISALives covered under self-

insured ERISA plans

Part 2 SUD claimsSUD claims provided by

Part 2 providers

Denied ClaimsFully denied claims not

collected

Test Result ValuesLab imaging biometrics

and physician derived data

Third Party Data Risk scoring social

determinants knowledge base etc

Dental ClaimsDental claims not required

for submission

Ancillary FinancialsPlan premiums capitation payments performance

payments administrative fees

Whatrsquos Not Available Through DRAPCD Data Release Update

HIPAA Safe Harbor Variables18 HIPAA identifiers

16

18 HIPAA identifiers removed from dataset

Identifiers removed as set forth in 45 CFR 164514

De-identification

De-Identified Data ReleaseAPCD Data Release Update

Age caps applied (over 89 less than 1) amp geography reduced to 3 digit zip

All dates related to service and payments masked

First three digits of zip codes only if the geographic area covered by all zip codes beginning with those three digits has a population greater than 20000 or the zip codes for those areas are changed to 000 in the data set

Supplementary safeguards imposed to reduce unique characteristics

17

Partnerships LicensingAccessibilityValue Add DataProcess

Improvement

Identify third party data that can supplement and enrich within release requirements

Third Party DataIdentify areas of process

improvement and automation

ScalabilityEstablish enclave capability

upon needdemand

Extract v EnclaveIdentify areas of opportunity for ongoing multiple use by

institutions

Engagement

Potential Future ImprovementsAPCD Data Release Update

18

AUGUST

16SEPTEMBER

7SEPTEMBER

15SEPTEMBER

22Committee review and

vote on first data request application

from UConn

DATA RELEASE COMMITTEE MEETING

To be canceled if no additional applications

submitted

DATA RELEASE COMMITTEE MEETING

Review and confirmation of de-

identification methods and implementation

EXTRACT AUDIT

Extract delivered and support channel

opened

DATA RELEASE

Data release activities within the next two months include

Open Action ItemsAPCD Data Release Update

Project Descriptions

bull State Innovation Modelndash Online dashboard of ~30 pace and performance measures

bull Used to monitor performance of SIM bull 12 measures use APCD databull Includes yearly targets for overall Connecticut

ndash Online Scorecard Online dashboard of FQHC and Advanced Network performancebull First health care performance scorecard in CTbull Provides transparency in provider performancebull Utilizes claims based measures from common scorecard and CAHPS surveys

bull Suicide Risk Identificationndash Improves identification of patients at risk of suicide

bull Utilizes APCD claims data EHR data from 5 health care providers and mortality databull Creation of phenotypic algorithm

19

APCD Based Dashboard Measures

Health Care DeliveryPercent of adults with regular source of careChildren well-child visits for at-risk popMammograms for women gt50 last 2 yearsOptimal diabetes care- 2+ annual A1c testsED use- asthma as primary dx (per 10k)

Percent of adults with HTN taking HTN medsFollow-Up after Discharge from the Emergency Department for Mental Health or Alcohol or other Drug

Follow-Up after Hospitalization for Mental Illness

Antidepressant Medication ManagementInitiation and Engagement of Alcohol and Other Drug Dependence Treatment

Health Care Costs

Cost of inpatient care PMPY

Cost of outpatient care PMPY

httpwwwpublichealthuconnedusim_dashhtmlohriNav=7C

15

ERISALives covered under self-

insured ERISA plans

Part 2 SUD claimsSUD claims provided by

Part 2 providers

Denied ClaimsFully denied claims not

collected

Test Result ValuesLab imaging biometrics

and physician derived data

Third Party Data Risk scoring social

determinants knowledge base etc

Dental ClaimsDental claims not required

for submission

Ancillary FinancialsPlan premiums capitation payments performance

payments administrative fees

Whatrsquos Not Available Through DRAPCD Data Release Update

HIPAA Safe Harbor Variables18 HIPAA identifiers

16

18 HIPAA identifiers removed from dataset

Identifiers removed as set forth in 45 CFR 164514

De-identification

De-Identified Data ReleaseAPCD Data Release Update

Age caps applied (over 89 less than 1) amp geography reduced to 3 digit zip

All dates related to service and payments masked

First three digits of zip codes only if the geographic area covered by all zip codes beginning with those three digits has a population greater than 20000 or the zip codes for those areas are changed to 000 in the data set

Supplementary safeguards imposed to reduce unique characteristics

17

Partnerships LicensingAccessibilityValue Add DataProcess

Improvement

Identify third party data that can supplement and enrich within release requirements

Third Party DataIdentify areas of process

improvement and automation

ScalabilityEstablish enclave capability

upon needdemand

Extract v EnclaveIdentify areas of opportunity for ongoing multiple use by

institutions

Engagement

Potential Future ImprovementsAPCD Data Release Update

18

AUGUST

16SEPTEMBER

7SEPTEMBER

15SEPTEMBER

22Committee review and

vote on first data request application

from UConn

DATA RELEASE COMMITTEE MEETING

To be canceled if no additional applications

submitted

DATA RELEASE COMMITTEE MEETING

Review and confirmation of de-

identification methods and implementation

EXTRACT AUDIT

Extract delivered and support channel

opened

DATA RELEASE

Data release activities within the next two months include

Open Action ItemsAPCD Data Release Update

Project Descriptions

bull State Innovation Modelndash Online dashboard of ~30 pace and performance measures

bull Used to monitor performance of SIM bull 12 measures use APCD databull Includes yearly targets for overall Connecticut

ndash Online Scorecard Online dashboard of FQHC and Advanced Network performancebull First health care performance scorecard in CTbull Provides transparency in provider performancebull Utilizes claims based measures from common scorecard and CAHPS surveys

bull Suicide Risk Identificationndash Improves identification of patients at risk of suicide

bull Utilizes APCD claims data EHR data from 5 health care providers and mortality databull Creation of phenotypic algorithm

19

APCD Based Dashboard Measures

Health Care DeliveryPercent of adults with regular source of careChildren well-child visits for at-risk popMammograms for women gt50 last 2 yearsOptimal diabetes care- 2+ annual A1c testsED use- asthma as primary dx (per 10k)

Percent of adults with HTN taking HTN medsFollow-Up after Discharge from the Emergency Department for Mental Health or Alcohol or other Drug

Follow-Up after Hospitalization for Mental Illness

Antidepressant Medication ManagementInitiation and Engagement of Alcohol and Other Drug Dependence Treatment

Health Care Costs

Cost of inpatient care PMPY

Cost of outpatient care PMPY

httpwwwpublichealthuconnedusim_dashhtmlohriNav=7C

16

18 HIPAA identifiers removed from dataset

Identifiers removed as set forth in 45 CFR 164514

De-identification

De-Identified Data ReleaseAPCD Data Release Update

Age caps applied (over 89 less than 1) amp geography reduced to 3 digit zip

All dates related to service and payments masked

First three digits of zip codes only if the geographic area covered by all zip codes beginning with those three digits has a population greater than 20000 or the zip codes for those areas are changed to 000 in the data set

Supplementary safeguards imposed to reduce unique characteristics

17

Partnerships LicensingAccessibilityValue Add DataProcess

Improvement

Identify third party data that can supplement and enrich within release requirements

Third Party DataIdentify areas of process

improvement and automation

ScalabilityEstablish enclave capability

upon needdemand

Extract v EnclaveIdentify areas of opportunity for ongoing multiple use by

institutions

Engagement

Potential Future ImprovementsAPCD Data Release Update

18

AUGUST

16SEPTEMBER

7SEPTEMBER

15SEPTEMBER

22Committee review and

vote on first data request application

from UConn

DATA RELEASE COMMITTEE MEETING

To be canceled if no additional applications

submitted

DATA RELEASE COMMITTEE MEETING

Review and confirmation of de-

identification methods and implementation

EXTRACT AUDIT

Extract delivered and support channel

opened

DATA RELEASE

Data release activities within the next two months include

Open Action ItemsAPCD Data Release Update

Project Descriptions

bull State Innovation Modelndash Online dashboard of ~30 pace and performance measures

bull Used to monitor performance of SIM bull 12 measures use APCD databull Includes yearly targets for overall Connecticut

ndash Online Scorecard Online dashboard of FQHC and Advanced Network performancebull First health care performance scorecard in CTbull Provides transparency in provider performancebull Utilizes claims based measures from common scorecard and CAHPS surveys

bull Suicide Risk Identificationndash Improves identification of patients at risk of suicide

bull Utilizes APCD claims data EHR data from 5 health care providers and mortality databull Creation of phenotypic algorithm

19

APCD Based Dashboard Measures

Health Care DeliveryPercent of adults with regular source of careChildren well-child visits for at-risk popMammograms for women gt50 last 2 yearsOptimal diabetes care- 2+ annual A1c testsED use- asthma as primary dx (per 10k)

Percent of adults with HTN taking HTN medsFollow-Up after Discharge from the Emergency Department for Mental Health or Alcohol or other Drug

Follow-Up after Hospitalization for Mental Illness

Antidepressant Medication ManagementInitiation and Engagement of Alcohol and Other Drug Dependence Treatment

Health Care Costs

Cost of inpatient care PMPY

Cost of outpatient care PMPY

httpwwwpublichealthuconnedusim_dashhtmlohriNav=7C

17

Partnerships LicensingAccessibilityValue Add DataProcess

Improvement

Identify third party data that can supplement and enrich within release requirements

Third Party DataIdentify areas of process

improvement and automation

ScalabilityEstablish enclave capability

upon needdemand

Extract v EnclaveIdentify areas of opportunity for ongoing multiple use by

institutions

Engagement

Potential Future ImprovementsAPCD Data Release Update

18

AUGUST

16SEPTEMBER

7SEPTEMBER

15SEPTEMBER

22Committee review and

vote on first data request application

from UConn

DATA RELEASE COMMITTEE MEETING

To be canceled if no additional applications

submitted

DATA RELEASE COMMITTEE MEETING

Review and confirmation of de-

identification methods and implementation

EXTRACT AUDIT

Extract delivered and support channel

opened

DATA RELEASE

Data release activities within the next two months include

Open Action ItemsAPCD Data Release Update

Project Descriptions

bull State Innovation Modelndash Online dashboard of ~30 pace and performance measures

bull Used to monitor performance of SIM bull 12 measures use APCD databull Includes yearly targets for overall Connecticut

ndash Online Scorecard Online dashboard of FQHC and Advanced Network performancebull First health care performance scorecard in CTbull Provides transparency in provider performancebull Utilizes claims based measures from common scorecard and CAHPS surveys

bull Suicide Risk Identificationndash Improves identification of patients at risk of suicide

bull Utilizes APCD claims data EHR data from 5 health care providers and mortality databull Creation of phenotypic algorithm

19

APCD Based Dashboard Measures

Health Care DeliveryPercent of adults with regular source of careChildren well-child visits for at-risk popMammograms for women gt50 last 2 yearsOptimal diabetes care- 2+ annual A1c testsED use- asthma as primary dx (per 10k)

Percent of adults with HTN taking HTN medsFollow-Up after Discharge from the Emergency Department for Mental Health or Alcohol or other Drug

Follow-Up after Hospitalization for Mental Illness

Antidepressant Medication ManagementInitiation and Engagement of Alcohol and Other Drug Dependence Treatment

Health Care Costs

Cost of inpatient care PMPY

Cost of outpatient care PMPY

httpwwwpublichealthuconnedusim_dashhtmlohriNav=7C

18

AUGUST

16SEPTEMBER

7SEPTEMBER

15SEPTEMBER

22Committee review and

vote on first data request application

from UConn

DATA RELEASE COMMITTEE MEETING

To be canceled if no additional applications

submitted

DATA RELEASE COMMITTEE MEETING

Review and confirmation of de-

identification methods and implementation

EXTRACT AUDIT

Extract delivered and support channel

opened

DATA RELEASE

Data release activities within the next two months include

Open Action ItemsAPCD Data Release Update

Project Descriptions

bull State Innovation Modelndash Online dashboard of ~30 pace and performance measures

bull Used to monitor performance of SIM bull 12 measures use APCD databull Includes yearly targets for overall Connecticut

ndash Online Scorecard Online dashboard of FQHC and Advanced Network performancebull First health care performance scorecard in CTbull Provides transparency in provider performancebull Utilizes claims based measures from common scorecard and CAHPS surveys

bull Suicide Risk Identificationndash Improves identification of patients at risk of suicide

bull Utilizes APCD claims data EHR data from 5 health care providers and mortality databull Creation of phenotypic algorithm

19

APCD Based Dashboard Measures

Health Care DeliveryPercent of adults with regular source of careChildren well-child visits for at-risk popMammograms for women gt50 last 2 yearsOptimal diabetes care- 2+ annual A1c testsED use- asthma as primary dx (per 10k)

Percent of adults with HTN taking HTN medsFollow-Up after Discharge from the Emergency Department for Mental Health or Alcohol or other Drug

Follow-Up after Hospitalization for Mental Illness

Antidepressant Medication ManagementInitiation and Engagement of Alcohol and Other Drug Dependence Treatment

Health Care Costs

Cost of inpatient care PMPY

Cost of outpatient care PMPY

httpwwwpublichealthuconnedusim_dashhtmlohriNav=7C

Project Descriptions

bull State Innovation Modelndash Online dashboard of ~30 pace and performance measures

bull Used to monitor performance of SIM bull 12 measures use APCD databull Includes yearly targets for overall Connecticut

ndash Online Scorecard Online dashboard of FQHC and Advanced Network performancebull First health care performance scorecard in CTbull Provides transparency in provider performancebull Utilizes claims based measures from common scorecard and CAHPS surveys

bull Suicide Risk Identificationndash Improves identification of patients at risk of suicide

bull Utilizes APCD claims data EHR data from 5 health care providers and mortality databull Creation of phenotypic algorithm

19

APCD Based Dashboard Measures

Health Care DeliveryPercent of adults with regular source of careChildren well-child visits for at-risk popMammograms for women gt50 last 2 yearsOptimal diabetes care- 2+ annual A1c testsED use- asthma as primary dx (per 10k)

Percent of adults with HTN taking HTN medsFollow-Up after Discharge from the Emergency Department for Mental Health or Alcohol or other Drug

Follow-Up after Hospitalization for Mental Illness

Antidepressant Medication ManagementInitiation and Engagement of Alcohol and Other Drug Dependence Treatment

Health Care Costs

Cost of inpatient care PMPY

Cost of outpatient care PMPY

httpwwwpublichealthuconnedusim_dashhtmlohriNav=7C

APCD Based Dashboard Measures

Health Care DeliveryPercent of adults with regular source of careChildren well-child visits for at-risk popMammograms for women gt50 last 2 yearsOptimal diabetes care- 2+ annual A1c testsED use- asthma as primary dx (per 10k)

Percent of adults with HTN taking HTN medsFollow-Up after Discharge from the Emergency Department for Mental Health or Alcohol or other Drug

Follow-Up after Hospitalization for Mental Illness

Antidepressant Medication ManagementInitiation and Engagement of Alcohol and Other Drug Dependence Treatment

Health Care Costs

Cost of inpatient care PMPY

Cost of outpatient care PMPY

httpwwwpublichealthuconnedusim_dashhtmlohriNav=7C

Scorecard MeasuresReporting Only

Coordination of Care30 day readmission

PCPs that meet Meaningful Use

Prevention

Non-recommended Cervical Cancer Screening in Adolescent Female

Well-child visits in the third fourth fifth and sixth years of life (Medicaid only)

Frequency of Ongoing Prenatal Care (FPC)

Oral Evaluation Dental Services (Medicaid only)

Acute and Chronic Care

Cardiac strss img Testing in asymptomatic low risk patients

Behavioral HealthAdult major depressive disorder (MDD) Coordination of care of patients with specific co-morbid conditions

Anti-Depressant Medication Management

Initiation and Engagement of Alcohol and Other Drug Dependence Treatment

Follow up after hospitalization for mental illness 7 amp 30 days

21

Provisional Core Measure SetCare CoordinationPlan all-cause readmissionAnnual monitoring for persistent medications (roll-up)PreventionBreast cancer screeningCervical cancer screeningChlamydia screening in womenAdolescent female immunizations HPV

Weight assessment and counseling for nutrition and physical activity for childrenadolescents

Well-child visits in the first 15 months of lifeAdolescent well-care visitsBehavioral health screening (pediatric Medicaid only custom measure)

Acute amp Chronic Care

Medication management for people w asthma

DM HbA1c Testing

DM Diabetes medical attention for nephropathy

Use of imaging studies for low back pain

Avoidance of antibiotic treatment in adults with acute bronchitis

Appr treatment for children with upper respiratory infection

Behavioral Health

Follow-up care for children prescribed ADHD medicationMetabolic Monitoring for Children and Adolescents on Antipsychotics (pediatric Medicaid only custom measure)

Suicide Risk Identification

22

23

CT APCD Data -

Preliminary Analysis

Examples amp Showcase

Title XxSubtitle Xx

Presenter TitleDate

24Proprietary and Confidential 24

Connecticut APCDPreliminary Analysis Examples amp Showcase

CT APCD Advisory Group Meeting August 10 2017

25

bull Data source CY2016 commercial data from the CT APCDbull Focus commercial population-based reportingbull Considerations risk adjustment for age gender and health statusbull Areas of exploration

ndash Multiple views of the CT APCD population total members health exchange members members with diabetes

ndash Expenditures utilization and effective and preventive care ratesndash Analysis by multiple geographic units county Hospital Service

Area (HSA) and Health Reference Group (HRG) bull Conclusion Recap and lessons learned

Presentation Overview

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

26

bull Member Any person covered in a submitterrsquos eligibility databull Average Members Member months divided by 12 (months)bull Expenditures Allowed amount bull Capping Capped outliers in the data at the 99th percentilebull Clinical Risk Groups Individualsrsquo categorized health statusbull County Administrative focus areasbull Hospital Service Area Local hospital marketsbull Health Reference Group Community types bull Rates Expenditures by average membersbull Risk Adjustment Adjusting for differences between member

populations by considering membersrsquo age gender and health status

Key Terms

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

27

Population-Based Reporting

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

bull Reporting units county modified Hospital Service Area (HSA) and Health Reference Group (HRG)

bull Risk adjustment age gender and health status (3M CRGs)

28

CT APCD Population Overview

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

Measure Count

Unique Members 875129

Total Member Months 9122482

Average Members 760207

Total Expenditures $40 Billion

Total Expenditures Per Member Per Year (PMPY) $5255

Total Expenditures Per Member Per Month (PMPM) $438

Total expenditures are capped at the 99th percentile

29

Expenditures PMPY by Age amp Gender

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

$0

$1000

$2000

$3000

$4000

$5000

$6000

$7000

$8000

$9000

0-18 Female 0-18 Male 18-34 Female 18-34 Male 35-44 Female 35-44 Male 45-54 Female 45-54 Male 55-64 Female 55-64 Male

30

Expenditures PMPY by CRGs

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

$-

$5000

$10000

$15000

$20000

$25000

$30000

$35000

$40000

Healthy Acute or Minor Chronic Moderate Chronic Significant Chronic Cancer or Catastrophic

$0

31

CT Health Exchange Population Overview

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

MeasureExchange Members

Non-Exchange Members

Average Members 86941 673266

Percentage of Members 55-64 Years of Age 31 20

Percentage of Members with Chronic Condition(s) 23 19

Expenditures PMPY $5378 $5239

Expenditures PMPY Risk Adjusted $4780 $5316 Expenditures PMPY for Members with Diabetes Risk-Adjusted $17561 $19291

32

CT Exchange vs Non-Exchange Rates

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

Rate per 1000 Rate per 1000 (Risk Adj)

