Surfing the Tsunamis: Managing in the Age of Abundant Information

1. Surfing the Tsunamis:Managing in the Age of Abundant Information Jay Want, MD July 22, 2014

2. The three tsunamis that are reshaping everything (not just medicine). 2

3. The first tsunami: red ink HC 6% of GDP in 1960, 17% in 2013 HC eats up nearly all productivity gains in the 2000s

4. The second tsunami: information Moore’s Law Big data emerges in health care Watson goes to medical school

5. The third tsunami: the empowered individual Individuals take on more financial responsibility Web decreases information asymmetry Consumer Reports comes to health care--literally

6. Colorado’s All Payer Claims Database (APCD)A Resource for All Coloradans

7. Vision for Colorado: Achieving The Triple Aim + 1 Improve Population Health Highly Integrated Delivery System Fully Engaged, Informed and Empowered Consumer/Patient Partners Risk-adjusted, Performance-based Global Payments Triple Aim Vibrant, Integrated Public/Community Health System Reduce Per Capita Costs Improve Patient Experience 7

8. Colorado’s All Payer Claims Database (APCD) • State mandate • CIVHC- Administrator; Private Non-Profit • Collect claims data from all public/private payers • First aggregated public reports published in Q4 2012 • Build towards increased transparency of the data over the next 2 years • No general funds… sustainability model • Utilize Treo Solutions & other business partners technology and analytics 8

9. Providing Answers to: Providers and Facilities… “How much will my knee MRI cost and what are my best options?” “How do I compare to my peers and demonstrate value?” Consumers… “How does cost, utilization and quality compare between public and private payers?” Businesses… Legislators and Policy Experts… “Which health plan provides the best value providers for our premium?” 9

10. View of www.cohealthdata.org

11. 11

12. 12

13. 13

14. High $2,049 Low $385

15. Resources for Patients SOURCE: New Hampshire APCD 15

16. Consumer Reports- Patient Survey Consumer Reports MQHP Health Insert July 2012 16

17. Consumer Reports- Quality Metrics Consumer Reports MNCM Health Insert July 2012 17

18. Possible Public Reporting of Relevant Cost and Quality Information – Minnesota

19. What happens if I do nothing about this? • Medicare data releases • Castlight IPOs at $3.5 billion • Health Designs Plus exports lucrative procedures to Centers of Excellence • Recent relaxation of telemedicine laws • Short answer: in a world where transparency is inevitable, do you want the data club in your bag? Or should you just let the other guys have it?

20. APCD Capabilities • Variation in risk-adjusted average allowed amounts • Generate employer-focused information to support value-based purchasing decisions • Advanced analytics based on multiple years of data 20

21. APCD Capabilities • Compare and contrast service utilization and paid amounts based on comparable, risk-adjusted populations • Incorporate quality and outcome measures • Align advanced analytics with additional data sources including disease registries and vital statistics

22. Value of the APCD for Providers • Standardized cost and quality reporting across payers and providers by geographic region • Analysis of market share, referral patterns and provider performance • Assessment of relative illness burden and other risk scores by provider panel • Identify within-practice treatment patterns and “leakage” • Identify ranges of allowed amounts for common procedures across payers • Relative cost and quality assessments across settings of care, e.g., PCMHs, ACOs 22

23. Contact Information • Tracey Campbell, Director APCD tcampbell@civhc.org • Join our APCD email list (www.cohealthdata.org home page) • Follow CIVHC on social media: @CIVHC_News Facebook.com/CIVHC LinkedIn (linkedin.com/company/2096991) 23