Spending Estimates for Health Care Episodes Minnesota All Payer - - PowerPoint PPT Presentation

Spending Estimates for Health Care Episodes

Minnesota All Payer Claims Database

Stefan Gildemeister State Health Economist | Director, Health Economics Program NAHDO Health Care Data Summit November 6, 2019

2 MDH/HEALTH ECONOMICS PROGRAM – MINNESOTA ALL PAYER CLAIMS DATABASE (MN APCD)

• How Minnesota Uses the MN APCD
• Episodes of Care
• Progress to Date
• Preliminary Results

➢

Chronic Episodes

➢

Procedural Episodes

• Next Steps

Overview

MDH/HEALTH ECONOMICS PROGRAM – MINNESOTA ALL PAYER CLAIMS DATABASE (MN APCD)

Analytic & Data Team

Altarum/Ctr. for Value in Health Care (Prometheus)

• Elijah Torrico
• Jim Burnham
• Matt Beatty
• Anirudh Deshpande
• Gregory Matthews

Minnesota Department of Health (MDH), Health Economics Program

• Karl Fernstrom
• Erinn Sanstead
• Ben Nicla
• Pamela Mink
• Stefan Gildemeister
• Information technology and

data security staff

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Project Overview

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Engage providers in a conversation about system efficiency Support community with statewide benchmarks Inform policy-makers about

• pportunities

for delivery system reform Demonstrate the applied research and policy value of the MN APCD

Goals and Priorities in the Use of the MN APCD

MDH/HEALTH ECONOMICS PROGRAM – MINNESOTA ALL PAYER CLAIMS DATABASE (MN APCD)

Work to Date on Health Care Spending

• Estimating cost drivers
• Identifying cost of:

➢Patients with chronic diseases ➢Disease attributable spending

• Reporting on spending on low-value care
• Analyzing prescription drug spending & trends
• Documenting concentration of spending
• Highlighting the failure of hospital markets to discipline prices

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MDH/HEALTH ECONOMICS PROGRAM – MINNESOTA ALL PAYER CLAIMS DATABASE (MN APCD)

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• Episode-based analyses:

➢ Group together procedures, services, and medications ➢ Outline the entire range of treatment for a single condition

• By grouping together clinically associated services across

disparate settings, episodes of care better reflect:

➢ The total cost of care for a specific condition ➢ The continuum of providers and services navigated in seeking treatment for a condition ➢ Impact of different treatment choices on spending

Episodes of Care Overview

MDH/HEALTH ECONOMICS PROGRAM – MINNESOTA ALL PAYER CLAIMS DATABASE (MN APCD)

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• Apply Altarum’s PROMETHEUS Analytics Episode of Care

definitions to MN APCD data

➢ Issue brief with key findings ➢ Public Use File (PUF) designed based on stakeholder feedback ➢ Engagement with employers and other stakeholders on the value of the analysis

Objectives

MDH/HEALTH ECONOMICS PROGRAM – MINNESOTA ALL PAYER CLAIMS DATABASE (MN APCD)

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PROMETHEUS episodes are…

➢ Patient-centered ➢ Time-delimited (including pre-op and post-acute phases)

PROMETHEUS episodes have been built for…

➢ Acute conditions ➢ Chronic conditions ➢ Inpatient/outpatient procedures

PROMETHEUS episodes…

➢ Include all covered services related to the care of the condition ➢ Differentiate “typical” services from services associated with

Potentially Avoidable Complications (PACs)

PROMETHEUS Analytics

Episode definitions can be made fully transparent to stakeholders

MDH/HEALTH ECONOMICS PROGRAM – MINNESOTA ALL PAYER CLAIMS DATABASE (MN APCD)

Progress to Date

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• Performed stakeholder engagement on the front end … and later on
• Build cloud-based IT solutions while maintaining data privacy
• Mapped MN APCD data for PROMETHEUS input

➢ Validated PROMETHEUS output ➢ Tested the interaction of various elements of pre/post grouping

• Underway:

➢ Finalize data runs across all payers ➢ Select episodes to publically report

Project Steps & Considerations

MDH/HEALTH ECONOMICS PROGRAM – MINNESOTA ALL PAYER CLAIMS DATABASE (MN APCD)

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• Stakeholders from hospital and provider association, local

measurement groups, employer coalition, and academia who recommended …

➢ Include all lines of business ➢ Report temporal trends ➢ Identify the cost attributable to specific complications (or the inverse) ➢ Choose episodes for PUF empirically

Key Takeaways from Stakeholder Meeting

MDH/HEALTH ECONOMICS PROGRAM – MINNESOTA ALL PAYER CLAIMS DATABASE (MN APCD)