Measure Exchange Members

Non-Exchange Members

Exchange Members

Non-Exchange Members

Inpatient Acute Visits 390 328 339 335Medical 210 144 181 147Surgical 140 116 115 119Maternity 41 69 41 69

Outpatient Emergency Visits 1941 1924 1944 1923MRIs 920 803 810 817CT Scans 1108 824 938 844Primary Care Office Visits 15216 18755 16068 18628Psychiatric Visits 9864 9783 9783 11092Chiropractic Visits 3403 7808 3088 7913

Utilization measures are capped at the 99th percentile

33

Expenditure PMPY Diabetes Population

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

$-

$5000

$10000

$15000

$20000

$25000

$30000

No Diabetes (n=730838) Diabetes amp no comorbidity (n=16419) Diabetes with comorbidity (n=12950)$0

No Diabetes (n = 730838)

Diabetes No Comorbidity(n = 16419)

Diabetes Comorbidity(n = 12950)

34

Vermont Blueprint for HealthDiabetes HbA1c Control amp Outcomes

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

Measure HbA1c in Control HbA1c Not in Control

Members 5619 786

Average annual expenditures per capita

$15726 ($15219 $16233)

$17328 ($16110 $18546)

Inpatient hospitalizations per 1000 members

1897 (1782 2011)

2531 (2177 2886)

Inpatient days per 1000 members

8685 (8440 8930)

11561 (10804 12318)

Outpatient ED visits per 1000 members

6275 (6067 6483)

8011 (7381 8642)

Risk-adjusted rates and 95 confidence intervals 99th percentile outliers excluded HbA1c not in control gt9

35

Expenditures PMPY by County

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

County Average Members Expenditures PMPYExpenditures PMPY

(Risk Adjusted)Fairfield 223295 $5182 $5539 New London 44741 $5913 $5342 New Haven 161763 $5494 $5335 Middlesex 38531 $5359 $5184 Litchfield 43224 $5136 $5118 Tolland 36304 $5047 $5019 Hartford 191415 $4998 $4958 Windham 20934 $5539 $4950

Total 760207 $5255 $5255

36

Expenditures PMPY by HSA Risk Adjusted

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

$0

$1000

$2000

$3000

$4000

$5000

$6000

$7000

37

EffectivePreventive Care

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

HEDIS MeasureCT APCD

CommercialNCQA

National HMONCQA

National PPOAvoidance of Antibiotic Treatment in Adults with Acute Bronchitis 268 276 258Anti-Depressant Medication Management 764 664 666Well-Child Visits 798 762 723Breast Cancer Screening 671 732 696

NCQA National HMO and NCQA National PPO benchmark metrics calculated for CY2015 Several other HEDIS measures can be run using the CT APCD data set and compared against the NCQA National HMO and PPO benchmarks Examples include Comprehensive Diabetes Care ndash HbA1C Testing Comprehensive Diabetes Care ndash Medical Attention for Nephrology Comprehensive Diabetes Care ndash Eye Exam Performed Adolescent Well-Care Visits Appropriate Treatment for Children with Upper Respiratory Infection etc

38

Breast Cancer Screening

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

60

62

64

66

68

70

72

Urban Centers (n=3369) Manufacturing Centers (n=10974) Diverse Suburbs (n=12206) Mill Towns (n=16281) Rural Towns (n=16789) Wealthy Suburbs (n=12266)

39

Vermont Blueprintrsquos Hub amp Spoke Model

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

bull Vermontrsquos ldquoHealth Homerdquo program designed to treat Vermonters with chronic opioid addiction

bull Hubs ndash designated providers ndash Provide coordinated care to patients through MAT services

ndash Coordinate referral to ongoing care

bull Spokes ndash teams of healthcare professionalsndash Blueprint Advanced Practice Medical Homes

ndash Federally-Qualified Health Centers

ndash Outpatient substance abuse and primary care providers

40copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

Medication Assisted Treatment

bull Vermont Blueprint baseline study comparing medication-assisted treatment (MAT) population versus non-MAT population

bull Study published in the Journal of Substance Abuse Treatment (August 2016)

41

bull The CT APCD is a comparable resource to other statewide APCDs ndash A powerful tool that will only continue to grow with usendash Encompasses a robust set of information including

expenditures procedure codes diagnosis coding drug codes and enhanced value-adds (eg claim type master membermaster provider IDsNPIs MS-DRGs etc)

bull Future considerations to enhance the CT APCDndash Add Medicare and Medicaid claims datandash Continue to strengthen the completeness and validity of data

elements of importance to downstream analytic use cases (eg member race and ethnicity codes) in data collection

Lessons Learned

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

43

Next Steps

44

01Task

02Task

Ensure data quality issues are identified documented communicated and resolved

Data Quality

Continue building breadth of payer database amp complete enclave load

Data ETL

Finalize strategy to ensure site accomplishes PA 13-247 and PA 15-146 intent

Establish Strategy

05Task

Identify leading consumer information and price transparency tools available

Consumer Tool Evaluation04Task

Tasks Until Next Meeting (11917)APCD Development and Strategy Update

Distinguish Critical Paths Across and Within Strategic Priorities and Maintain Focus on ldquoMust Havesrdquo and ldquoQuick Winsrdquo

Ensure APCD staff can generate self-service extracts at little cost with minimal lead time

Deliver First DR Extract03Task

45

Future MeetingsAPCD Development and Strategy Update

November

9Legislative Office

Building Room 1D 300 Capitol Avenue

Hartford

All Payer Claims Database Advisory GroupMeeting

900ndash1100 AM

• Slide Number 1
• Slide Number 2
• Slide Number 3
• Slide Number 4
• Slide Number 5
• Slide Number 6
• Slide Number 7
• Slide Number 8
• Slide Number 9
• Slide Number 10
• Slide Number 11
• Slide Number 12
• Slide Number 13
• Slide Number 14
• Slide Number 15
• Slide Number 16
• Slide Number 17
• Slide Number 18
• Project Descriptions
• Slide Number 20
• Scorecard Measures
• Suicide Risk Identification
• Slide Number 23
• Slide Number 24
• Slide Number 25
• Slide Number 26
• Slide Number 27
• Slide Number 28
• Slide Number 29
• Slide Number 30
• Slide Number 31
• Slide Number 32
• Slide Number 33
• Slide Number 34
• Slide Number 35
• Slide Number 36
• Slide Number 37
• Slide Number 38
• Slide Number 39
• Slide Number 40
• Slide Number 41
• Slide Number 42
• Slide Number 43
• Slide Number 44
• Slide Number 45

Suicide Risk Identification

22

23

CT APCD Data -

Preliminary Analysis

Examples amp Showcase

Title XxSubtitle Xx

Presenter TitleDate

24Proprietary and Confidential 24

Connecticut APCDPreliminary Analysis Examples amp Showcase

CT APCD Advisory Group Meeting August 10 2017

25

bull Data source CY2016 commercial data from the CT APCDbull Focus commercial population-based reportingbull Considerations risk adjustment for age gender and health statusbull Areas of exploration

ndash Multiple views of the CT APCD population total members health exchange members members with diabetes

ndash Expenditures utilization and effective and preventive care ratesndash Analysis by multiple geographic units county Hospital Service

Area (HSA) and Health Reference Group (HRG) bull Conclusion Recap and lessons learned

Presentation Overview

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

26

bull Member Any person covered in a submitterrsquos eligibility databull Average Members Member months divided by 12 (months)bull Expenditures Allowed amount bull Capping Capped outliers in the data at the 99th percentilebull Clinical Risk Groups Individualsrsquo categorized health statusbull County Administrative focus areasbull Hospital Service Area Local hospital marketsbull Health Reference Group Community types bull Rates Expenditures by average membersbull Risk Adjustment Adjusting for differences between member

populations by considering membersrsquo age gender and health status

Key Terms

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

27

Population-Based Reporting

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

bull Reporting units county modified Hospital Service Area (HSA) and Health Reference Group (HRG)

bull Risk adjustment age gender and health status (3M CRGs)

28

CT APCD Population Overview

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

Measure Count

Unique Members 875129

Total Member Months 9122482

Average Members 760207

Total Expenditures $40 Billion

Total Expenditures Per Member Per Year (PMPY) $5255

Total Expenditures Per Member Per Month (PMPM) $438

Total expenditures are capped at the 99th percentile

29

Expenditures PMPY by Age amp Gender

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

$0

$1000

$2000

$3000

$4000

$5000

$6000

$7000

$8000

$9000

0-18 Female 0-18 Male 18-34 Female 18-34 Male 35-44 Female 35-44 Male 45-54 Female 45-54 Male 55-64 Female 55-64 Male

30

Expenditures PMPY by CRGs

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

$-

$5000

$10000

$15000

$20000

$25000

$30000

$35000

$40000

Healthy Acute or Minor Chronic Moderate Chronic Significant Chronic Cancer or Catastrophic

$0

31

CT Health Exchange Population Overview

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

MeasureExchange Members

Non-Exchange Members

Average Members 86941 673266

Percentage of Members 55-64 Years of Age 31 20

Percentage of Members with Chronic Condition(s) 23 19

Expenditures PMPY $5378 $5239

Expenditures PMPY Risk Adjusted $4780 $5316 Expenditures PMPY for Members with Diabetes Risk-Adjusted $17561 $19291

32

CT Exchange vs Non-Exchange Rates

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

Rate per 1000 Rate per 1000 (Risk Adj)

Measure Exchange Members

Non-Exchange Members

Exchange Members

Non-Exchange Members

Inpatient Acute Visits 390 328 339 335Medical 210 144 181 147Surgical 140 116 115 119Maternity 41 69 41 69

Outpatient Emergency Visits 1941 1924 1944 1923MRIs 920 803 810 817CT Scans 1108 824 938 844Primary Care Office Visits 15216 18755 16068 18628Psychiatric Visits 9864 9783 9783 11092Chiropractic Visits 3403 7808 3088 7913

Utilization measures are capped at the 99th percentile

33

Expenditure PMPY Diabetes Population

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

$-

$5000

$10000

$15000

$20000

$25000

$30000

No Diabetes (n=730838) Diabetes amp no comorbidity (n=16419) Diabetes with comorbidity (n=12950)$0

No Diabetes (n = 730838)

Diabetes No Comorbidity(n = 16419)

Diabetes Comorbidity(n = 12950)

34

Vermont Blueprint for HealthDiabetes HbA1c Control amp Outcomes

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

Measure HbA1c in Control HbA1c Not in Control

Members 5619 786

Average annual expenditures per capita

$15726 ($15219 $16233)

$17328 ($16110 $18546)

Inpatient hospitalizations per 1000 members

1897 (1782 2011)

2531 (2177 2886)

Inpatient days per 1000 members

8685 (8440 8930)

11561 (10804 12318)

Outpatient ED visits per 1000 members

6275 (6067 6483)

8011 (7381 8642)

Risk-adjusted rates and 95 confidence intervals 99th percentile outliers excluded HbA1c not in control gt9

35

Expenditures PMPY by County

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

County Average Members Expenditures PMPYExpenditures PMPY

(Risk Adjusted)Fairfield 223295 $5182 $5539 New London 44741 $5913 $5342 New Haven 161763 $5494 $5335 Middlesex 38531 $5359 $5184 Litchfield 43224 $5136 $5118 Tolland 36304 $5047 $5019 Hartford 191415 $4998 $4958 Windham 20934 $5539 $4950

Total 760207 $5255 $5255

36

Expenditures PMPY by HSA Risk Adjusted

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

$0

$1000

$2000

$3000

$4000

$5000

$6000

$7000

37

EffectivePreventive Care

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

HEDIS MeasureCT APCD

CommercialNCQA

National HMONCQA

National PPOAvoidance of Antibiotic Treatment in Adults with Acute Bronchitis 268 276 258Anti-Depressant Medication Management 764 664 666Well-Child Visits 798 762 723Breast Cancer Screening 671 732 696

NCQA National HMO and NCQA National PPO benchmark metrics calculated for CY2015 Several other HEDIS measures can be run using the CT APCD data set and compared against the NCQA National HMO and PPO benchmarks Examples include Comprehensive Diabetes Care ndash HbA1C Testing Comprehensive Diabetes Care ndash Medical Attention for Nephrology Comprehensive Diabetes Care ndash Eye Exam Performed Adolescent Well-Care Visits Appropriate Treatment for Children with Upper Respiratory Infection etc

38

Breast Cancer Screening

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

60

62

64

66

68

70

72

Urban Centers (n=3369) Manufacturing Centers (n=10974) Diverse Suburbs (n=12206) Mill Towns (n=16281) Rural Towns (n=16789) Wealthy Suburbs (n=12266)

39

Vermont Blueprintrsquos Hub amp Spoke Model

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

bull Vermontrsquos ldquoHealth Homerdquo program designed to treat Vermonters with chronic opioid addiction

bull Hubs ndash designated providers ndash Provide coordinated care to patients through MAT services

ndash Coordinate referral to ongoing care

bull Spokes ndash teams of healthcare professionalsndash Blueprint Advanced Practice Medical Homes

ndash Federally-Qualified Health Centers

ndash Outpatient substance abuse and primary care providers

40copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

Medication Assisted Treatment

bull Vermont Blueprint baseline study comparing medication-assisted treatment (MAT) population versus non-MAT population

bull Study published in the Journal of Substance Abuse Treatment (August 2016)

41

bull The CT APCD is a comparable resource to other statewide APCDs ndash A powerful tool that will only continue to grow with usendash Encompasses a robust set of information including

expenditures procedure codes diagnosis coding drug codes and enhanced value-adds (eg claim type master membermaster provider IDsNPIs MS-DRGs etc)

bull Future considerations to enhance the CT APCDndash Add Medicare and Medicaid claims datandash Continue to strengthen the completeness and validity of data

elements of importance to downstream analytic use cases (eg member race and ethnicity codes) in data collection

Lessons Learned

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

43

Next Steps

44

01Task

02Task

Ensure data quality issues are identified documented communicated and resolved

Data Quality

Continue building breadth of payer database amp complete enclave load

Data ETL

Finalize strategy to ensure site accomplishes PA 13-247 and PA 15-146 intent

Establish Strategy

05Task

Identify leading consumer information and price transparency tools available

Consumer Tool Evaluation04Task

Tasks Until Next Meeting (11917)APCD Development and Strategy Update

Distinguish Critical Paths Across and Within Strategic Priorities and Maintain Focus on ldquoMust Havesrdquo and ldquoQuick Winsrdquo

Ensure APCD staff can generate self-service extracts at little cost with minimal lead time

Deliver First DR Extract03Task

45

Future MeetingsAPCD Development and Strategy Update

November

9Legislative Office

Building Room 1D 300 Capitol Avenue

Hartford

All Payer Claims Database Advisory GroupMeeting

900ndash1100 AM

• Slide Number 1
• Slide Number 2
• Slide Number 3
• Slide Number 4
• Slide Number 5
• Slide Number 6
• Slide Number 7
• Slide Number 8
• Slide Number 9
• Slide Number 10
• Slide Number 11
• Slide Number 12
• Slide Number 13
• Slide Number 14
• Slide Number 15
• Slide Number 16
• Slide Number 17
• Slide Number 18
• Project Descriptions
• Slide Number 20
• Scorecard Measures
• Suicide Risk Identification
• Slide Number 23
• Slide Number 24
• Slide Number 25
• Slide Number 26
• Slide Number 27
• Slide Number 28
• Slide Number 29
• Slide Number 30
• Slide Number 31
• Slide Number 32
• Slide Number 33
• Slide Number 34
• Slide Number 35
• Slide Number 36
• Slide Number 37
• Slide Number 38
• Slide Number 39
• Slide Number 40
• Slide Number 41
• Slide Number 42
• Slide Number 43
• Slide Number 44
• Slide Number 45

23

CT APCD Data -

Preliminary Analysis

Examples amp Showcase

Title XxSubtitle Xx

Presenter TitleDate

24Proprietary and Confidential 24

Connecticut APCDPreliminary Analysis Examples amp Showcase

CT APCD Advisory Group Meeting August 10 2017

25

bull Data source CY2016 commercial data from the CT APCDbull Focus commercial population-based reportingbull Considerations risk adjustment for age gender and health statusbull Areas of exploration

ndash Multiple views of the CT APCD population total members health exchange members members with diabetes

ndash Expenditures utilization and effective and preventive care ratesndash Analysis by multiple geographic units county Hospital Service

Area (HSA) and Health Reference Group (HRG) bull Conclusion Recap and lessons learned

Presentation Overview

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

26

bull Member Any person covered in a submitterrsquos eligibility databull Average Members Member months divided by 12 (months)bull Expenditures Allowed amount bull Capping Capped outliers in the data at the 99th percentilebull Clinical Risk Groups Individualsrsquo categorized health statusbull County Administrative focus areasbull Hospital Service Area Local hospital marketsbull Health Reference Group Community types bull Rates Expenditures by average membersbull Risk Adjustment Adjusting for differences between member

populations by considering membersrsquo age gender and health status

Key Terms

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

27

Population-Based Reporting

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

bull Reporting units county modified Hospital Service Area (HSA) and Health Reference Group (HRG)

bull Risk adjustment age gender and health status (3M CRGs)

28

CT APCD Population Overview

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

Measure Count

Unique Members 875129

Total Member Months 9122482

Average Members 760207

Total Expenditures $40 Billion

Total Expenditures Per Member Per Year (PMPY) $5255

Total Expenditures Per Member Per Month (PMPM) $438

Total expenditures are capped at the 99th percentile

29

Expenditures PMPY by Age amp Gender

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

$0

$1000

$2000

$3000

$4000

$5000

$6000

$7000

$8000

$9000

0-18 Female 0-18 Male 18-34 Female 18-34 Male 35-44 Female 35-44 Male 45-54 Female 45-54 Male 55-64 Female 55-64 Male

30

Expenditures PMPY by CRGs

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

$-

$5000

$10000

$15000

$20000

$25000

$30000

$35000

$40000

Healthy Acute or Minor Chronic Moderate Chronic Significant Chronic Cancer or Catastrophic

$0

31

CT Health Exchange Population Overview

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

MeasureExchange Members

Non-Exchange Members

Average Members 86941 673266

Percentage of Members 55-64 Years of Age 31 20

Percentage of Members with Chronic Condition(s) 23 19

Expenditures PMPY $5378 $5239

Expenditures PMPY Risk Adjusted $4780 $5316 Expenditures PMPY for Members with Diabetes Risk-Adjusted $17561 $19291

32

CT Exchange vs Non-Exchange Rates

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

Rate per 1000 Rate per 1000 (Risk Adj)

Measure Exchange Members

Non-Exchange Members

Exchange Members

Non-Exchange Members

Inpatient Acute Visits 390 328 339 335Medical 210 144 181 147Surgical 140 116 115 119Maternity 41 69 41 69

Outpatient Emergency Visits 1941 1924 1944 1923MRIs 920 803 810 817CT Scans 1108 824 938 844Primary Care Office Visits 15216 18755 16068 18628Psychiatric Visits 9864 9783 9783 11092Chiropractic Visits 3403 7808 3088 7913

Utilization measures are capped at the 99th percentile

33

Expenditure PMPY Diabetes Population

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

$-

$5000

$10000

$15000

$20000

$25000

$30000

No Diabetes (n=730838) Diabetes amp no comorbidity (n=16419) Diabetes with comorbidity (n=12950)$0

No Diabetes (n = 730838)

Diabetes No Comorbidity(n = 16419)

Diabetes Comorbidity(n = 12950)

34

Vermont Blueprint for HealthDiabetes HbA1c Control amp Outcomes

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

Measure HbA1c in Control HbA1c Not in Control

Members 5619 786

Average annual expenditures per capita

$15726 ($15219 $16233)

