How Title Xx Vermont s Broadening

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1 How Title Xx Vermont s Broadening Subtitle Xx APCD Offers New Opportunities to Drive Value & Efficiencies Adam Moody, Director of Analytic Operations Onpoint Health Data Pat Jones, Assistant Director Presenter, Title Date 1 VT Blueprint for Health, Department of VT Health Access

2 Agenda What is VHCURES? (A. Moody, Onpoint) How does Blueprint use VHCURES for evaluation? (P. Jones, Blueprint) What additional studies does VHCURES enable? (A. Moody, Onpoint) 2

3 What is VHCURES? The Vermont Healthcare Claims Uniform Reporting & Evaluation System (VHCURES) Adam Moody, Director of Analytic Operations Onpoint Health Data

4 What Makes VHCURES Unique? A Comprehensive Resource for Complex Analytics Fully integrated database: Medicaid, Medicare, and commercially insured Includes historical data from 2007 through June 2012 (incurred) Government payer-specific data elements in addition to core elements» Aid category» Dual eligible status Robust and rich data set 561,000 covered lives (2011) 4

5 About the VHCURES Program A Detail-Rich Resource for Follow-on Research Stakeholder involvement Data users providing quality feedback Shared, collaborative resources Continuous quality improvement Ability to track patients across Medicaid, Medicare, and commercial products with precision Data usage Supports health expenditure and utilization reporting Supports Vermont s funding of the HIT fund Supports community-based care evaluations 5

6 How Does the Blueprint Use VHCURES for Evaluation? Pat Jones, Assistant Director VT Blueprint for Health, Department of VT Health Access

7 The Vermont Blueprint for Health Building a Foundation for the Future Advanced Primary Care Practices (Patient Centered Medical Homes) Community Health Teams (core and extended) Multi-insurer payment reforms Health information infrastructure Evaluation and reporting systems Learning health system activities 7

8 Blueprint for Health Implementation Specialty Care & Disease Management Programs Social, Economic, & Community Services Mental Health & Substance Abuse Programs Healthier Living Workshops Hospitals Community Health Team Nurse Coordinator Social Workers Nutrition Specialists Community Health Workers Public Health Specialist Extended Community Health Team Medicaid Care Coordinators Senior Support Teams Addiction ( Spoke ) Teams Public Health Programs & Services Advanced Primary Care Advanced Primary Care Advanced Primary Care Advanced Primary Care A foundation of medical homes and community health teams that can support coordinated care and linkages with a broad range of services Multi-insurer payment reform that supports this foundation of medical homes and community health teams A health information infrastructure that includes EMRs, hospital data sources, a health information exchange network, and a centralized registry An evaluation infrastructure that uses routinely collected data to support services, guide quality improvement, and determine program impact Health IT Framework Evaluation Framework Multi-Insurer Payment Reform Framework 8

9 How Does the Blueprint Use VHCURES for Evaluation? Uses include evaluation, financial modeling, practice profiles, special studies Compares Blueprint participants and controls Expenditure measures (e.g., inpatient, ED, professional, pharmacy, mental health) Utilization measures (e.g., inpatient discharges, ambulatory care sensitive conditions, readmissions, preventable ED visits, advanced imaging, medical and surgical specialty care) 9

10 How Does the Blueprint Use VHCURES for Evaluation? HEDIS effective and preventive care measures (e.g., breast cancer screening, well child visits) Expenditure, utilization and HEDIS measures are evaluated separately for members with seven targeted chronic conditions (i.e., diabetes, asthma, COPD, hypertension, CHF, coronary heart disease, depression) 10

11 Example of Expenditure Reporting Based on Data Prepared for 2011 Blueprint Annual Report $190 $180 Outpatient ED Expenditures per Capita $ $170 $160 $ $750 Inpatient Expenditures per Capita $150 $ % +50% $700 $ $ $130 $650 $120 $110 $ $ Participants Comparison Group $600 $550 $500 $ % +50% Source: Blueprint Annual Report, January 2011 $450 $ Participants Comparison Group 11

12 Example of Utilization Reporting Based on Data Prepared for 2011 Blueprint Annual Report 175 Outpatient ED Visits Outpatient ED Visit Rate Per 1, % % Participants Comparison Group Inpatient Discharge Rate Per 1, Inpatient Discharges % -6% Participants Comparison Group 12

13 Practice Profiling Template Based on Data Prepared for 2011 Blueprint Annual Report 400 Outpatient ED Visits Adjusted Rate Per 1, Lower Confidence Limit Adjusted Rate Upper Confidence Limit PJ Practice PB PL PN PH PD PG PI PP PM PK PR PO PC PT PF PS PQ PE 13

14 What Additional Studies Does VHCURES Enable? Adam Moody, Director of Analytic Operations Onpoint Health Data

15 What Additional Studies Does VHCURES Enable? Tri-state APCD study (Vermont, New Hampshire, Maine) Primary care service area and expenditure flow study Medicaid reporting integration Blueprint program evaluation and enhanced studies 15

16 Variation in Cost Per Capita Caribou ($370) Burlington ($240) Portland ($243) Portsmouth ($389) 16

17 Variation in Potentially Avoidable ED Visits Per Capita Caribou (136.3) Burlington (16.1) Portland (30.1) 17

18 18 Vermont Blueprint for Health Department of Vermont Health Access 312 Hurricane Lane Williston, VT fax dvha.vermont.gov