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DRAFT PUF Stratifications

Unique Row ID Number Episode ID Episode Name Episode Type ZCTA Zip 3 Year Payer 12 EP0813 Knee Replacement Procedure 551 2015/2016 Commercial 13 EP0813 Knee Replacement Procedure 551 2015/2016 Medicaid 14 EP0813 Knee Replacement Procedure 551 2016/2017 Commercial 15 EP0813 Knee Replacement Procedure 551 2016/2017 Medicaid 220 EP0813 Knee Replacement Procedure 552 2015/2016 Commercial 221 EP0813 Knee Replacement Procedure 552 2015/2016 Medicaid 222 EP0813 Knee Replacement Procedure 552 2016/2017 Commercial 223 EP0813 Knee Replacement Procedure 552 2016/2017 Medicaid Etc… Episode Count Average Cost 50th percentile cost Inpatient cost proportion Outpatient cost proportion Professional cost proportion RX cost proportion PAC Percent 50th percentile PAC Percent 12,062 $21,010 $18,908 0.69 0.09 0.19 0.03 10.0% 8.0% 6,010 $14,500 $12,220 0.57 0.14 0.24 0.05 11.0% 6.5% 12,987 $21,959 $20,010 0.69 0.09 0.19 0.03 10.0% 8.0% 6,109 $14,987 $13,987 0.69 0.09 0.19 0.03 11.0% 6.5% 9,003 $22,898 $20,387 0.69 0.09 0.19 0.03 10.0% 8.0% 8,109 $15,118 $14,980 0.69 0.09 0.19 0.03 11.0% 6.5% Etc…

MDH/HEALTH ECONOMICS PROGRAM – MINNESOTA ALL PAYER CLAIMS DATABASE (MN APCD)

Preliminary Results

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50,000 Beneficiaries $331 Million Total Allowed Amount

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Preliminary Episode Spending Analysis

Sample of Commercially Insured Population, 2015-2017 Input Data PROMETHEUS Episodes 61% of total allowed amount assigned to episodes ($198 million)

Preliminary results were derived from a convenience sample of Minnesota's commercially enrolled individuals. Data shared today are illustrative and not intended for inference. MDH/HEALTH ECONOMICS PROGRAM – MINNESOTA ALL PAYER CLAIMS DATABASE (MN APCD)

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Procedural Episodes with Highest Spending

• Annualized and unsplit

costs

➢ Reflect total cost of care ➢ Can apply to concurrent

episodes

• Variation in proportion of

costs attributable to PACs

➢ 0.6% (Colonoscopy) ➢ 7.6% (Coronary

angioplasty)

$2,889 $32,952 $45,971 $107,193 $3,470 $17 $847 $3,485 $7,771 $134 $0 $20,000 $40,000 $60,000 $80,000 $100,000 $120,000 Colonoscopy Knee Replacement & Revision Coronary Angioplasty CABG &/or Value Replacement Upper GI Endoscopy Average Annualized Cost PAC Attributable Portion

MDH/HEALTH ECONOMICS PROGRAM – MINNESOTA ALL PAYER CLAIMS DATABASE (MN APCD)

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Chronic Episodes with Highest Spending

• Annualized and unsplit

costs

➢ Reflect total cost of care ➢ Can apply to concurrent

episodes

• Variation in proportion of

costs attributable to PACs

➢ 4.3% (Diabetes) ➢ 10.6% (Hypertension)

$598 $1,581 $550 $256 $645 $36 $67 $40 $27 $18 $0 $200 $400 $600 $800 $1,000 $1,200 $1,400 $1,600 $1,800 Depression & Anxiety Diabetes Low Back Pain Hypertension Asthma Average Annualized Cost PAC Attributable Portion

MDH/HEALTH ECONOMICS PROGRAM – MINNESOTA ALL PAYER CLAIMS DATABASE (MN APCD)

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In Summary

Continue Shedding Light on Health Spending

Chronic conditions Procedural episodes

Identify Opportunities for Further System Efficiencies

Cost associated with avoidable complications Effect of variation in services use on cost & outcomes

Build Out PUF Portfolio

First Generation + new designs underway PUFs with applied value

But: Episode Grouping Is Complex

Computationally and analytically challenging Challenging to apply concept to multi-payer data A lot needs to go right

MDH/HEALTH ECONOMICS PROGRAM – MINNESOTA ALL PAYER CLAIMS DATABASE (MN APCD)

Thank you!

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Health Economics Program: www.health.state.mn.us/healtheconomics Health Care Market Statistics: www.health.state.mn.us/data/economics/chartbook/ Minnesota All Payer Claims Data: www.health.state.mn.us/data/apcd/ Contact: Stefan.Gildemeister@state.mn.us/ 651.201.3550

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PUF Requesters

• Approximately 200

individuals have requested the first generation of PUFs since 2016

• Average of about 6

requests per month

• Most individuals request

all 3 PUFs

10 20 30 40 50 60 70 80 Agency/regulator Consumer/patient Employer Health care payer Health care provider Media Other Researcher PUF Requests

MDH/HEALTH ECONOMICS PROGRAM – MINNESOTA ALL PAYER CLAIMS DATABASE (MN APCD)