$17328 ($16110 $18546)

Inpatient hospitalizations per 1000 members

1897 (1782 2011)

2531 (2177 2886)

Inpatient days per 1000 members

8685 (8440 8930)

11561 (10804 12318)

Outpatient ED visits per 1000 members

6275 (6067 6483)

8011 (7381 8642)

Risk-adjusted rates and 95 confidence intervals 99th percentile outliers excluded HbA1c not in control gt9

35

Expenditures PMPY by County

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

County Average Members Expenditures PMPYExpenditures PMPY

(Risk Adjusted)Fairfield 223295 $5182 $5539 New London 44741 $5913 $5342 New Haven 161763 $5494 $5335 Middlesex 38531 $5359 $5184 Litchfield 43224 $5136 $5118 Tolland 36304 $5047 $5019 Hartford 191415 $4998 $4958 Windham 20934 $5539 $4950

Total 760207 $5255 $5255

36

Expenditures PMPY by HSA Risk Adjusted

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

$0

$1000

$2000

$3000

$4000

$5000

$6000

$7000

37

EffectivePreventive Care

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

HEDIS MeasureCT APCD

CommercialNCQA

National HMONCQA

National PPOAvoidance of Antibiotic Treatment in Adults with Acute Bronchitis 268 276 258Anti-Depressant Medication Management 764 664 666Well-Child Visits 798 762 723Breast Cancer Screening 671 732 696

NCQA National HMO and NCQA National PPO benchmark metrics calculated for CY2015 Several other HEDIS measures can be run using the CT APCD data set and compared against the NCQA National HMO and PPO benchmarks Examples include Comprehensive Diabetes Care ndash HbA1C Testing Comprehensive Diabetes Care ndash Medical Attention for Nephrology Comprehensive Diabetes Care ndash Eye Exam Performed Adolescent Well-Care Visits Appropriate Treatment for Children with Upper Respiratory Infection etc

38

Breast Cancer Screening

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

60

62

64

66

68

70

72

Urban Centers (n=3369) Manufacturing Centers (n=10974) Diverse Suburbs (n=12206) Mill Towns (n=16281) Rural Towns (n=16789) Wealthy Suburbs (n=12266)

39

Vermont Blueprintrsquos Hub amp Spoke Model

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

bull Vermontrsquos ldquoHealth Homerdquo program designed to treat Vermonters with chronic opioid addiction

bull Hubs ndash designated providers ndash Provide coordinated care to patients through MAT services

ndash Coordinate referral to ongoing care

bull Spokes ndash teams of healthcare professionalsndash Blueprint Advanced Practice Medical Homes

ndash Federally-Qualified Health Centers

ndash Outpatient substance abuse and primary care providers

40copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

Medication Assisted Treatment

bull Vermont Blueprint baseline study comparing medication-assisted treatment (MAT) population versus non-MAT population

bull Study published in the Journal of Substance Abuse Treatment (August 2016)

41

bull The CT APCD is a comparable resource to other statewide APCDs ndash A powerful tool that will only continue to grow with usendash Encompasses a robust set of information including

expenditures procedure codes diagnosis coding drug codes and enhanced value-adds (eg claim type master membermaster provider IDsNPIs MS-DRGs etc)

bull Future considerations to enhance the CT APCDndash Add Medicare and Medicaid claims datandash Continue to strengthen the completeness and validity of data

elements of importance to downstream analytic use cases (eg member race and ethnicity codes) in data collection

Lessons Learned

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

43

Next Steps

44

01Task

02Task

Ensure data quality issues are identified documented communicated and resolved

Data Quality

Continue building breadth of payer database amp complete enclave load

Data ETL

Finalize strategy to ensure site accomplishes PA 13-247 and PA 15-146 intent

Establish Strategy

05Task

Identify leading consumer information and price transparency tools available

Consumer Tool Evaluation04Task

Tasks Until Next Meeting (11917)APCD Development and Strategy Update

Distinguish Critical Paths Across and Within Strategic Priorities and Maintain Focus on ldquoMust Havesrdquo and ldquoQuick Winsrdquo

Ensure APCD staff can generate self-service extracts at little cost with minimal lead time

Deliver First DR Extract03Task

45

Future MeetingsAPCD Development and Strategy Update

November

9Legislative Office

Building Room 1D 300 Capitol Avenue

Hartford

All Payer Claims Database Advisory GroupMeeting

900ndash1100 AM

• Slide Number 1
• Slide Number 2
• Slide Number 3
• Slide Number 4
• Slide Number 5
• Slide Number 6
• Slide Number 7
• Slide Number 8
• Slide Number 9
• Slide Number 10
• Slide Number 11
• Slide Number 12
• Slide Number 13
• Slide Number 14
• Slide Number 15
• Slide Number 16
• Slide Number 17
• Slide Number 18
• Project Descriptions
• Slide Number 20
• Scorecard Measures
• Suicide Risk Identification
• Slide Number 23
• Slide Number 24
• Slide Number 25
• Slide Number 26
• Slide Number 27
• Slide Number 28
• Slide Number 29
• Slide Number 30
• Slide Number 31
• Slide Number 32
• Slide Number 33
• Slide Number 34
• Slide Number 35
• Slide Number 36
• Slide Number 37
• Slide Number 38
• Slide Number 39
• Slide Number 40
• Slide Number 41
• Slide Number 42
• Slide Number 43
• Slide Number 44
• Slide Number 45

Title XxSubtitle Xx

Presenter TitleDate

24Proprietary and Confidential 24

Connecticut APCDPreliminary Analysis Examples amp Showcase

CT APCD Advisory Group Meeting August 10 2017

25

bull Data source CY2016 commercial data from the CT APCDbull Focus commercial population-based reportingbull Considerations risk adjustment for age gender and health statusbull Areas of exploration

ndash Multiple views of the CT APCD population total members health exchange members members with diabetes

ndash Expenditures utilization and effective and preventive care ratesndash Analysis by multiple geographic units county Hospital Service

Area (HSA) and Health Reference Group (HRG) bull Conclusion Recap and lessons learned

Presentation Overview

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

26

bull Member Any person covered in a submitterrsquos eligibility databull Average Members Member months divided by 12 (months)bull Expenditures Allowed amount bull Capping Capped outliers in the data at the 99th percentilebull Clinical Risk Groups Individualsrsquo categorized health statusbull County Administrative focus areasbull Hospital Service Area Local hospital marketsbull Health Reference Group Community types bull Rates Expenditures by average membersbull Risk Adjustment Adjusting for differences between member

populations by considering membersrsquo age gender and health status

Key Terms

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

27

Population-Based Reporting

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

bull Reporting units county modified Hospital Service Area (HSA) and Health Reference Group (HRG)

bull Risk adjustment age gender and health status (3M CRGs)

28

CT APCD Population Overview

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

Measure Count

Unique Members 875129

Total Member Months 9122482

Average Members 760207

Total Expenditures $40 Billion

Total Expenditures Per Member Per Year (PMPY) $5255

Total Expenditures Per Member Per Month (PMPM) $438

Total expenditures are capped at the 99th percentile

29

Expenditures PMPY by Age amp Gender

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

$0

$1000

$2000

$3000

$4000

$5000

$6000

$7000

$8000

$9000

0-18 Female 0-18 Male 18-34 Female 18-34 Male 35-44 Female 35-44 Male 45-54 Female 45-54 Male 55-64 Female 55-64 Male

30

Expenditures PMPY by CRGs

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

$-

$5000

$10000

$15000

$20000

$25000

$30000

$35000

$40000

Healthy Acute or Minor Chronic Moderate Chronic Significant Chronic Cancer or Catastrophic

$0

31

CT Health Exchange Population Overview

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

MeasureExchange Members

Non-Exchange Members

Average Members 86941 673266

Percentage of Members 55-64 Years of Age 31 20

Percentage of Members with Chronic Condition(s) 23 19

Expenditures PMPY $5378 $5239

Expenditures PMPY Risk Adjusted $4780 $5316 Expenditures PMPY for Members with Diabetes Risk-Adjusted $17561 $19291

32

CT Exchange vs Non-Exchange Rates

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

Rate per 1000 Rate per 1000 (Risk Adj)

Measure Exchange Members

Non-Exchange Members

Exchange Members

Non-Exchange Members

Inpatient Acute Visits 390 328 339 335Medical 210 144 181 147Surgical 140 116 115 119Maternity 41 69 41 69

Outpatient Emergency Visits 1941 1924 1944 1923MRIs 920 803 810 817CT Scans 1108 824 938 844Primary Care Office Visits 15216 18755 16068 18628Psychiatric Visits 9864 9783 9783 11092Chiropractic Visits 3403 7808 3088 7913

Utilization measures are capped at the 99th percentile

33

Expenditure PMPY Diabetes Population

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

$-

$5000

$10000

$15000

$20000

$25000

$30000

No Diabetes (n=730838) Diabetes amp no comorbidity (n=16419) Diabetes with comorbidity (n=12950)$0

No Diabetes (n = 730838)

Diabetes No Comorbidity(n = 16419)

Diabetes Comorbidity(n = 12950)

34

Vermont Blueprint for HealthDiabetes HbA1c Control amp Outcomes

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

Measure HbA1c in Control HbA1c Not in Control

Members 5619 786

Average annual expenditures per capita

$15726 ($15219 $16233)

$17328 ($16110 $18546)

Inpatient hospitalizations per 1000 members

1897 (1782 2011)

2531 (2177 2886)

Inpatient days per 1000 members

8685 (8440 8930)

11561 (10804 12318)

Outpatient ED visits per 1000 members

6275 (6067 6483)

8011 (7381 8642)

Risk-adjusted rates and 95 confidence intervals 99th percentile outliers excluded HbA1c not in control gt9

35

Expenditures PMPY by County

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

County Average Members Expenditures PMPYExpenditures PMPY

(Risk Adjusted)Fairfield 223295 $5182 $5539 New London 44741 $5913 $5342 New Haven 161763 $5494 $5335 Middlesex 38531 $5359 $5184 Litchfield 43224 $5136 $5118 Tolland 36304 $5047 $5019 Hartford 191415 $4998 $4958 Windham 20934 $5539 $4950

Total 760207 $5255 $5255

36

Expenditures PMPY by HSA Risk Adjusted

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

$0

$1000

$2000

$3000

$4000

$5000

$6000

$7000

37

EffectivePreventive Care

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

HEDIS MeasureCT APCD

CommercialNCQA

National HMONCQA

National PPOAvoidance of Antibiotic Treatment in Adults with Acute Bronchitis 268 276 258Anti-Depressant Medication Management 764 664 666Well-Child Visits 798 762 723Breast Cancer Screening 671 732 696

NCQA National HMO and NCQA National PPO benchmark metrics calculated for CY2015 Several other HEDIS measures can be run using the CT APCD data set and compared against the NCQA National HMO and PPO benchmarks Examples include Comprehensive Diabetes Care ndash HbA1C Testing Comprehensive Diabetes Care ndash Medical Attention for Nephrology Comprehensive Diabetes Care ndash Eye Exam Performed Adolescent Well-Care Visits Appropriate Treatment for Children with Upper Respiratory Infection etc

38

Breast Cancer Screening

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

60

62

64

66

68

70

72

Urban Centers (n=3369) Manufacturing Centers (n=10974) Diverse Suburbs (n=12206) Mill Towns (n=16281) Rural Towns (n=16789) Wealthy Suburbs (n=12266)

39

Vermont Blueprintrsquos Hub amp Spoke Model

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

bull Vermontrsquos ldquoHealth Homerdquo program designed to treat Vermonters with chronic opioid addiction

bull Hubs ndash designated providers ndash Provide coordinated care to patients through MAT services

ndash Coordinate referral to ongoing care

bull Spokes ndash teams of healthcare professionalsndash Blueprint Advanced Practice Medical Homes

ndash Federally-Qualified Health Centers

ndash Outpatient substance abuse and primary care providers

40copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

Medication Assisted Treatment

bull Vermont Blueprint baseline study comparing medication-assisted treatment (MAT) population versus non-MAT population

bull Study published in the Journal of Substance Abuse Treatment (August 2016)

41

bull The CT APCD is a comparable resource to other statewide APCDs ndash A powerful tool that will only continue to grow with usendash Encompasses a robust set of information including

expenditures procedure codes diagnosis coding drug codes and enhanced value-adds (eg claim type master membermaster provider IDsNPIs MS-DRGs etc)

bull Future considerations to enhance the CT APCDndash Add Medicare and Medicaid claims datandash Continue to strengthen the completeness and validity of data

elements of importance to downstream analytic use cases (eg member race and ethnicity codes) in data collection

Lessons Learned

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

43

Next Steps

44

01Task

02Task

Ensure data quality issues are identified documented communicated and resolved

Data Quality

Continue building breadth of payer database amp complete enclave load

Data ETL

Finalize strategy to ensure site accomplishes PA 13-247 and PA 15-146 intent

Establish Strategy

05Task

Identify leading consumer information and price transparency tools available

Consumer Tool Evaluation04Task

Tasks Until Next Meeting (11917)APCD Development and Strategy Update

Distinguish Critical Paths Across and Within Strategic Priorities and Maintain Focus on ldquoMust Havesrdquo and ldquoQuick Winsrdquo

Ensure APCD staff can generate self-service extracts at little cost with minimal lead time

Deliver First DR Extract03Task

45

Future MeetingsAPCD Development and Strategy Update

November

9Legislative Office

Building Room 1D 300 Capitol Avenue

Hartford

All Payer Claims Database Advisory GroupMeeting

900ndash1100 AM

• Slide Number 1
• Slide Number 2
• Slide Number 3
• Slide Number 4
• Slide Number 5
• Slide Number 6
• Slide Number 7
• Slide Number 8
• Slide Number 9
• Slide Number 10
• Slide Number 11
• Slide Number 12
• Slide Number 13
• Slide Number 14
• Slide Number 15
• Slide Number 16
• Slide Number 17
• Slide Number 18
• Project Descriptions
• Slide Number 20
• Scorecard Measures
• Suicide Risk Identification
• Slide Number 23
• Slide Number 24
• Slide Number 25
• Slide Number 26
• Slide Number 27
• Slide Number 28
• Slide Number 29
• Slide Number 30
• Slide Number 31
• Slide Number 32
• Slide Number 33
• Slide Number 34
• Slide Number 35
• Slide Number 36
• Slide Number 37
• Slide Number 38
• Slide Number 39
• Slide Number 40
• Slide Number 41
• Slide Number 42
• Slide Number 43
• Slide Number 44
• Slide Number 45

25

bull Data source CY2016 commercial data from the CT APCDbull Focus commercial population-based reportingbull Considerations risk adjustment for age gender and health statusbull Areas of exploration

ndash Multiple views of the CT APCD population total members health exchange members members with diabetes

ndash Expenditures utilization and effective and preventive care ratesndash Analysis by multiple geographic units county Hospital Service

Area (HSA) and Health Reference Group (HRG) bull Conclusion Recap and lessons learned

Presentation Overview

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

26

bull Member Any person covered in a submitterrsquos eligibility databull Average Members Member months divided by 12 (months)bull Expenditures Allowed amount bull Capping Capped outliers in the data at the 99th percentilebull Clinical Risk Groups Individualsrsquo categorized health statusbull County Administrative focus areasbull Hospital Service Area Local hospital marketsbull Health Reference Group Community types bull Rates Expenditures by average membersbull Risk Adjustment Adjusting for differences between member

populations by considering membersrsquo age gender and health status

Key Terms

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

27

Population-Based Reporting

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

bull Reporting units county modified Hospital Service Area (HSA) and Health Reference Group (HRG)

bull Risk adjustment age gender and health status (3M CRGs)

28

CT APCD Population Overview

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

Measure Count

Unique Members 875129

Total Member Months 9122482

Average Members 760207

Total Expenditures $40 Billion

Total Expenditures Per Member Per Year (PMPY) $5255

Total Expenditures Per Member Per Month (PMPM) $438

Total expenditures are capped at the 99th percentile

29

Expenditures PMPY by Age amp Gender

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

$0

$1000

$2000

$3000

$4000

$5000

$6000

$7000

$8000

$9000

0-18 Female 0-18 Male 18-34 Female 18-34 Male 35-44 Female 35-44 Male 45-54 Female 45-54 Male 55-64 Female 55-64 Male

30

Expenditures PMPY by CRGs

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

$-

$5000

$10000

$15000

$20000

$25000

$30000

$35000

$40000

Healthy Acute or Minor Chronic Moderate Chronic Significant Chronic Cancer or Catastrophic

$0

31

CT Health Exchange Population Overview

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

MeasureExchange Members

Non-Exchange Members

Average Members 86941 673266

Percentage of Members 55-64 Years of Age 31 20

Percentage of Members with Chronic Condition(s) 23 19

Expenditures PMPY $5378 $5239

Expenditures PMPY Risk Adjusted $4780 $5316 Expenditures PMPY for Members with Diabetes Risk-Adjusted $17561 $19291

32

CT Exchange vs Non-Exchange Rates

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

Rate per 1000 Rate per 1000 (Risk Adj)

Measure Exchange Members

Non-Exchange Members

Exchange Members

Non-Exchange Members

Inpatient Acute Visits 390 328 339 335Medical 210 144 181 147Surgical 140 116 115 119Maternity 41 69 41 69

Outpatient Emergency Visits 1941 1924 1944 1923MRIs 920 803 810 817CT Scans 1108 824 938 844Primary Care Office Visits 15216 18755 16068 18628Psychiatric Visits 9864 9783 9783 11092Chiropractic Visits 3403 7808 3088 7913

Utilization measures are capped at the 99th percentile

33

Expenditure PMPY Diabetes Population

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

$-

$5000

$10000

$15000

$20000

$25000

$30000

No Diabetes (n=730838) Diabetes amp no comorbidity (n=16419) Diabetes with comorbidity (n=12950)$0

No Diabetes (n = 730838)

Diabetes No Comorbidity(n = 16419)

Diabetes Comorbidity(n = 12950)

34

Vermont Blueprint for HealthDiabetes HbA1c Control amp Outcomes

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

Measure HbA1c in Control HbA1c Not in Control

Members 5619 786

Average annual expenditures per capita

$15726 ($15219 $16233)

$17328 ($16110 $18546)

Inpatient hospitalizations per 1000 members

1897 (1782 2011)

2531 (2177 2886)

Inpatient days per 1000 members

8685 (8440 8930)

11561 (10804 12318)

Outpatient ED visits per 1000 members

6275 (6067 6483)

8011 (7381 8642)

Risk-adjusted rates and 95 confidence intervals 99th percentile outliers excluded HbA1c not in control gt9

35

Expenditures PMPY by County

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

County Average Members Expenditures PMPYExpenditures PMPY

(Risk Adjusted)Fairfield 223295 $5182 $5539 New London 44741 $5913 $5342 New Haven 161763 $5494 $5335 Middlesex 38531 $5359 $5184 Litchfield 43224 $5136 $5118 Tolland 36304 $5047 $5019 Hartford 191415 $4998 $4958 Windham 20934 $5539 $4950

Total 760207 $5255 $5255

36

Expenditures PMPY by HSA Risk Adjusted

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

$0

$1000

$2000

$3000

$4000

$5000

$6000

$7000

37

EffectivePreventive Care

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

HEDIS MeasureCT APCD

CommercialNCQA

National HMONCQA

National PPOAvoidance of Antibiotic Treatment in Adults with Acute Bronchitis 268 276 258Anti-Depressant Medication Management 764 664 666Well-Child Visits 798 762 723Breast Cancer Screening 671 732 696

NCQA National HMO and NCQA National PPO benchmark metrics calculated for CY2015 Several other HEDIS measures can be run using the CT APCD data set and compared against the NCQA National HMO and PPO benchmarks Examples include Comprehensive Diabetes Care ndash HbA1C Testing Comprehensive Diabetes Care ndash Medical Attention for Nephrology Comprehensive Diabetes Care ndash Eye Exam Performed Adolescent Well-Care Visits Appropriate Treatment for Children with Upper Respiratory Infection etc

38

Breast Cancer Screening

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

60

62

64

66

68

70

72

Urban Centers (n=3369) Manufacturing Centers (n=10974) Diverse Suburbs (n=12206) Mill Towns (n=16281) Rural Towns (n=16789) Wealthy Suburbs (n=12266)

39

Vermont Blueprintrsquos Hub amp Spoke Model

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

bull Vermontrsquos ldquoHealth Homerdquo program designed to treat Vermonters with chronic opioid addiction

bull Hubs ndash designated providers ndash Provide coordinated care to patients through MAT services

ndash Coordinate referral to ongoing care

bull Spokes ndash teams of healthcare professionalsndash Blueprint Advanced Practice Medical Homes

ndash Federally-Qualified Health Centers

ndash Outpatient substance abuse and primary care providers

40copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

Medication Assisted Treatment

bull Vermont Blueprint baseline study comparing medication-assisted treatment (MAT) population versus non-MAT population

bull Study published in the Journal of Substance Abuse Treatment (August 2016)

41

bull The CT APCD is a comparable resource to other statewide APCDs ndash A powerful tool that will only continue to grow with usendash Encompasses a robust set of information including

expenditures procedure codes diagnosis coding drug codes and enhanced value-adds (eg claim type master membermaster provider IDsNPIs MS-DRGs etc)

bull Future considerations to enhance the CT APCDndash Add Medicare and Medicaid claims datandash Continue to strengthen the completeness and validity of data

elements of importance to downstream analytic use cases (eg member race and ethnicity codes) in data collection

Lessons Learned

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

43

Next Steps

44

01Task

02Task

Ensure data quality issues are identified documented communicated and resolved

Data Quality

Continue building breadth of payer database amp complete enclave load

Data ETL

Finalize strategy to ensure site accomplishes PA 13-247 and PA 15-146 intent

Establish Strategy

05Task

Identify leading consumer information and price transparency tools available

Consumer Tool Evaluation04Task

Tasks Until Next Meeting (11917)APCD Development and Strategy Update

Distinguish Critical Paths Across and Within Strategic Priorities and Maintain Focus on ldquoMust Havesrdquo and ldquoQuick Winsrdquo

Ensure APCD staff can generate self-service extracts at little cost with minimal lead time

Deliver First DR Extract03Task

45

Future MeetingsAPCD Development and Strategy Update

November

9Legislative Office

Building Room 1D 300 Capitol Avenue

Hartford

All Payer Claims Database Advisory GroupMeeting

900ndash1100 AM

• Slide Number 1
• Slide Number 2
• Slide Number 3
• Slide Number 4
• Slide Number 5
• Slide Number 6
• Slide Number 7
• Slide Number 8
• Slide Number 9
• Slide Number 10
• Slide Number 11
• Slide Number 12
• Slide Number 13
• Slide Number 14
• Slide Number 15
• Slide Number 16
• Slide Number 17
• Slide Number 18
• Project Descriptions
• Slide Number 20
• Scorecard Measures
• Suicide Risk Identification
• Slide Number 23
• Slide Number 24
• Slide Number 25
• Slide Number 26
• Slide Number 27
• Slide Number 28
• Slide Number 29
• Slide Number 30
• Slide Number 31
• Slide Number 32
• Slide Number 33
• Slide Number 34
• Slide Number 35
• Slide Number 36
• Slide Number 37
• Slide Number 38
• Slide Number 39
• Slide Number 40
• Slide Number 41
• Slide Number 42
• Slide Number 43
• Slide Number 44
• Slide Number 45

26

bull Member Any person covered in a submitterrsquos eligibility databull Average Members Member months divided by 12 (months)bull Expenditures Allowed amount bull Capping Capped outliers in the data at the 99th percentilebull Clinical Risk Groups Individualsrsquo categorized health statusbull County Administrative focus areasbull Hospital Service Area Local hospital marketsbull Health Reference Group Community types bull Rates Expenditures by average membersbull Risk Adjustment Adjusting for differences between member

populations by considering membersrsquo age gender and health status

Key Terms

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

27

Population-Based Reporting

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

bull Reporting units county modified Hospital Service Area (HSA) and Health Reference Group (HRG)

bull Risk adjustment age gender and health status (3M CRGs)

28

CT APCD Population Overview

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

Measure Count

Unique Members 875129

Total Member Months 9122482

Average Members 760207

Total Expenditures $40 Billion

Total Expenditures Per Member Per Year (PMPY) $5255

Total Expenditures Per Member Per Month (PMPM) $438

Total expenditures are capped at the 99th percentile

29

Expenditures PMPY by Age amp Gender

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

$0

$1000

$2000

$3000

$4000

$5000

$6000

$7000

$8000

$9000

0-18 Female 0-18 Male 18-34 Female 18-34 Male 35-44 Female 35-44 Male 45-54 Female 45-54 Male 55-64 Female 55-64 Male

30

Expenditures PMPY by CRGs

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

$-

$5000

$10000

$15000

$20000

$25000

$30000

$35000

$40000

Healthy Acute or Minor Chronic Moderate Chronic Significant Chronic Cancer or Catastrophic

$0

31

CT Health Exchange Population Overview

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

MeasureExchange Members

Non-Exchange Members

Average Members 86941 673266

Percentage of Members 55-64 Years of Age 31 20

Percentage of Members with Chronic Condition(s) 23 19

Expenditures PMPY $5378 $5239

Expenditures PMPY Risk Adjusted $4780 $5316 Expenditures PMPY for Members with Diabetes Risk-Adjusted $17561 $19291

32

CT Exchange vs Non-Exchange Rates

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

Rate per 1000 Rate per 1000 (Risk Adj)

Measure Exchange Members

Non-Exchange Members

Exchange Members

Non-Exchange Members

Inpatient Acute Visits 390 328 339 335Medical 210 144 181 147Surgical 140 116 115 119Maternity 41 69 41 69

Outpatient Emergency Visits 1941 1924 1944 1923MRIs 920 803 810 817CT Scans 1108 824 938 844Primary Care Office Visits 15216 18755 16068 18628Psychiatric Visits 9864 9783 9783 11092Chiropractic Visits 3403 7808 3088 7913

Utilization measures are capped at the 99th percentile

33

Expenditure PMPY Diabetes Population

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

$-

$5000

$10000

$15000

$20000

$25000

$30000

No Diabetes (n=730838) Diabetes amp no comorbidity (n=16419) Diabetes with comorbidity (n=12950)$0

No Diabetes (n = 730838)

Diabetes No Comorbidity(n = 16419)

Diabetes Comorbidity(n = 12950)

34

Vermont Blueprint for HealthDiabetes HbA1c Control amp Outcomes

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

Measure HbA1c in Control HbA1c Not in Control

Members 5619 786

Average annual expenditures per capita

$15726 ($15219 $16233)

$17328 ($16110 $18546)

Inpatient hospitalizations per 1000 members

1897 (1782 2011)

2531 (2177 2886)

Inpatient days per 1000 members

8685 (8440 8930)

11561 (10804 12318)

Outpatient ED visits per 1000 members

6275 (6067 6483)

8011 (7381 8642)

Risk-adjusted rates and 95 confidence intervals 99th percentile outliers excluded HbA1c not in control gt9

35

Expenditures PMPY by County

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

County Average Members Expenditures PMPYExpenditures PMPY

(Risk Adjusted)Fairfield 223295 $5182 $5539 New London 44741 $5913 $5342 New Haven 161763 $5494 $5335 Middlesex 38531 $5359 $5184 Litchfield 43224 $5136 $5118 Tolland 36304 $5047 $5019 Hartford 191415 $4998 $4958 Windham 20934 $5539 $4950

Total 760207 $5255 $5255

36

Expenditures PMPY by HSA Risk Adjusted

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

$0

$1000

$2000

$3000

$4000

$5000

$6000

$7000

37

EffectivePreventive Care

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

HEDIS MeasureCT APCD

CommercialNCQA

National HMONCQA

National PPOAvoidance of Antibiotic Treatment in Adults with Acute Bronchitis 268 276 258Anti-Depressant Medication Management 764 664 666Well-Child Visits 798 762 723Breast Cancer Screening 671 732 696

NCQA National HMO and NCQA National PPO benchmark metrics calculated for CY2015 Several other HEDIS measures can be run using the CT APCD data set and compared against the NCQA National HMO and PPO benchmarks Examples include Comprehensive Diabetes Care ndash HbA1C Testing Comprehensive Diabetes Care ndash Medical Attention for Nephrology Comprehensive Diabetes Care ndash Eye Exam Performed Adolescent Well-Care Visits Appropriate Treatment for Children with Upper Respiratory Infection etc

38

Breast Cancer Screening

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

60

62

64

66

68

70

72

Urban Centers (n=3369) Manufacturing Centers (n=10974) Diverse Suburbs (n=12206) Mill Towns (n=16281) Rural Towns (n=16789) Wealthy Suburbs (n=12266)

39

Vermont Blueprintrsquos Hub amp Spoke Model

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

bull Vermontrsquos ldquoHealth Homerdquo program designed to treat Vermonters with chronic opioid addiction

bull Hubs ndash designated providers ndash Provide coordinated care to patients through MAT services

ndash Coordinate referral to ongoing care

bull Spokes ndash teams of healthcare professionalsndash Blueprint Advanced Practice Medical Homes

ndash Federally-Qualified Health Centers

ndash Outpatient substance abuse and primary care providers

40copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

Medication Assisted Treatment

bull Vermont Blueprint baseline study comparing medication-assisted treatment (MAT) population versus non-MAT population

bull Study published in the Journal of Substance Abuse Treatment (August 2016)

41

bull The CT APCD is a comparable resource to other statewide APCDs ndash A powerful tool that will only continue to grow with usendash Encompasses a robust set of information including

expenditures procedure codes diagnosis coding drug codes and enhanced value-adds (eg claim type master membermaster provider IDsNPIs MS-DRGs etc)

bull Future considerations to enhance the CT APCDndash Add Medicare and Medicaid claims datandash Continue to strengthen the completeness and validity of data

elements of importance to downstream analytic use cases (eg member race and ethnicity codes) in data collection

Lessons Learned

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

43

Next Steps

44

01Task

02Task

Ensure data quality issues are identified documented communicated and resolved

Data Quality

Continue building breadth of payer database amp complete enclave load

Data ETL

Finalize strategy to ensure site accomplishes PA 13-247 and PA 15-146 intent

Establish Strategy

05Task

Identify leading consumer information and price transparency tools available

Consumer Tool Evaluation04Task

Tasks Until Next Meeting (11917)APCD Development and Strategy Update

Distinguish Critical Paths Across and Within Strategic Priorities and Maintain Focus on ldquoMust Havesrdquo and ldquoQuick Winsrdquo

Ensure APCD staff can generate self-service extracts at little cost with minimal lead time

Deliver First DR Extract03Task

45

Future MeetingsAPCD Development and Strategy Update

November

9Legislative Office

Building Room 1D 300 Capitol Avenue

Hartford

All Payer Claims Database Advisory GroupMeeting

900ndash1100 AM

• Slide Number 1
• Slide Number 2
• Slide Number 3
• Slide Number 4
• Slide Number 5
• Slide Number 6
• Slide Number 7
• Slide Number 8
• Slide Number 9
• Slide Number 10
• Slide Number 11
• Slide Number 12
• Slide Number 13
• Slide Number 14
• Slide Number 15
• Slide Number 16
• Slide Number 17
• Slide Number 18
• Project Descriptions
• Slide Number 20
• Scorecard Measures
• Suicide Risk Identification
• Slide Number 23
• Slide Number 24
• Slide Number 25
• Slide Number 26
• Slide Number 27
• Slide Number 28
• Slide Number 29
• Slide Number 30
• Slide Number 31
• Slide Number 32
• Slide Number 33
• Slide Number 34
• Slide Number 35
• Slide Number 36
• Slide Number 37
• Slide Number 38
• Slide Number 39
• Slide Number 40
• Slide Number 41
• Slide Number 42
• Slide Number 43
• Slide Number 44
• Slide Number 45

27

Population-Based Reporting

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

bull Reporting units county modified Hospital Service Area (HSA) and Health Reference Group (HRG)

bull Risk adjustment age gender and health status (3M CRGs)

28

CT APCD Population Overview

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

Measure Count

Unique Members 875129

Total Member Months 9122482

Average Members 760207

Total Expenditures $40 Billion

Total Expenditures Per Member Per Year (PMPY) $5255

Total Expenditures Per Member Per Month (PMPM) $438

Total expenditures are capped at the 99th percentile

29

Expenditures PMPY by Age amp Gender

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

$0

$1000

$2000

$3000

$4000

$5000

$6000

$7000

$8000

$9000

0-18 Female 0-18 Male 18-34 Female 18-34 Male 35-44 Female 35-44 Male 45-54 Female 45-54 Male 55-64 Female 55-64 Male

30

Expenditures PMPY by CRGs

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

$-

$5000

$10000

$15000

$20000

$25000

$30000

$35000

$40000

Healthy Acute or Minor Chronic Moderate Chronic Significant Chronic Cancer or Catastrophic

$0

31

CT Health Exchange Population Overview

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

MeasureExchange Members

Non-Exchange Members

Average Members 86941 673266

Percentage of Members 55-64 Years of Age 31 20

Percentage of Members with Chronic Condition(s) 23 19

Expenditures PMPY $5378 $5239

Expenditures PMPY Risk Adjusted $4780 $5316 Expenditures PMPY for Members with Diabetes Risk-Adjusted $17561 $19291

32

CT Exchange vs Non-Exchange Rates

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

Rate per 1000 Rate per 1000 (Risk Adj)

Measure Exchange Members

Non-Exchange Members

Exchange Members

Non-Exchange Members

Inpatient Acute Visits 390 328 339 335Medical 210 144 181 147Surgical 140 116 115 119Maternity 41 69 41 69

Outpatient Emergency Visits 1941 1924 1944 1923MRIs 920 803 810 817CT Scans 1108 824 938 844Primary Care Office Visits 15216 18755 16068 18628Psychiatric Visits 9864 9783 9783 11092Chiropractic Visits 3403 7808 3088 7913

Utilization measures are capped at the 99th percentile

33

Expenditure PMPY Diabetes Population

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

$-

$5000

$10000

$15000

$20000

$25000

$30000

No Diabetes (n=730838) Diabetes amp no comorbidity (n=16419) Diabetes with comorbidity (n=12950)$0

No Diabetes (n = 730838)

Diabetes No Comorbidity(n = 16419)

Diabetes Comorbidity(n = 12950)

34

Vermont Blueprint for HealthDiabetes HbA1c Control amp Outcomes

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

Measure HbA1c in Control HbA1c Not in Control

Members 5619 786

Average annual expenditures per capita

$15726 ($15219 $16233)

$17328 ($16110 $18546)

Inpatient hospitalizations per 1000 members

1897 (1782 2011)

2531 (2177 2886)

Inpatient days per 1000 members

8685 (8440 8930)

11561 (10804 12318)

Outpatient ED visits per 1000 members

6275 (6067 6483)

8011 (7381 8642)

Risk-adjusted rates and 95 confidence intervals 99th percentile outliers excluded HbA1c not in control gt9

35

Expenditures PMPY by County

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

County Average Members Expenditures PMPYExpenditures PMPY

(Risk Adjusted)Fairfield 223295 $5182 $5539 New London 44741 $5913 $5342 New Haven 161763 $5494 $5335 Middlesex 38531 $5359 $5184 Litchfield 43224 $5136 $5118 Tolland 36304 $5047 $5019 Hartford 191415 $4998 $4958 Windham 20934 $5539 $4950

Total 760207 $5255 $5255

36

Expenditures PMPY by HSA Risk Adjusted

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

$0

$1000

$2000

$3000

$4000

$5000

$6000

$7000

37

EffectivePreventive Care

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

HEDIS MeasureCT APCD

CommercialNCQA

National HMONCQA

National PPOAvoidance of Antibiotic Treatment in Adults with Acute Bronchitis 268 276 258Anti-Depressant Medication Management 764 664 666Well-Child Visits 798 762 723Breast Cancer Screening 671 732 696

NCQA National HMO and NCQA National PPO benchmark metrics calculated for CY2015 Several other HEDIS measures can be run using the CT APCD data set and compared against the NCQA National HMO and PPO benchmarks Examples include Comprehensive Diabetes Care ndash HbA1C Testing Comprehensive Diabetes Care ndash Medical Attention for Nephrology Comprehensive Diabetes Care ndash Eye Exam Performed Adolescent Well-Care Visits Appropriate Treatment for Children with Upper Respiratory Infection etc

38

Breast Cancer Screening

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

60

62

64

66

68

70

72

Urban Centers (n=3369) Manufacturing Centers (n=10974) Diverse Suburbs (n=12206) Mill Towns (n=16281) Rural Towns (n=16789) Wealthy Suburbs (n=12266)

39

Vermont Blueprintrsquos Hub amp Spoke Model

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

bull Vermontrsquos ldquoHealth Homerdquo program designed to treat Vermonters with chronic opioid addiction

bull Hubs ndash designated providers ndash Provide coordinated care to patients through MAT services

ndash Coordinate referral to ongoing care

bull Spokes ndash teams of healthcare professionalsndash Blueprint Advanced Practice Medical Homes

ndash Federally-Qualified Health Centers

ndash Outpatient substance abuse and primary care providers

40copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

Medication Assisted Treatment

bull Vermont Blueprint baseline study comparing medication-assisted treatment (MAT) population versus non-MAT population

bull Study published in the Journal of Substance Abuse Treatment (August 2016)

41

bull The CT APCD is a comparable resource to other statewide APCDs ndash A powerful tool that will only continue to grow with usendash Encompasses a robust set of information including

expenditures procedure codes diagnosis coding drug codes and enhanced value-adds (eg claim type master membermaster provider IDsNPIs MS-DRGs etc)

bull Future considerations to enhance the CT APCDndash Add Medicare and Medicaid claims datandash Continue to strengthen the completeness and validity of data

elements of importance to downstream analytic use cases (eg member race and ethnicity codes) in data collection

Lessons Learned

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

43

Next Steps

44

01Task

02Task

Ensure data quality issues are identified documented communicated and resolved

Data Quality

Continue building breadth of payer database amp complete enclave load

Data ETL

Finalize strategy to ensure site accomplishes PA 13-247 and PA 15-146 intent

Establish Strategy

05Task

Identify leading consumer information and price transparency tools available

Consumer Tool Evaluation04Task

Tasks Until Next Meeting (11917)APCD Development and Strategy Update

Distinguish Critical Paths Across and Within Strategic Priorities and Maintain Focus on ldquoMust Havesrdquo and ldquoQuick Winsrdquo

Ensure APCD staff can generate self-service extracts at little cost with minimal lead time

Deliver First DR Extract03Task

45

Future MeetingsAPCD Development and Strategy Update

November

9Legislative Office

Building Room 1D 300 Capitol Avenue

Hartford

All Payer Claims Database Advisory GroupMeeting

900ndash1100 AM

• Slide Number 1
• Slide Number 2
• Slide Number 3
• Slide Number 4
• Slide Number 5
• Slide Number 6
• Slide Number 7
• Slide Number 8
• Slide Number 9
• Slide Number 10
• Slide Number 11
• Slide Number 12
• Slide Number 13
• Slide Number 14
• Slide Number 15
• Slide Number 16
• Slide Number 17
• Slide Number 18
• Project Descriptions
• Slide Number 20
• Scorecard Measures
• Suicide Risk Identification
• Slide Number 23
• Slide Number 24
• Slide Number 25
• Slide Number 26
• Slide Number 27
• Slide Number 28
• Slide Number 29
• Slide Number 30
• Slide Number 31
• Slide Number 32
• Slide Number 33
• Slide Number 34
• Slide Number 35
• Slide Number 36
• Slide Number 37
• Slide Number 38
• Slide Number 39
• Slide Number 40
• Slide Number 41
• Slide Number 42
• Slide Number 43
• Slide Number 44
• Slide Number 45

28

CT APCD Population Overview

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

Measure Count

Unique Members 875129

Total Member Months 9122482

Average Members 760207

Total Expenditures $40 Billion

Total Expenditures Per Member Per Year (PMPY) $5255

Total Expenditures Per Member Per Month (PMPM) $438

Total expenditures are capped at the 99th percentile

29

Expenditures PMPY by Age amp Gender

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

$0

$1000

$2000

$3000

$4000

$5000

$6000

$7000

$8000

$9000

0-18 Female 0-18 Male 18-34 Female 18-34 Male 35-44 Female 35-44 Male 45-54 Female 45-54 Male 55-64 Female 55-64 Male

30

Expenditures PMPY by CRGs

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

$-

$5000

$10000

$15000

$20000

$25000

$30000

$35000

$40000

Healthy Acute or Minor Chronic Moderate Chronic Significant Chronic Cancer or Catastrophic

$0

31

CT Health Exchange Population Overview

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

MeasureExchange Members

Non-Exchange Members

Average Members 86941 673266

Percentage of Members 55-64 Years of Age 31 20

Percentage of Members with Chronic Condition(s) 23 19

Expenditures PMPY $5378 $5239

Expenditures PMPY Risk Adjusted $4780 $5316 Expenditures PMPY for Members with Diabetes Risk-Adjusted $17561 $19291

32

CT Exchange vs Non-Exchange Rates

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

Rate per 1000 Rate per 1000 (Risk Adj)

Measure Exchange Members

Non-Exchange Members

Exchange Members

Non-Exchange Members

Inpatient Acute Visits 390 328 339 335Medical 210 144 181 147Surgical 140 116 115 119Maternity 41 69 41 69

Outpatient Emergency Visits 1941 1924 1944 1923MRIs 920 803 810 817CT Scans 1108 824 938 844Primary Care Office Visits 15216 18755 16068 18628Psychiatric Visits 9864 9783 9783 11092Chiropractic Visits 3403 7808 3088 7913

Utilization measures are capped at the 99th percentile

33

Expenditure PMPY Diabetes Population

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

$-

$5000

$10000

$15000

$20000

$25000

$30000

No Diabetes (n=730838) Diabetes amp no comorbidity (n=16419) Diabetes with comorbidity (n=12950)$0

No Diabetes (n = 730838)

Diabetes No Comorbidity(n = 16419)

Diabetes Comorbidity(n = 12950)

34

Vermont Blueprint for HealthDiabetes HbA1c Control amp Outcomes

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

Measure HbA1c in Control HbA1c Not in Control

Members 5619 786

Average annual expenditures per capita

$15726 ($15219 $16233)

$17328 ($16110 $18546)

Inpatient hospitalizations per 1000 members

1897 (1782 2011)

2531 (2177 2886)

Inpatient days per 1000 members

8685 (8440 8930)

11561 (10804 12318)

Outpatient ED visits per 1000 members

6275 (6067 6483)

8011 (7381 8642)

Risk-adjusted rates and 95 confidence intervals 99th percentile outliers excluded HbA1c not in control gt9

35

Expenditures PMPY by County

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

County Average Members Expenditures PMPYExpenditures PMPY

(Risk Adjusted)Fairfield 223295 $5182 $5539 New London 44741 $5913 $5342 New Haven 161763 $5494 $5335 Middlesex 38531 $5359 $5184 Litchfield 43224 $5136 $5118 Tolland 36304 $5047 $5019 Hartford 191415 $4998 $4958 Windham 20934 $5539 $4950

Total 760207 $5255 $5255

36

Expenditures PMPY by HSA Risk Adjusted

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

$0

$1000

$2000

$3000

$4000

$5000

$6000

$7000

37

EffectivePreventive Care

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

HEDIS MeasureCT APCD

CommercialNCQA

National HMONCQA

National PPOAvoidance of Antibiotic Treatment in Adults with Acute Bronchitis 268 276 258Anti-Depressant Medication Management 764 664 666Well-Child Visits 798 762 723Breast Cancer Screening 671 732 696

NCQA National HMO and NCQA National PPO benchmark metrics calculated for CY2015 Several other HEDIS measures can be run using the CT APCD data set and compared against the NCQA National HMO and PPO benchmarks Examples include Comprehensive Diabetes Care ndash HbA1C Testing Comprehensive Diabetes Care ndash Medical Attention for Nephrology Comprehensive Diabetes Care ndash Eye Exam Performed Adolescent Well-Care Visits Appropriate Treatment for Children with Upper Respiratory Infection etc

38

Breast Cancer Screening

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

60

62

64

66

68

70

72

Urban Centers (n=3369) Manufacturing Centers (n=10974) Diverse Suburbs (n=12206) Mill Towns (n=16281) Rural Towns (n=16789) Wealthy Suburbs (n=12266)

39

Vermont Blueprintrsquos Hub amp Spoke Model

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

bull Vermontrsquos ldquoHealth Homerdquo program designed to treat Vermonters with chronic opioid addiction

bull Hubs ndash designated providers ndash Provide coordinated care to patients through MAT services

ndash Coordinate referral to ongoing care

bull Spokes ndash teams of healthcare professionalsndash Blueprint Advanced Practice Medical Homes

ndash Federally-Qualified Health Centers

ndash Outpatient substance abuse and primary care providers

40copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

Medication Assisted Treatment

bull Vermont Blueprint baseline study comparing medication-assisted treatment (MAT) population versus non-MAT population

bull Study published in the Journal of Substance Abuse Treatment (August 2016)

41

bull The CT APCD is a comparable resource to other statewide APCDs ndash A powerful tool that will only continue to grow with usendash Encompasses a robust set of information including

expenditures procedure codes diagnosis coding drug codes and enhanced value-adds (eg claim type master membermaster provider IDsNPIs MS-DRGs etc)

bull Future considerations to enhance the CT APCDndash Add Medicare and Medicaid claims datandash Continue to strengthen the completeness and validity of data

elements of importance to downstream analytic use cases (eg member race and ethnicity codes) in data collection

Lessons Learned

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

43

Next Steps

44

01Task

02Task

Ensure data quality issues are identified documented communicated and resolved

Data Quality

Continue building breadth of payer database amp complete enclave load

Data ETL

Finalize strategy to ensure site accomplishes PA 13-247 and PA 15-146 intent

Establish Strategy

05Task

Identify leading consumer information and price transparency tools available

Consumer Tool Evaluation04Task

Tasks Until Next Meeting (11917)APCD Development and Strategy Update

Distinguish Critical Paths Across and Within Strategic Priorities and Maintain Focus on ldquoMust Havesrdquo and ldquoQuick Winsrdquo

Ensure APCD staff can generate self-service extracts at little cost with minimal lead time

Deliver First DR Extract03Task

45

Future MeetingsAPCD Development and Strategy Update

November

9Legislative Office

Building Room 1D 300 Capitol Avenue

Hartford

All Payer Claims Database Advisory GroupMeeting

900ndash1100 AM

• Slide Number 1
• Slide Number 2
• Slide Number 3
• Slide Number 4
• Slide Number 5
• Slide Number 6
• Slide Number 7
• Slide Number 8
• Slide Number 9
• Slide Number 10
• Slide Number 11
• Slide Number 12
• Slide Number 13
• Slide Number 14
• Slide Number 15
• Slide Number 16
• Slide Number 17
• Slide Number 18
• Project Descriptions
• Slide Number 20
• Scorecard Measures
• Suicide Risk Identification
• Slide Number 23
• Slide Number 24
• Slide Number 25
• Slide Number 26
• Slide Number 27
• Slide Number 28
• Slide Number 29
• Slide Number 30
• Slide Number 31
• Slide Number 32
• Slide Number 33
• Slide Number 34
• Slide Number 35
• Slide Number 36
• Slide Number 37
• Slide Number 38
• Slide Number 39
• Slide Number 40
• Slide Number 41
• Slide Number 42
• Slide Number 43
• Slide Number 44
• Slide Number 45

29

Expenditures PMPY by Age amp Gender

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

$0

$1000

$2000

$3000

$4000

$5000

$6000

$7000

$8000

$9000

0-18 Female 0-18 Male 18-34 Female 18-34 Male 35-44 Female 35-44 Male 45-54 Female 45-54 Male 55-64 Female 55-64 Male

30

Expenditures PMPY by CRGs

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

$-

$5000

$10000

$15000

$20000

$25000

$30000

$35000

$40000

Healthy Acute or Minor Chronic Moderate Chronic Significant Chronic Cancer or Catastrophic

$0

31

CT Health Exchange Population Overview

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

MeasureExchange Members

Non-Exchange Members

Average Members 86941 673266

Percentage of Members 55-64 Years of Age 31 20

Percentage of Members with Chronic Condition(s) 23 19

Expenditures PMPY $5378 $5239

Expenditures PMPY Risk Adjusted $4780 $5316 Expenditures PMPY for Members with Diabetes Risk-Adjusted $17561 $19291

32

CT Exchange vs Non-Exchange Rates

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

Rate per 1000 Rate per 1000 (Risk Adj)

Measure Exchange Members

Non-Exchange Members

Exchange Members

Non-Exchange Members

Inpatient Acute Visits 390 328 339 335Medical 210 144 181 147Surgical 140 116 115 119Maternity 41 69 41 69

Outpatient Emergency Visits 1941 1924 1944 1923MRIs 920 803 810 817CT Scans 1108 824 938 844Primary Care Office Visits 15216 18755 16068 18628Psychiatric Visits 9864 9783 9783 11092Chiropractic Visits 3403 7808 3088 7913

Utilization measures are capped at the 99th percentile

33

Expenditure PMPY Diabetes Population

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

$-

$5000

$10000

$15000

$20000

$25000

$30000

No Diabetes (n=730838) Diabetes amp no comorbidity (n=16419) Diabetes with comorbidity (n=12950)$0

No Diabetes (n = 730838)

Diabetes No Comorbidity(n = 16419)

Diabetes Comorbidity(n = 12950)

34

Vermont Blueprint for HealthDiabetes HbA1c Control amp Outcomes

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

Measure HbA1c in Control HbA1c Not in Control

Members 5619 786

Average annual expenditures per capita

$15726 ($15219 $16233)

$17328 ($16110 $18546)

Inpatient hospitalizations per 1000 members

1897 (1782 2011)

2531 (2177 2886)

Inpatient days per 1000 members

8685 (8440 8930)

11561 (10804 12318)

Outpatient ED visits per 1000 members

6275 (6067 6483)

8011 (7381 8642)

Risk-adjusted rates and 95 confidence intervals 99th percentile outliers excluded HbA1c not in control gt9

35

Expenditures PMPY by County

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

County Average Members Expenditures PMPYExpenditures PMPY

(Risk Adjusted)Fairfield 223295 $5182 $5539 New London 44741 $5913 $5342 New Haven 161763 $5494 $5335 Middlesex 38531 $5359 $5184 Litchfield 43224 $5136 $5118 Tolland 36304 $5047 $5019 Hartford 191415 $4998 $4958 Windham 20934 $5539 $4950

Total 760207 $5255 $5255

36

Expenditures PMPY by HSA Risk Adjusted

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

$0

$1000

$2000

$3000

$4000

$5000

$6000

$7000

37

EffectivePreventive Care

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

HEDIS MeasureCT APCD

CommercialNCQA

National HMONCQA

National PPOAvoidance of Antibiotic Treatment in Adults with Acute Bronchitis 268 276 258Anti-Depressant Medication Management 764 664 666Well-Child Visits 798 762 723Breast Cancer Screening 671 732 696

NCQA National HMO and NCQA National PPO benchmark metrics calculated for CY2015 Several other HEDIS measures can be run using the CT APCD data set and compared against the NCQA National HMO and PPO benchmarks Examples include Comprehensive Diabetes Care ndash HbA1C Testing Comprehensive Diabetes Care ndash Medical Attention for Nephrology Comprehensive Diabetes Care ndash Eye Exam Performed Adolescent Well-Care Visits Appropriate Treatment for Children with Upper Respiratory Infection etc

38

Breast Cancer Screening

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

60

62

64

66

68

70

72

Urban Centers (n=3369) Manufacturing Centers (n=10974) Diverse Suburbs (n=12206) Mill Towns (n=16281) Rural Towns (n=16789) Wealthy Suburbs (n=12266)

39

Vermont Blueprintrsquos Hub amp Spoke Model

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

bull Vermontrsquos ldquoHealth Homerdquo program designed to treat Vermonters with chronic opioid addiction

bull Hubs ndash designated providers ndash Provide coordinated care to patients through MAT services

ndash Coordinate referral to ongoing care

bull Spokes ndash teams of healthcare professionalsndash Blueprint Advanced Practice Medical Homes

ndash Federally-Qualified Health Centers

ndash Outpatient substance abuse and primary care providers

40copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

Medication Assisted Treatment

bull Vermont Blueprint baseline study comparing medication-assisted treatment (MAT) population versus non-MAT population

bull Study published in the Journal of Substance Abuse Treatment (August 2016)

41

bull The CT APCD is a comparable resource to other statewide APCDs ndash A powerful tool that will only continue to grow with usendash Encompasses a robust set of information including

expenditures procedure codes diagnosis coding drug codes and enhanced value-adds (eg claim type master membermaster provider IDsNPIs MS-DRGs etc)

bull Future considerations to enhance the CT APCDndash Add Medicare and Medicaid claims datandash Continue to strengthen the completeness and validity of data

elements of importance to downstream analytic use cases (eg member race and ethnicity codes) in data collection

Lessons Learned

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

43

Next Steps

44

01Task

02Task

Ensure data quality issues are identified documented communicated and resolved

Data Quality

Continue building breadth of payer database amp complete enclave load

Data ETL

Finalize strategy to ensure site accomplishes PA 13-247 and PA 15-146 intent

Establish Strategy

05Task

Identify leading consumer information and price transparency tools available

Consumer Tool Evaluation04Task

Tasks Until Next Meeting (11917)APCD Development and Strategy Update

Distinguish Critical Paths Across and Within Strategic Priorities and Maintain Focus on ldquoMust Havesrdquo and ldquoQuick Winsrdquo

Ensure APCD staff can generate self-service extracts at little cost with minimal lead time

Deliver First DR Extract03Task

45

Future MeetingsAPCD Development and Strategy Update

November

9Legislative Office

Building Room 1D 300 Capitol Avenue

Hartford

All Payer Claims Database Advisory GroupMeeting

900ndash1100 AM

• Slide Number 1
• Slide Number 2
• Slide Number 3
• Slide Number 4
• Slide Number 5
• Slide Number 6
• Slide Number 7
• Slide Number 8
• Slide Number 9
• Slide Number 10
• Slide Number 11
• Slide Number 12
• Slide Number 13
• Slide Number 14
• Slide Number 15
• Slide Number 16
• Slide Number 17
• Slide Number 18
• Project Descriptions
• Slide Number 20
• Scorecard Measures
• Suicide Risk Identification
• Slide Number 23
• Slide Number 24
• Slide Number 25
• Slide Number 26
• Slide Number 27
• Slide Number 28
• Slide Number 29
• Slide Number 30
• Slide Number 31
• Slide Number 32
• Slide Number 33
• Slide Number 34
• Slide Number 35
• Slide Number 36
• Slide Number 37
• Slide Number 38
• Slide Number 39
• Slide Number 40
• Slide Number 41
• Slide Number 42
• Slide Number 43
• Slide Number 44
• Slide Number 45

30

Expenditures PMPY by CRGs

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

$-

$5000

$10000

$15000

$20000

$25000

$30000

$35000

$40000

Healthy Acute or Minor Chronic Moderate Chronic Significant Chronic Cancer or Catastrophic

$0

31

CT Health Exchange Population Overview

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

MeasureExchange Members

Non-Exchange Members

Average Members 86941 673266

Percentage of Members 55-64 Years of Age 31 20

Percentage of Members with Chronic Condition(s) 23 19

Expenditures PMPY $5378 $5239

Expenditures PMPY Risk Adjusted $4780 $5316 Expenditures PMPY for Members with Diabetes Risk-Adjusted $17561 $19291

32

CT Exchange vs Non-Exchange Rates

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

Rate per 1000 Rate per 1000 (Risk Adj)

Measure Exchange Members

Non-Exchange Members

Exchange Members

Non-Exchange Members

Inpatient Acute Visits 390 328 339 335Medical 210 144 181 147Surgical 140 116 115 119Maternity 41 69 41 69

Outpatient Emergency Visits 1941 1924 1944 1923MRIs 920 803 810 817CT Scans 1108 824 938 844Primary Care Office Visits 15216 18755 16068 18628Psychiatric Visits 9864 9783 9783 11092Chiropractic Visits 3403 7808 3088 7913

Utilization measures are capped at the 99th percentile

33

Expenditure PMPY Diabetes Population

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

$-

$5000

$10000

$15000

$20000

$25000

$30000

No Diabetes (n=730838) Diabetes amp no comorbidity (n=16419) Diabetes with comorbidity (n=12950)$0

No Diabetes (n = 730838)

Diabetes No Comorbidity(n = 16419)

Diabetes Comorbidity(n = 12950)

34

Vermont Blueprint for HealthDiabetes HbA1c Control amp Outcomes

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

Measure HbA1c in Control HbA1c Not in Control

Members 5619 786

Average annual expenditures per capita

$15726 ($15219 $16233)

$17328 ($16110 $18546)

Inpatient hospitalizations per 1000 members

1897 (1782 2011)

2531 (2177 2886)

Inpatient days per 1000 members

8685 (8440 8930)

11561 (10804 12318)

Outpatient ED visits per 1000 members

6275 (6067 6483)

8011 (7381 8642)

Risk-adjusted rates and 95 confidence intervals 99th percentile outliers excluded HbA1c not in control gt9

35

Expenditures PMPY by County

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

County Average Members Expenditures PMPYExpenditures PMPY

(Risk Adjusted)Fairfield 223295 $5182 $5539 New London 44741 $5913 $5342 New Haven 161763 $5494 $5335 Middlesex 38531 $5359 $5184 Litchfield 43224 $5136 $5118 Tolland 36304 $5047 $5019 Hartford 191415 $4998 $4958 Windham 20934 $5539 $4950

Total 760207 $5255 $5255

36

Expenditures PMPY by HSA Risk Adjusted

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

$0

$1000

$2000

$3000

$4000

$5000

$6000

$7000

37

EffectivePreventive Care

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

HEDIS MeasureCT APCD

CommercialNCQA

National HMONCQA

National PPOAvoidance of Antibiotic Treatment in Adults with Acute Bronchitis 268 276 258Anti-Depressant Medication Management 764 664 666Well-Child Visits 798 762 723Breast Cancer Screening 671 732 696

NCQA National HMO and NCQA National PPO benchmark metrics calculated for CY2015 Several other HEDIS measures can be run using the CT APCD data set and compared against the NCQA National HMO and PPO benchmarks Examples include Comprehensive Diabetes Care ndash HbA1C Testing Comprehensive Diabetes Care ndash Medical Attention for Nephrology Comprehensive Diabetes Care ndash Eye Exam Performed Adolescent Well-Care Visits Appropriate Treatment for Children with Upper Respiratory Infection etc

38

Breast Cancer Screening

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

60

62

64

66

68

70

72

Urban Centers (n=3369) Manufacturing Centers (n=10974) Diverse Suburbs (n=12206) Mill Towns (n=16281) Rural Towns (n=16789) Wealthy Suburbs (n=12266)

39

Vermont Blueprintrsquos Hub amp Spoke Model

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

bull Vermontrsquos ldquoHealth Homerdquo program designed to treat Vermonters with chronic opioid addiction

bull Hubs ndash designated providers ndash Provide coordinated care to patients through MAT services

ndash Coordinate referral to ongoing care

bull Spokes ndash teams of healthcare professionalsndash Blueprint Advanced Practice Medical Homes

ndash Federally-Qualified Health Centers

ndash Outpatient substance abuse and primary care providers

40copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

Medication Assisted Treatment

bull Vermont Blueprint baseline study comparing medication-assisted treatment (MAT) population versus non-MAT population

bull Study published in the Journal of Substance Abuse Treatment (August 2016)

41

bull The CT APCD is a comparable resource to other statewide APCDs ndash A powerful tool that will only continue to grow with usendash Encompasses a robust set of information including

expenditures procedure codes diagnosis coding drug codes and enhanced value-adds (eg claim type master membermaster provider IDsNPIs MS-DRGs etc)

bull Future considerations to enhance the CT APCDndash Add Medicare and Medicaid claims datandash Continue to strengthen the completeness and validity of data

elements of importance to downstream analytic use cases (eg member race and ethnicity codes) in data collection

Lessons Learned

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

43

Next Steps

44

01Task

02Task

Ensure data quality issues are identified documented communicated and resolved

Data Quality

Continue building breadth of payer database amp complete enclave load

Data ETL

Finalize strategy to ensure site accomplishes PA 13-247 and PA 15-146 intent

Establish Strategy

05Task

Identify leading consumer information and price transparency tools available

Consumer Tool Evaluation04Task

Tasks Until Next Meeting (11917)APCD Development and Strategy Update

Distinguish Critical Paths Across and Within Strategic Priorities and Maintain Focus on ldquoMust Havesrdquo and ldquoQuick Winsrdquo

Ensure APCD staff can generate self-service extracts at little cost with minimal lead time

Deliver First DR Extract03Task

45

Future MeetingsAPCD Development and Strategy Update

November

9Legislative Office

Building Room 1D 300 Capitol Avenue

Hartford

All Payer Claims Database Advisory GroupMeeting

900ndash1100 AM

• Slide Number 1
• Slide Number 2
• Slide Number 3
• Slide Number 4
• Slide Number 5
• Slide Number 6
• Slide Number 7
• Slide Number 8
• Slide Number 9
• Slide Number 10
• Slide Number 11
• Slide Number 12
• Slide Number 13
• Slide Number 14
• Slide Number 15
• Slide Number 16
• Slide Number 17
• Slide Number 18
• Project Descriptions
• Slide Number 20
• Scorecard Measures
• Suicide Risk Identification
• Slide Number 23
• Slide Number 24
• Slide Number 25
• Slide Number 26
• Slide Number 27
• Slide Number 28
• Slide Number 29
• Slide Number 30
• Slide Number 31
• Slide Number 32
• Slide Number 33
• Slide Number 34
• Slide Number 35
• Slide Number 36
• Slide Number 37
• Slide Number 38
• Slide Number 39
• Slide Number 40
• Slide Number 41
• Slide Number 42
• Slide Number 43
• Slide Number 44
• Slide Number 45

31

CT Health Exchange Population Overview

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

MeasureExchange Members

Non-Exchange Members

Average Members 86941 673266

Percentage of Members 55-64 Years of Age 31 20

Percentage of Members with Chronic Condition(s) 23 19

Expenditures PMPY $5378 $5239

Expenditures PMPY Risk Adjusted $4780 $5316 Expenditures PMPY for Members with Diabetes Risk-Adjusted $17561 $19291

32

CT Exchange vs Non-Exchange Rates

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

Rate per 1000 Rate per 1000 (Risk Adj)

Measure Exchange Members

Non-Exchange Members

Exchange Members

Non-Exchange Members

Inpatient Acute Visits 390 328 339 335Medical 210 144 181 147Surgical 140 116 115 119Maternity 41 69 41 69

Outpatient Emergency Visits 1941 1924 1944 1923MRIs 920 803 810 817CT Scans 1108 824 938 844Primary Care Office Visits 15216 18755 16068 18628Psychiatric Visits 9864 9783 9783 11092Chiropractic Visits 3403 7808 3088 7913

Utilization measures are capped at the 99th percentile

33

Expenditure PMPY Diabetes Population

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

$-

$5000

$10000

$15000

$20000

$25000

$30000

No Diabetes (n=730838) Diabetes amp no comorbidity (n=16419) Diabetes with comorbidity (n=12950)$0

No Diabetes (n = 730838)

Diabetes No Comorbidity(n = 16419)

Diabetes Comorbidity(n = 12950)

34

Vermont Blueprint for HealthDiabetes HbA1c Control amp Outcomes

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

Measure HbA1c in Control HbA1c Not in Control

Members 5619 786

Average annual expenditures per capita

$15726 ($15219 $16233)

$17328 ($16110 $18546)

Inpatient hospitalizations per 1000 members

1897 (1782 2011)

2531 (2177 2886)

Inpatient days per 1000 members

8685 (8440 8930)

11561 (10804 12318)

Outpatient ED visits per 1000 members

6275 (6067 6483)

8011 (7381 8642)

Risk-adjusted rates and 95 confidence intervals 99th percentile outliers excluded HbA1c not in control gt9

35

Expenditures PMPY by County

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

County Average Members Expenditures PMPYExpenditures PMPY

(Risk Adjusted)Fairfield 223295 $5182 $5539 New London 44741 $5913 $5342 New Haven 161763 $5494 $5335 Middlesex 38531 $5359 $5184 Litchfield 43224 $5136 $5118 Tolland 36304 $5047 $5019 Hartford 191415 $4998 $4958 Windham 20934 $5539 $4950

Total 760207 $5255 $5255

36

Expenditures PMPY by HSA Risk Adjusted

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

$0

$1000

$2000

$3000

$4000

$5000

$6000

$7000

37

EffectivePreventive Care

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

HEDIS MeasureCT APCD

CommercialNCQA

National HMONCQA

National PPOAvoidance of Antibiotic Treatment in Adults with Acute Bronchitis 268 276 258Anti-Depressant Medication Management 764 664 666Well-Child Visits 798 762 723Breast Cancer Screening 671 732 696

NCQA National HMO and NCQA National PPO benchmark metrics calculated for CY2015 Several other HEDIS measures can be run using the CT APCD data set and compared against the NCQA National HMO and PPO benchmarks Examples include Comprehensive Diabetes Care ndash HbA1C Testing Comprehensive Diabetes Care ndash Medical Attention for Nephrology Comprehensive Diabetes Care ndash Eye Exam Performed Adolescent Well-Care Visits Appropriate Treatment for Children with Upper Respiratory Infection etc

38

Breast Cancer Screening

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

60

62

64

66

68

70

72

Urban Centers (n=3369) Manufacturing Centers (n=10974) Diverse Suburbs (n=12206) Mill Towns (n=16281) Rural Towns (n=16789) Wealthy Suburbs (n=12266)

39

Vermont Blueprintrsquos Hub amp Spoke Model

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

bull Vermontrsquos ldquoHealth Homerdquo program designed to treat Vermonters with chronic opioid addiction

bull Hubs ndash designated providers ndash Provide coordinated care to patients through MAT services

ndash Coordinate referral to ongoing care

bull Spokes ndash teams of healthcare professionalsndash Blueprint Advanced Practice Medical Homes

ndash Federally-Qualified Health Centers

ndash Outpatient substance abuse and primary care providers

40copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

Medication Assisted Treatment

bull Vermont Blueprint baseline study comparing medication-assisted treatment (MAT) population versus non-MAT population

bull Study published in the Journal of Substance Abuse Treatment (August 2016)

41

bull The CT APCD is a comparable resource to other statewide APCDs ndash A powerful tool that will only continue to grow with usendash Encompasses a robust set of information including

expenditures procedure codes diagnosis coding drug codes and enhanced value-adds (eg claim type master membermaster provider IDsNPIs MS-DRGs etc)

bull Future considerations to enhance the CT APCDndash Add Medicare and Medicaid claims datandash Continue to strengthen the completeness and validity of data

elements of importance to downstream analytic use cases (eg member race and ethnicity codes) in data collection

Lessons Learned

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

43

Next Steps

44

01Task

02Task

Ensure data quality issues are identified documented communicated and resolved

Data Quality

Continue building breadth of payer database amp complete enclave load

Data ETL

Finalize strategy to ensure site accomplishes PA 13-247 and PA 15-146 intent

Establish Strategy

05Task

Identify leading consumer information and price transparency tools available

Consumer Tool Evaluation04Task

Tasks Until Next Meeting (11917)APCD Development and Strategy Update

Distinguish Critical Paths Across and Within Strategic Priorities and Maintain Focus on ldquoMust Havesrdquo and ldquoQuick Winsrdquo

Ensure APCD staff can generate self-service extracts at little cost with minimal lead time

Deliver First DR Extract03Task

45

Future MeetingsAPCD Development and Strategy Update

November

9Legislative Office

Building Room 1D 300 Capitol Avenue

Hartford

All Payer Claims Database Advisory GroupMeeting

900ndash1100 AM

• Slide Number 1
• Slide Number 2
• Slide Number 3
• Slide Number 4
• Slide Number 5
• Slide Number 6
• Slide Number 7
• Slide Number 8
• Slide Number 9
• Slide Number 10
• Slide Number 11
• Slide Number 12
• Slide Number 13
• Slide Number 14
• Slide Number 15
• Slide Number 16
• Slide Number 17
• Slide Number 18
• Project Descriptions
• Slide Number 20
• Scorecard Measures
• Suicide Risk Identification
• Slide Number 23
• Slide Number 24
• Slide Number 25
• Slide Number 26
• Slide Number 27
• Slide Number 28
• Slide Number 29
• Slide Number 30
• Slide Number 31
• Slide Number 32
• Slide Number 33
• Slide Number 34
• Slide Number 35
• Slide Number 36
• Slide Number 37
• Slide Number 38
• Slide Number 39
• Slide Number 40
• Slide Number 41
• Slide Number 42
• Slide Number 43
• Slide Number 44
• Slide Number 45

32

CT Exchange vs Non-Exchange Rates

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

Rate per 1000 Rate per 1000 (Risk Adj)

Measure Exchange Members

Non-Exchange Members

Exchange Members

Non-Exchange Members

Inpatient Acute Visits 390 328 339 335Medical 210 144 181 147Surgical 140 116 115 119Maternity 41 69 41 69

Outpatient Emergency Visits 1941 1924 1944 1923MRIs 920 803 810 817CT Scans 1108 824 938 844Primary Care Office Visits 15216 18755 16068 18628Psychiatric Visits 9864 9783 9783 11092Chiropractic Visits 3403 7808 3088 7913

Utilization measures are capped at the 99th percentile

33

Expenditure PMPY Diabetes Population

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

$-

$5000

$10000

$15000

$20000

$25000

$30000

No Diabetes (n=730838) Diabetes amp no comorbidity (n=16419) Diabetes with comorbidity (n=12950)$0

No Diabetes (n = 730838)

Diabetes No Comorbidity(n = 16419)

Diabetes Comorbidity(n = 12950)

34

Vermont Blueprint for HealthDiabetes HbA1c Control amp Outcomes

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

Measure HbA1c in Control HbA1c Not in Control

Members 5619 786

Average annual expenditures per capita

$15726 ($15219 $16233)

$17328 ($16110 $18546)

Inpatient hospitalizations per 1000 members

1897 (1782 2011)

2531 (2177 2886)

Inpatient days per 1000 members

8685 (8440 8930)

11561 (10804 12318)

Outpatient ED visits per 1000 members

6275 (6067 6483)

8011 (7381 8642)

Risk-adjusted rates and 95 confidence intervals 99th percentile outliers excluded HbA1c not in control gt9

35

Expenditures PMPY by County

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

County Average Members Expenditures PMPYExpenditures PMPY

(Risk Adjusted)Fairfield 223295 $5182 $5539 New London 44741 $5913 $5342 New Haven 161763 $5494 $5335 Middlesex 38531 $5359 $5184 Litchfield 43224 $5136 $5118 Tolland 36304 $5047 $5019 Hartford 191415 $4998 $4958 Windham 20934 $5539 $4950

Total 760207 $5255 $5255

36

Expenditures PMPY by HSA Risk Adjusted

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

$0

$1000

$2000

$3000

$4000

$5000

$6000

$7000

37

EffectivePreventive Care

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

HEDIS MeasureCT APCD

CommercialNCQA

National HMONCQA

National PPOAvoidance of Antibiotic Treatment in Adults with Acute Bronchitis 268 276 258Anti-Depressant Medication Management 764 664 666Well-Child Visits 798 762 723Breast Cancer Screening 671 732 696

NCQA National HMO and NCQA National PPO benchmark metrics calculated for CY2015 Several other HEDIS measures can be run using the CT APCD data set and compared against the NCQA National HMO and PPO benchmarks Examples include Comprehensive Diabetes Care ndash HbA1C Testing Comprehensive Diabetes Care ndash Medical Attention for Nephrology Comprehensive Diabetes Care ndash Eye Exam Performed Adolescent Well-Care Visits Appropriate Treatment for Children with Upper Respiratory Infection etc

38

Breast Cancer Screening

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

60

62

64

66

68

70

72

Urban Centers (n=3369) Manufacturing Centers (n=10974) Diverse Suburbs (n=12206) Mill Towns (n=16281) Rural Towns (n=16789) Wealthy Suburbs (n=12266)

39

Vermont Blueprintrsquos Hub amp Spoke Model

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

bull Vermontrsquos ldquoHealth Homerdquo program designed to treat Vermonters with chronic opioid addiction

bull Hubs ndash designated providers ndash Provide coordinated care to patients through MAT services

ndash Coordinate referral to ongoing care

bull Spokes ndash teams of healthcare professionalsndash Blueprint Advanced Practice Medical Homes

ndash Federally-Qualified Health Centers

ndash Outpatient substance abuse and primary care providers

40copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

Medication Assisted Treatment

bull Vermont Blueprint baseline study comparing medication-assisted treatment (MAT) population versus non-MAT population

bull Study published in the Journal of Substance Abuse Treatment (August 2016)

41

bull The CT APCD is a comparable resource to other statewide APCDs ndash A powerful tool that will only continue to grow with usendash Encompasses a robust set of information including

expenditures procedure codes diagnosis coding drug codes and enhanced value-adds (eg claim type master membermaster provider IDsNPIs MS-DRGs etc)

bull Future considerations to enhance the CT APCDndash Add Medicare and Medicaid claims datandash Continue to strengthen the completeness and validity of data

elements of importance to downstream analytic use cases (eg member race and ethnicity codes) in data collection

Lessons Learned

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

43

Next Steps

44

01Task

02Task

Ensure data quality issues are identified documented communicated and resolved

Data Quality

Continue building breadth of payer database amp complete enclave load

Data ETL

Finalize strategy to ensure site accomplishes PA 13-247 and PA 15-146 intent

Establish Strategy

05Task

Identify leading consumer information and price transparency tools available

Consumer Tool Evaluation04Task

Tasks Until Next Meeting (11917)APCD Development and Strategy Update

Distinguish Critical Paths Across and Within Strategic Priorities and Maintain Focus on ldquoMust Havesrdquo and ldquoQuick Winsrdquo

Ensure APCD staff can generate self-service extracts at little cost with minimal lead time

Deliver First DR Extract03Task

45

Future MeetingsAPCD Development and Strategy Update

November

9Legislative Office

Building Room 1D 300 Capitol Avenue

Hartford

All Payer Claims Database Advisory GroupMeeting

900ndash1100 AM

• Slide Number 1
• Slide Number 2
• Slide Number 3
• Slide Number 4
• Slide Number 5
• Slide Number 6
• Slide Number 7
• Slide Number 8
• Slide Number 9
• Slide Number 10
• Slide Number 11
• Slide Number 12
• Slide Number 13
• Slide Number 14
• Slide Number 15
• Slide Number 16
• Slide Number 17
• Slide Number 18
• Project Descriptions
• Slide Number 20
• Scorecard Measures
• Suicide Risk Identification
• Slide Number 23
• Slide Number 24
• Slide Number 25
• Slide Number 26
• Slide Number 27
• Slide Number 28
• Slide Number 29
• Slide Number 30
• Slide Number 31
• Slide Number 32
• Slide Number 33
• Slide Number 34
• Slide Number 35
• Slide Number 36
• Slide Number 37
• Slide Number 38
• Slide Number 39
• Slide Number 40
• Slide Number 41
• Slide Number 42
• Slide Number 43
• Slide Number 44
• Slide Number 45

33

Expenditure PMPY Diabetes Population

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

$-

$5000

$10000

$15000

$20000

$25000

$30000

No Diabetes (n=730838) Diabetes amp no comorbidity (n=16419) Diabetes with comorbidity (n=12950)$0

No Diabetes (n = 730838)

Diabetes No Comorbidity(n = 16419)

Diabetes Comorbidity(n = 12950)

34

Vermont Blueprint for HealthDiabetes HbA1c Control amp Outcomes

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

Measure HbA1c in Control HbA1c Not in Control

Members 5619 786

Average annual expenditures per capita

$15726 ($15219 $16233)

$17328 ($16110 $18546)

Inpatient hospitalizations per 1000 members

1897 (1782 2011)

2531 (2177 2886)

Inpatient days per 1000 members

8685 (8440 8930)

11561 (10804 12318)

Outpatient ED visits per 1000 members

6275 (6067 6483)

8011 (7381 8642)

Risk-adjusted rates and 95 confidence intervals 99th percentile outliers excluded HbA1c not in control gt9

35

Expenditures PMPY by County

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

County Average Members Expenditures PMPYExpenditures PMPY

(Risk Adjusted)Fairfield 223295 $5182 $5539 New London 44741 $5913 $5342 New Haven 161763 $5494 $5335 Middlesex 38531 $5359 $5184 Litchfield 43224 $5136 $5118 Tolland 36304 $5047 $5019 Hartford 191415 $4998 $4958 Windham 20934 $5539 $4950

Total 760207 $5255 $5255

36

Expenditures PMPY by HSA Risk Adjusted

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

$0

$1000

$2000

$3000

$4000

$5000

$6000

$7000

37

EffectivePreventive Care

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

HEDIS MeasureCT APCD

CommercialNCQA

National HMONCQA

National PPOAvoidance of Antibiotic Treatment in Adults with Acute Bronchitis 268 276 258Anti-Depressant Medication Management 764 664 666Well-Child Visits 798 762 723Breast Cancer Screening 671 732 696

NCQA National HMO and NCQA National PPO benchmark metrics calculated for CY2015 Several other HEDIS measures can be run using the CT APCD data set and compared against the NCQA National HMO and PPO benchmarks Examples include Comprehensive Diabetes Care ndash HbA1C Testing Comprehensive Diabetes Care ndash Medical Attention for Nephrology Comprehensive Diabetes Care ndash Eye Exam Performed Adolescent Well-Care Visits Appropriate Treatment for Children with Upper Respiratory Infection etc

38

Breast Cancer Screening

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

60

62

64

66

68

70

72

Urban Centers (n=3369) Manufacturing Centers (n=10974) Diverse Suburbs (n=12206) Mill Towns (n=16281) Rural Towns (n=16789) Wealthy Suburbs (n=12266)

39

Vermont Blueprintrsquos Hub amp Spoke Model

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

bull Vermontrsquos ldquoHealth Homerdquo program designed to treat Vermonters with chronic opioid addiction

bull Hubs ndash designated providers ndash Provide coordinated care to patients through MAT services

ndash Coordinate referral to ongoing care

bull Spokes ndash teams of healthcare professionalsndash Blueprint Advanced Practice Medical Homes

ndash Federally-Qualified Health Centers

ndash Outpatient substance abuse and primary care providers

40copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

Medication Assisted Treatment

bull Vermont Blueprint baseline study comparing medication-assisted treatment (MAT) population versus non-MAT population

bull Study published in the Journal of Substance Abuse Treatment (August 2016)

41

bull The CT APCD is a comparable resource to other statewide APCDs ndash A powerful tool that will only continue to grow with usendash Encompasses a robust set of information including

expenditures procedure codes diagnosis coding drug codes and enhanced value-adds (eg claim type master membermaster provider IDsNPIs MS-DRGs etc)

bull Future considerations to enhance the CT APCDndash Add Medicare and Medicaid claims datandash Continue to strengthen the completeness and validity of data

elements of importance to downstream analytic use cases (eg member race and ethnicity codes) in data collection

Lessons Learned

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

43

Next Steps

44

01Task

02Task

Ensure data quality issues are identified documented communicated and resolved

Data Quality

Continue building breadth of payer database amp complete enclave load

Data ETL

Finalize strategy to ensure site accomplishes PA 13-247 and PA 15-146 intent

Establish Strategy

05Task

Identify leading consumer information and price transparency tools available

Consumer Tool Evaluation04Task

Tasks Until Next Meeting (11917)APCD Development and Strategy Update

Distinguish Critical Paths Across and Within Strategic Priorities and Maintain Focus on ldquoMust Havesrdquo and ldquoQuick Winsrdquo

Ensure APCD staff can generate self-service extracts at little cost with minimal lead time

Deliver First DR Extract03Task

45

Future MeetingsAPCD Development and Strategy Update

November

9Legislative Office

Building Room 1D 300 Capitol Avenue

Hartford

All Payer Claims Database Advisory GroupMeeting

900ndash1100 AM

• Slide Number 1
• Slide Number 2
• Slide Number 3
• Slide Number 4
• Slide Number 5
• Slide Number 6
• Slide Number 7
• Slide Number 8
• Slide Number 9
• Slide Number 10
• Slide Number 11
• Slide Number 12
• Slide Number 13
• Slide Number 14
• Slide Number 15
• Slide Number 16
• Slide Number 17
• Slide Number 18
• Project Descriptions
• Slide Number 20
• Scorecard Measures
• Suicide Risk Identification
• Slide Number 23
• Slide Number 24
• Slide Number 25
• Slide Number 26
• Slide Number 27
• Slide Number 28
• Slide Number 29
• Slide Number 30
• Slide Number 31
• Slide Number 32
• Slide Number 33
• Slide Number 34
• Slide Number 35
• Slide Number 36
• Slide Number 37
• Slide Number 38
• Slide Number 39
• Slide Number 40
• Slide Number 41
• Slide Number 42
• Slide Number 43
• Slide Number 44
• Slide Number 45

34

Vermont Blueprint for HealthDiabetes HbA1c Control amp Outcomes

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

Measure HbA1c in Control HbA1c Not in Control

Members 5619 786

Average annual expenditures per capita

$15726 ($15219 $16233)

$17328 ($16110 $18546)

Inpatient hospitalizations per 1000 members

1897 (1782 2011)

2531 (2177 2886)

Inpatient days per 1000 members

8685 (8440 8930)

11561 (10804 12318)

Outpatient ED visits per 1000 members

6275 (6067 6483)

8011 (7381 8642)

Risk-adjusted rates and 95 confidence intervals 99th percentile outliers excluded HbA1c not in control gt9

35

Expenditures PMPY by County

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

County Average Members Expenditures PMPYExpenditures PMPY

(Risk Adjusted)Fairfield 223295 $5182 $5539 New London 44741 $5913 $5342 New Haven 161763 $5494 $5335 Middlesex 38531 $5359 $5184 Litchfield 43224 $5136 $5118 Tolland 36304 $5047 $5019 Hartford 191415 $4998 $4958 Windham 20934 $5539 $4950

Total 760207 $5255 $5255

36

Expenditures PMPY by HSA Risk Adjusted

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

$0

$1000

$2000

$3000

$4000

$5000

$6000

$7000

37

EffectivePreventive Care

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

HEDIS MeasureCT APCD

CommercialNCQA

National HMONCQA

National PPOAvoidance of Antibiotic Treatment in Adults with Acute Bronchitis 268 276 258Anti-Depressant Medication Management 764 664 666Well-Child Visits 798 762 723Breast Cancer Screening 671 732 696

NCQA National HMO and NCQA National PPO benchmark metrics calculated for CY2015 Several other HEDIS measures can be run using the CT APCD data set and compared against the NCQA National HMO and PPO benchmarks Examples include Comprehensive Diabetes Care ndash HbA1C Testing Comprehensive Diabetes Care ndash Medical Attention for Nephrology Comprehensive Diabetes Care ndash Eye Exam Performed Adolescent Well-Care Visits Appropriate Treatment for Children with Upper Respiratory Infection etc

38

Breast Cancer Screening

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

60

62

64

66

68

70

72

Urban Centers (n=3369) Manufacturing Centers (n=10974) Diverse Suburbs (n=12206) Mill Towns (n=16281) Rural Towns (n=16789) Wealthy Suburbs (n=12266)

39

Vermont Blueprintrsquos Hub amp Spoke Model

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

bull Vermontrsquos ldquoHealth Homerdquo program designed to treat Vermonters with chronic opioid addiction

bull Hubs ndash designated providers ndash Provide coordinated care to patients through MAT services

ndash Coordinate referral to ongoing care

bull Spokes ndash teams of healthcare professionalsndash Blueprint Advanced Practice Medical Homes

ndash Federally-Qualified Health Centers

ndash Outpatient substance abuse and primary care providers

40copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

Medication Assisted Treatment

bull Vermont Blueprint baseline study comparing medication-assisted treatment (MAT) population versus non-MAT population

bull Study published in the Journal of Substance Abuse Treatment (August 2016)

41

bull The CT APCD is a comparable resource to other statewide APCDs ndash A powerful tool that will only continue to grow with usendash Encompasses a robust set of information including

expenditures procedure codes diagnosis coding drug codes and enhanced value-adds (eg claim type master membermaster provider IDsNPIs MS-DRGs etc)

bull Future considerations to enhance the CT APCDndash Add Medicare and Medicaid claims datandash Continue to strengthen the completeness and validity of data

elements of importance to downstream analytic use cases (eg member race and ethnicity codes) in data collection

Lessons Learned

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

43

Next Steps

44

01Task

02Task

Ensure data quality issues are identified documented communicated and resolved

Data Quality

Continue building breadth of payer database amp complete enclave load

Data ETL

Finalize strategy to ensure site accomplishes PA 13-247 and PA 15-146 intent

Establish Strategy

05Task

Identify leading consumer information and price transparency tools available

Consumer Tool Evaluation04Task

Tasks Until Next Meeting (11917)APCD Development and Strategy Update

Distinguish Critical Paths Across and Within Strategic Priorities and Maintain Focus on ldquoMust Havesrdquo and ldquoQuick Winsrdquo

Ensure APCD staff can generate self-service extracts at little cost with minimal lead time

Deliver First DR Extract03Task

45

Future MeetingsAPCD Development and Strategy Update

November

9Legislative Office

Building Room 1D 300 Capitol Avenue

Hartford

All Payer Claims Database Advisory GroupMeeting

900ndash1100 AM

• Slide Number 1
• Slide Number 2
• Slide Number 3
• Slide Number 4
• Slide Number 5
• Slide Number 6
• Slide Number 7
• Slide Number 8
• Slide Number 9
• Slide Number 10
• Slide Number 11
• Slide Number 12
• Slide Number 13
• Slide Number 14
• Slide Number 15
• Slide Number 16
• Slide Number 17
• Slide Number 18
• Project Descriptions
• Slide Number 20
• Scorecard Measures
• Suicide Risk Identification
• Slide Number 23
• Slide Number 24
• Slide Number 25
• Slide Number 26
• Slide Number 27
• Slide Number 28
• Slide Number 29
• Slide Number 30
• Slide Number 31
• Slide Number 32
• Slide Number 33
• Slide Number 34
• Slide Number 35
• Slide Number 36
• Slide Number 37
• Slide Number 38
• Slide Number 39
• Slide Number 40
• Slide Number 41
• Slide Number 42
• Slide Number 43
• Slide Number 44
• Slide Number 45

35

Expenditures PMPY by County

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

County Average Members Expenditures PMPYExpenditures PMPY

(Risk Adjusted)Fairfield 223295 $5182 $5539 New London 44741 $5913 $5342 New Haven 161763 $5494 $5335 Middlesex 38531 $5359 $5184 Litchfield 43224 $5136 $5118 Tolland 36304 $5047 $5019 Hartford 191415 $4998 $4958 Windham 20934 $5539 $4950

Total 760207 $5255 $5255

36

Expenditures PMPY by HSA Risk Adjusted

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

$0

$1000

$2000

$3000

$4000

$5000

$6000

$7000

37

EffectivePreventive Care

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

HEDIS MeasureCT APCD

CommercialNCQA

National HMONCQA

National PPOAvoidance of Antibiotic Treatment in Adults with Acute Bronchitis 268 276 258Anti-Depressant Medication Management 764 664 666Well-Child Visits 798 762 723Breast Cancer Screening 671 732 696

NCQA National HMO and NCQA National PPO benchmark metrics calculated for CY2015 Several other HEDIS measures can be run using the CT APCD data set and compared against the NCQA National HMO and PPO benchmarks Examples include Comprehensive Diabetes Care ndash HbA1C Testing Comprehensive Diabetes Care ndash Medical Attention for Nephrology Comprehensive Diabetes Care ndash Eye Exam Performed Adolescent Well-Care Visits Appropriate Treatment for Children with Upper Respiratory Infection etc

38

Breast Cancer Screening

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

60

62

64

66

68

70

72

Urban Centers (n=3369) Manufacturing Centers (n=10974) Diverse Suburbs (n=12206) Mill Towns (n=16281) Rural Towns (n=16789) Wealthy Suburbs (n=12266)

39

Vermont Blueprintrsquos Hub amp Spoke Model

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

bull Vermontrsquos ldquoHealth Homerdquo program designed to treat Vermonters with chronic opioid addiction

bull Hubs ndash designated providers ndash Provide coordinated care to patients through MAT services

ndash Coordinate referral to ongoing care

bull Spokes ndash teams of healthcare professionalsndash Blueprint Advanced Practice Medical Homes

ndash Federally-Qualified Health Centers

ndash Outpatient substance abuse and primary care providers

40copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

Medication Assisted Treatment

bull Vermont Blueprint baseline study comparing medication-assisted treatment (MAT) population versus non-MAT population

bull Study published in the Journal of Substance Abuse Treatment (August 2016)

41

bull The CT APCD is a comparable resource to other statewide APCDs ndash A powerful tool that will only continue to grow with usendash Encompasses a robust set of information including

expenditures procedure codes diagnosis coding drug codes and enhanced value-adds (eg claim type master membermaster provider IDsNPIs MS-DRGs etc)

bull Future considerations to enhance the CT APCDndash Add Medicare and Medicaid claims datandash Continue to strengthen the completeness and validity of data

elements of importance to downstream analytic use cases (eg member race and ethnicity codes) in data collection

Lessons Learned

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

43

Next Steps

44

01Task

02Task

Ensure data quality issues are identified documented communicated and resolved

Data Quality

Continue building breadth of payer database amp complete enclave load

Data ETL

Finalize strategy to ensure site accomplishes PA 13-247 and PA 15-146 intent

Establish Strategy

05Task

Identify leading consumer information and price transparency tools available

Consumer Tool Evaluation04Task

Tasks Until Next Meeting (11917)APCD Development and Strategy Update

Distinguish Critical Paths Across and Within Strategic Priorities and Maintain Focus on ldquoMust Havesrdquo and ldquoQuick Winsrdquo

Ensure APCD staff can generate self-service extracts at little cost with minimal lead time

Deliver First DR Extract03Task

45

Future MeetingsAPCD Development and Strategy Update

November

9Legislative Office

Building Room 1D 300 Capitol Avenue

Hartford

All Payer Claims Database Advisory GroupMeeting

900ndash1100 AM

• Slide Number 1
• Slide Number 2
• Slide Number 3
• Slide Number 4
• Slide Number 5
• Slide Number 6
• Slide Number 7
• Slide Number 8
• Slide Number 9
• Slide Number 10
• Slide Number 11
• Slide Number 12
• Slide Number 13
• Slide Number 14
• Slide Number 15
• Slide Number 16
• Slide Number 17
• Slide Number 18
• Project Descriptions
• Slide Number 20
• Scorecard Measures
• Suicide Risk Identification
• Slide Number 23
• Slide Number 24
• Slide Number 25
• Slide Number 26
• Slide Number 27
• Slide Number 28
• Slide Number 29
• Slide Number 30
• Slide Number 31
• Slide Number 32
• Slide Number 33
• Slide Number 34
• Slide Number 35
• Slide Number 36
• Slide Number 37
• Slide Number 38
• Slide Number 39
• Slide Number 40
• Slide Number 41
• Slide Number 42
• Slide Number 43
• Slide Number 44
• Slide Number 45

36

Expenditures PMPY by HSA Risk Adjusted

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

$0

$1000

$2000

$3000

$4000

$5000

$6000

$7000

37

EffectivePreventive Care

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

HEDIS MeasureCT APCD

CommercialNCQA

National HMONCQA

National PPOAvoidance of Antibiotic Treatment in Adults with Acute Bronchitis 268 276 258Anti-Depressant Medication Management 764 664 666Well-Child Visits 798 762 723Breast Cancer Screening 671 732 696

NCQA National HMO and NCQA National PPO benchmark metrics calculated for CY2015 Several other HEDIS measures can be run using the CT APCD data set and compared against the NCQA National HMO and PPO benchmarks Examples include Comprehensive Diabetes Care ndash HbA1C Testing Comprehensive Diabetes Care ndash Medical Attention for Nephrology Comprehensive Diabetes Care ndash Eye Exam Performed Adolescent Well-Care Visits Appropriate Treatment for Children with Upper Respiratory Infection etc

38

Breast Cancer Screening

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

60

62

64

66

68

70

72

Urban Centers (n=3369) Manufacturing Centers (n=10974) Diverse Suburbs (n=12206) Mill Towns (n=16281) Rural Towns (n=16789) Wealthy Suburbs (n=12266)

39

Vermont Blueprintrsquos Hub amp Spoke Model

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

bull Vermontrsquos ldquoHealth Homerdquo program designed to treat Vermonters with chronic opioid addiction

bull Hubs ndash designated providers ndash Provide coordinated care to patients through MAT services

ndash Coordinate referral to ongoing care

bull Spokes ndash teams of healthcare professionalsndash Blueprint Advanced Practice Medical Homes

ndash Federally-Qualified Health Centers

ndash Outpatient substance abuse and primary care providers

40copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

Medication Assisted Treatment

bull Vermont Blueprint baseline study comparing medication-assisted treatment (MAT) population versus non-MAT population

bull Study published in the Journal of Substance Abuse Treatment (August 2016)

41

bull The CT APCD is a comparable resource to other statewide APCDs ndash A powerful tool that will only continue to grow with usendash Encompasses a robust set of information including

expenditures procedure codes diagnosis coding drug codes and enhanced value-adds (eg claim type master membermaster provider IDsNPIs MS-DRGs etc)

bull Future considerations to enhance the CT APCDndash Add Medicare and Medicaid claims datandash Continue to strengthen the completeness and validity of data

elements of importance to downstream analytic use cases (eg member race and ethnicity codes) in data collection

Lessons Learned

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

43

Next Steps

44

01Task

02Task

Ensure data quality issues are identified documented communicated and resolved

Data Quality

Continue building breadth of payer database amp complete enclave load

Data ETL

Finalize strategy to ensure site accomplishes PA 13-247 and PA 15-146 intent

Establish Strategy

05Task

Identify leading consumer information and price transparency tools available

Consumer Tool Evaluation04Task

Tasks Until Next Meeting (11917)APCD Development and Strategy Update

Distinguish Critical Paths Across and Within Strategic Priorities and Maintain Focus on ldquoMust Havesrdquo and ldquoQuick Winsrdquo

Ensure APCD staff can generate self-service extracts at little cost with minimal lead time

Deliver First DR Extract03Task

45

Future MeetingsAPCD Development and Strategy Update

November

9Legislative Office

Building Room 1D 300 Capitol Avenue

Hartford

All Payer Claims Database Advisory GroupMeeting

900ndash1100 AM

• Slide Number 1
• Slide Number 2
• Slide Number 3
• Slide Number 4
• Slide Number 5
• Slide Number 6
• Slide Number 7
• Slide Number 8
• Slide Number 9
• Slide Number 10
• Slide Number 11
• Slide Number 12
• Slide Number 13
• Slide Number 14
• Slide Number 15
• Slide Number 16
• Slide Number 17
• Slide Number 18
• Project Descriptions
• Slide Number 20
• Scorecard Measures
• Suicide Risk Identification
• Slide Number 23
• Slide Number 24
• Slide Number 25
• Slide Number 26
• Slide Number 27
• Slide Number 28
• Slide Number 29
• Slide Number 30
• Slide Number 31
• Slide Number 32
• Slide Number 33
• Slide Number 34
• Slide Number 35
• Slide Number 36
• Slide Number 37
• Slide Number 38
• Slide Number 39
• Slide Number 40
• Slide Number 41
• Slide Number 42
• Slide Number 43
• Slide Number 44
• Slide Number 45

37

EffectivePreventive Care

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

HEDIS MeasureCT APCD

CommercialNCQA

National HMONCQA

National PPOAvoidance of Antibiotic Treatment in Adults with Acute Bronchitis 268 276 258Anti-Depressant Medication Management 764 664 666Well-Child Visits 798 762 723Breast Cancer Screening 671 732 696

NCQA National HMO and NCQA National PPO benchmark metrics calculated for CY2015 Several other HEDIS measures can be run using the CT APCD data set and compared against the NCQA National HMO and PPO benchmarks Examples include Comprehensive Diabetes Care ndash HbA1C Testing Comprehensive Diabetes Care ndash Medical Attention for Nephrology Comprehensive Diabetes Care ndash Eye Exam Performed Adolescent Well-Care Visits Appropriate Treatment for Children with Upper Respiratory Infection etc

38

Breast Cancer Screening

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

60

62

64

66

68

70

72

Urban Centers (n=3369) Manufacturing Centers (n=10974) Diverse Suburbs (n=12206) Mill Towns (n=16281) Rural Towns (n=16789) Wealthy Suburbs (n=12266)

39

Vermont Blueprintrsquos Hub amp Spoke Model

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

bull Vermontrsquos ldquoHealth Homerdquo program designed to treat Vermonters with chronic opioid addiction

bull Hubs ndash designated providers ndash Provide coordinated care to patients through MAT services

ndash Coordinate referral to ongoing care

bull Spokes ndash teams of healthcare professionalsndash Blueprint Advanced Practice Medical Homes

ndash Federally-Qualified Health Centers

ndash Outpatient substance abuse and primary care providers

40copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

Medication Assisted Treatment

bull Vermont Blueprint baseline study comparing medication-assisted treatment (MAT) population versus non-MAT population

bull Study published in the Journal of Substance Abuse Treatment (August 2016)

41

bull The CT APCD is a comparable resource to other statewide APCDs ndash A powerful tool that will only continue to grow with usendash Encompasses a robust set of information including

expenditures procedure codes diagnosis coding drug codes and enhanced value-adds (eg claim type master membermaster provider IDsNPIs MS-DRGs etc)

bull Future considerations to enhance the CT APCDndash Add Medicare and Medicaid claims datandash Continue to strengthen the completeness and validity of data

elements of importance to downstream analytic use cases (eg member race and ethnicity codes) in data collection

Lessons Learned

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

43

Next Steps

44

01Task

02Task

Ensure data quality issues are identified documented communicated and resolved

Data Quality

Continue building breadth of payer database amp complete enclave load

Data ETL

Finalize strategy to ensure site accomplishes PA 13-247 and PA 15-146 intent

Establish Strategy

05Task

Identify leading consumer information and price transparency tools available

Consumer Tool Evaluation04Task

Tasks Until Next Meeting (11917)APCD Development and Strategy Update

Distinguish Critical Paths Across and Within Strategic Priorities and Maintain Focus on ldquoMust Havesrdquo and ldquoQuick Winsrdquo

Ensure APCD staff can generate self-service extracts at little cost with minimal lead time

Deliver First DR Extract03Task

45

Future MeetingsAPCD Development and Strategy Update

November

9Legislative Office

Building Room 1D 300 Capitol Avenue

Hartford

All Payer Claims Database Advisory GroupMeeting

900ndash1100 AM

• Slide Number 1
• Slide Number 2
• Slide Number 3
• Slide Number 4
• Slide Number 5
• Slide Number 6
• Slide Number 7
• Slide Number 8
• Slide Number 9
• Slide Number 10
• Slide Number 11
• Slide Number 12
• Slide Number 13
• Slide Number 14
• Slide Number 15
• Slide Number 16
• Slide Number 17
• Slide Number 18
• Project Descriptions
• Slide Number 20
• Scorecard Measures
• Suicide Risk Identification
• Slide Number 23
• Slide Number 24
• Slide Number 25
• Slide Number 26
• Slide Number 27
• Slide Number 28
• Slide Number 29
• Slide Number 30
• Slide Number 31
• Slide Number 32
• Slide Number 33
• Slide Number 34
• Slide Number 35
• Slide Number 36
• Slide Number 37
• Slide Number 38
• Slide Number 39
• Slide Number 40
• Slide Number 41
• Slide Number 42
• Slide Number 43
• Slide Number 44
• Slide Number 45

38

Breast Cancer Screening

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

60

62

64

66

68

70

72

Urban Centers (n=3369) Manufacturing Centers (n=10974) Diverse Suburbs (n=12206) Mill Towns (n=16281) Rural Towns (n=16789) Wealthy Suburbs (n=12266)

39

Vermont Blueprintrsquos Hub amp Spoke Model

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

bull Vermontrsquos ldquoHealth Homerdquo program designed to treat Vermonters with chronic opioid addiction

bull Hubs ndash designated providers ndash Provide coordinated care to patients through MAT services

ndash Coordinate referral to ongoing care

bull Spokes ndash teams of healthcare professionalsndash Blueprint Advanced Practice Medical Homes

ndash Federally-Qualified Health Centers

ndash Outpatient substance abuse and primary care providers

40copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

Medication Assisted Treatment

bull Vermont Blueprint baseline study comparing medication-assisted treatment (MAT) population versus non-MAT population

bull Study published in the Journal of Substance Abuse Treatment (August 2016)

41

bull The CT APCD is a comparable resource to other statewide APCDs ndash A powerful tool that will only continue to grow with usendash Encompasses a robust set of information including

expenditures procedure codes diagnosis coding drug codes and enhanced value-adds (eg claim type master membermaster provider IDsNPIs MS-DRGs etc)

bull Future considerations to enhance the CT APCDndash Add Medicare and Medicaid claims datandash Continue to strengthen the completeness and validity of data

elements of importance to downstream analytic use cases (eg member race and ethnicity codes) in data collection

Lessons Learned

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

43

Next Steps

44

01Task

02Task

Ensure data quality issues are identified documented communicated and resolved

Data Quality

Continue building breadth of payer database amp complete enclave load

Data ETL

Finalize strategy to ensure site accomplishes PA 13-247 and PA 15-146 intent

Establish Strategy

05Task

Identify leading consumer information and price transparency tools available

Consumer Tool Evaluation04Task

Tasks Until Next Meeting (11917)APCD Development and Strategy Update

Distinguish Critical Paths Across and Within Strategic Priorities and Maintain Focus on ldquoMust Havesrdquo and ldquoQuick Winsrdquo

Ensure APCD staff can generate self-service extracts at little cost with minimal lead time

Deliver First DR Extract03Task

45

Future MeetingsAPCD Development and Strategy Update

November

9Legislative Office

Building Room 1D 300 Capitol Avenue

Hartford

All Payer Claims Database Advisory GroupMeeting

900ndash1100 AM

• Slide Number 1
• Slide Number 2
• Slide Number 3
• Slide Number 4
• Slide Number 5
• Slide Number 6
• Slide Number 7
• Slide Number 8
• Slide Number 9
• Slide Number 10
• Slide Number 11
• Slide Number 12
• Slide Number 13
• Slide Number 14
• Slide Number 15
• Slide Number 16
• Slide Number 17
• Slide Number 18
• Project Descriptions
• Slide Number 20
• Scorecard Measures
• Suicide Risk Identification
• Slide Number 23
• Slide Number 24
• Slide Number 25
• Slide Number 26
• Slide Number 27
• Slide Number 28
• Slide Number 29
• Slide Number 30
• Slide Number 31
• Slide Number 32
• Slide Number 33
• Slide Number 34
• Slide Number 35
• Slide Number 36
• Slide Number 37
• Slide Number 38
• Slide Number 39
• Slide Number 40
• Slide Number 41
• Slide Number 42
• Slide Number 43
• Slide Number 44
• Slide Number 45

39

Vermont Blueprintrsquos Hub amp Spoke Model

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

bull Vermontrsquos ldquoHealth Homerdquo program designed to treat Vermonters with chronic opioid addiction

bull Hubs ndash designated providers ndash Provide coordinated care to patients through MAT services

ndash Coordinate referral to ongoing care

bull Spokes ndash teams of healthcare professionalsndash Blueprint Advanced Practice Medical Homes

ndash Federally-Qualified Health Centers

ndash Outpatient substance abuse and primary care providers

40copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

Medication Assisted Treatment

bull Vermont Blueprint baseline study comparing medication-assisted treatment (MAT) population versus non-MAT population

bull Study published in the Journal of Substance Abuse Treatment (August 2016)

41

bull The CT APCD is a comparable resource to other statewide APCDs ndash A powerful tool that will only continue to grow with usendash Encompasses a robust set of information including

expenditures procedure codes diagnosis coding drug codes and enhanced value-adds (eg claim type master membermaster provider IDsNPIs MS-DRGs etc)

bull Future considerations to enhance the CT APCDndash Add Medicare and Medicaid claims datandash Continue to strengthen the completeness and validity of data

elements of importance to downstream analytic use cases (eg member race and ethnicity codes) in data collection

Lessons Learned

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

43

Next Steps

44

01Task

02Task

Ensure data quality issues are identified documented communicated and resolved

Data Quality

Continue building breadth of payer database amp complete enclave load

Data ETL

Finalize strategy to ensure site accomplishes PA 13-247 and PA 15-146 intent

Establish Strategy

05Task

Identify leading consumer information and price transparency tools available

Consumer Tool Evaluation04Task

Tasks Until Next Meeting (11917)APCD Development and Strategy Update

Distinguish Critical Paths Across and Within Strategic Priorities and Maintain Focus on ldquoMust Havesrdquo and ldquoQuick Winsrdquo

Ensure APCD staff can generate self-service extracts at little cost with minimal lead time

Deliver First DR Extract03Task

45

Future MeetingsAPCD Development and Strategy Update

November

9Legislative Office

Building Room 1D 300 Capitol Avenue

Hartford

All Payer Claims Database Advisory GroupMeeting

900ndash1100 AM

• Slide Number 1
• Slide Number 2
• Slide Number 3
• Slide Number 4
• Slide Number 5
• Slide Number 6
• Slide Number 7
• Slide Number 8
• Slide Number 9
• Slide Number 10
• Slide Number 11
• Slide Number 12
• Slide Number 13
• Slide Number 14
• Slide Number 15
• Slide Number 16
• Slide Number 17
• Slide Number 18
• Project Descriptions
• Slide Number 20
• Scorecard Measures
• Suicide Risk Identification
• Slide Number 23
• Slide Number 24
• Slide Number 25
• Slide Number 26
• Slide Number 27
• Slide Number 28
• Slide Number 29
• Slide Number 30
• Slide Number 31
• Slide Number 32
• Slide Number 33
• Slide Number 34
• Slide Number 35
• Slide Number 36
• Slide Number 37
• Slide Number 38
• Slide Number 39
• Slide Number 40
• Slide Number 41
• Slide Number 42
• Slide Number 43
• Slide Number 44
• Slide Number 45

40copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

Medication Assisted Treatment

bull Vermont Blueprint baseline study comparing medication-assisted treatment (MAT) population versus non-MAT population

bull Study published in the Journal of Substance Abuse Treatment (August 2016)

41

bull The CT APCD is a comparable resource to other statewide APCDs ndash A powerful tool that will only continue to grow with usendash Encompasses a robust set of information including

expenditures procedure codes diagnosis coding drug codes and enhanced value-adds (eg claim type master membermaster provider IDsNPIs MS-DRGs etc)

bull Future considerations to enhance the CT APCDndash Add Medicare and Medicaid claims datandash Continue to strengthen the completeness and validity of data

elements of importance to downstream analytic use cases (eg member race and ethnicity codes) in data collection

Lessons Learned

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

43

Next Steps

44

01Task

02Task

Ensure data quality issues are identified documented communicated and resolved

Data Quality

Continue building breadth of payer database amp complete enclave load

Data ETL

Finalize strategy to ensure site accomplishes PA 13-247 and PA 15-146 intent

Establish Strategy

05Task

Identify leading consumer information and price transparency tools available

Consumer Tool Evaluation04Task

Tasks Until Next Meeting (11917)APCD Development and Strategy Update

Distinguish Critical Paths Across and Within Strategic Priorities and Maintain Focus on ldquoMust Havesrdquo and ldquoQuick Winsrdquo

Ensure APCD staff can generate self-service extracts at little cost with minimal lead time

Deliver First DR Extract03Task

45

Future MeetingsAPCD Development and Strategy Update

November

9Legislative Office

Building Room 1D 300 Capitol Avenue

Hartford

All Payer Claims Database Advisory GroupMeeting

900ndash1100 AM

• Slide Number 1
• Slide Number 2
• Slide Number 3
• Slide Number 4
• Slide Number 5
• Slide Number 6
• Slide Number 7
• Slide Number 8
• Slide Number 9
• Slide Number 10
• Slide Number 11
• Slide Number 12
• Slide Number 13
• Slide Number 14
• Slide Number 15
• Slide Number 16
• Slide Number 17
• Slide Number 18
• Project Descriptions
• Slide Number 20
• Scorecard Measures
• Suicide Risk Identification
• Slide Number 23
• Slide Number 24
• Slide Number 25
• Slide Number 26
• Slide Number 27
• Slide Number 28
• Slide Number 29
• Slide Number 30
• Slide Number 31
• Slide Number 32
• Slide Number 33
• Slide Number 34
• Slide Number 35
• Slide Number 36
• Slide Number 37
• Slide Number 38
• Slide Number 39
• Slide Number 40
• Slide Number 41
• Slide Number 42
• Slide Number 43
• Slide Number 44
• Slide Number 45

41

bull The CT APCD is a comparable resource to other statewide APCDs ndash A powerful tool that will only continue to grow with usendash Encompasses a robust set of information including

expenditures procedure codes diagnosis coding drug codes and enhanced value-adds (eg claim type master membermaster provider IDsNPIs MS-DRGs etc)

bull Future considerations to enhance the CT APCDndash Add Medicare and Medicaid claims datandash Continue to strengthen the completeness and validity of data

elements of importance to downstream analytic use cases (eg member race and ethnicity codes) in data collection

Lessons Learned

copy Onpoint Health Data ∙ Confidential amp proprietary information ∙ Not for redistribution

43

Next Steps

44

01Task

02Task

Ensure data quality issues are identified documented communicated and resolved

Data Quality

Continue building breadth of payer database amp complete enclave load

Data ETL

Finalize strategy to ensure site accomplishes PA 13-247 and PA 15-146 intent

Establish Strategy

05Task

Identify leading consumer information and price transparency tools available

Consumer Tool Evaluation04Task

Tasks Until Next Meeting (11917)APCD Development and Strategy Update

Distinguish Critical Paths Across and Within Strategic Priorities and Maintain Focus on ldquoMust Havesrdquo and ldquoQuick Winsrdquo

Ensure APCD staff can generate self-service extracts at little cost with minimal lead time

Deliver First DR Extract03Task

45

Future MeetingsAPCD Development and Strategy Update

November

9Legislative Office

Building Room 1D 300 Capitol Avenue

Hartford

All Payer Claims Database Advisory GroupMeeting

900ndash1100 AM

• Slide Number 1
• Slide Number 2
• Slide Number 3
• Slide Number 4
• Slide Number 5
• Slide Number 6
• Slide Number 7
• Slide Number 8
• Slide Number 9
• Slide Number 10
• Slide Number 11
• Slide Number 12
• Slide Number 13
• Slide Number 14
• Slide Number 15
• Slide Number 16
• Slide Number 17
• Slide Number 18
• Project Descriptions
• Slide Number 20
• Scorecard Measures
• Suicide Risk Identification
• Slide Number 23
• Slide Number 24
• Slide Number 25
• Slide Number 26
• Slide Number 27
• Slide Number 28
• Slide Number 29
• Slide Number 30
• Slide Number 31
• Slide Number 32
• Slide Number 33
• Slide Number 34
• Slide Number 35
• Slide Number 36
• Slide Number 37
• Slide Number 38
• Slide Number 39
• Slide Number 40
• Slide Number 41
• Slide Number 42
• Slide Number 43
• Slide Number 44
• Slide Number 45

43

Next Steps

44

01Task

02Task

Ensure data quality issues are identified documented communicated and resolved

Data Quality

Continue building breadth of payer database amp complete enclave load

Data ETL

Finalize strategy to ensure site accomplishes PA 13-247 and PA 15-146 intent

Establish Strategy

05Task

Identify leading consumer information and price transparency tools available

Consumer Tool Evaluation04Task

Tasks Until Next Meeting (11917)APCD Development and Strategy Update

Distinguish Critical Paths Across and Within Strategic Priorities and Maintain Focus on ldquoMust Havesrdquo and ldquoQuick Winsrdquo

Ensure APCD staff can generate self-service extracts at little cost with minimal lead time

Deliver First DR Extract03Task

45

Future MeetingsAPCD Development and Strategy Update

November

9Legislative Office

Building Room 1D 300 Capitol Avenue

Hartford

All Payer Claims Database Advisory GroupMeeting

900ndash1100 AM

• Slide Number 1
• Slide Number 2
• Slide Number 3
• Slide Number 4
• Slide Number 5
• Slide Number 6
• Slide Number 7
• Slide Number 8
• Slide Number 9
• Slide Number 10
• Slide Number 11
• Slide Number 12
• Slide Number 13
• Slide Number 14
• Slide Number 15
• Slide Number 16
• Slide Number 17
• Slide Number 18
• Project Descriptions
• Slide Number 20
• Scorecard Measures
• Suicide Risk Identification
• Slide Number 23
• Slide Number 24
• Slide Number 25
• Slide Number 26
• Slide Number 27
• Slide Number 28
• Slide Number 29
• Slide Number 30
• Slide Number 31
• Slide Number 32
• Slide Number 33
• Slide Number 34
• Slide Number 35
• Slide Number 36
• Slide Number 37
• Slide Number 38
• Slide Number 39
• Slide Number 40
• Slide Number 41
• Slide Number 42
• Slide Number 43
• Slide Number 44
• Slide Number 45

44

01Task

02Task

Ensure data quality issues are identified documented communicated and resolved

Data Quality

Continue building breadth of payer database amp complete enclave load

Data ETL

Finalize strategy to ensure site accomplishes PA 13-247 and PA 15-146 intent

Establish Strategy

05Task

Identify leading consumer information and price transparency tools available

Consumer Tool Evaluation04Task

Tasks Until Next Meeting (11917)APCD Development and Strategy Update

Distinguish Critical Paths Across and Within Strategic Priorities and Maintain Focus on ldquoMust Havesrdquo and ldquoQuick Winsrdquo

Ensure APCD staff can generate self-service extracts at little cost with minimal lead time

Deliver First DR Extract03Task

45

Future MeetingsAPCD Development and Strategy Update

November

9Legislative Office

Building Room 1D 300 Capitol Avenue

Hartford

All Payer Claims Database Advisory GroupMeeting

900ndash1100 AM

• Slide Number 1
• Slide Number 2
• Slide Number 3
• Slide Number 4
• Slide Number 5
• Slide Number 6
• Slide Number 7
• Slide Number 8
• Slide Number 9
• Slide Number 10
• Slide Number 11
• Slide Number 12
• Slide Number 13
• Slide Number 14
• Slide Number 15
• Slide Number 16
• Slide Number 17
• Slide Number 18
• Project Descriptions
• Slide Number 20
• Scorecard Measures
• Suicide Risk Identification
• Slide Number 23
• Slide Number 24
• Slide Number 25
• Slide Number 26
• Slide Number 27
• Slide Number 28
• Slide Number 29
• Slide Number 30
• Slide Number 31
• Slide Number 32
• Slide Number 33
• Slide Number 34
• Slide Number 35
• Slide Number 36
• Slide Number 37
• Slide Number 38
• Slide Number 39
• Slide Number 40
• Slide Number 41
• Slide Number 42
• Slide Number 43
• Slide Number 44
• Slide Number 45

45

Future MeetingsAPCD Development and Strategy Update

November

9Legislative Office

Building Room 1D 300 Capitol Avenue

Hartford

All Payer Claims Database Advisory GroupMeeting

900ndash1100 AM

• Slide Number 1
• Slide Number 2
• Slide Number 3
• Slide Number 4
• Slide Number 5
• Slide Number 6
• Slide Number 7
• Slide Number 8
• Slide Number 9
• Slide Number 10
• Slide Number 11
• Slide Number 12
• Slide Number 13
• Slide Number 14
• Slide Number 15
• Slide Number 16
• Slide Number 17
• Slide Number 18
• Project Descriptions
• Slide Number 20
• Scorecard Measures
• Suicide Risk Identification
• Slide Number 23
• Slide Number 24
• Slide Number 25
• Slide Number 26
• Slide Number 27
• Slide Number 28
• Slide Number 29
• Slide Number 30
• Slide Number 31
• Slide Number 32
• Slide Number 33
• Slide Number 34
• Slide Number 35
• Slide Number 36
• Slide Number 37
• Slide Number 38
• Slide Number 39
• Slide Number 40
• Slide Number 41
• Slide Number 42
• Slide Number 43
• Slide Number 44
• Slide Number 45