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Mark Gaskill, MFT Utah APD Program Manager Utah Dept of Health

Mark Gaskill, MFT Utah APD Program Manager Utah Dept of Health. Utah APD Architecture. The Utah All Payer Database. Utah is poised to become the first in the country to analyze episodes of care (EOC) derived from statewide – cross payer – health insurance claims.

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Mark Gaskill, MFT Utah APD Program Manager Utah Dept of Health

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  1. Mark Gaskill, MFT Utah APD Program Manager Utah Dept of Health

  2. Utah APD Architecture

  3. The Utah All Payer Database Utah is poised to become the first in the country to analyze episodes of care (EOC) derived from statewide – cross payer – health insurance claims. An EOC is defined as a complete course of care from the initial diagnosis through treatment and follow-up. Maternity: EOC = the first prenatal visit, all other visits, pharmacy claims, lab tests, special procedures, delivery of the baby and postpartum care of the mother. • What happened? (by Episode of Care – EOC) • When and where did it happen? • How much did it cost? • Who paid for what (including healthcare consumer out of pocket costs)? • Which costs were not covered? (including denied claims) • What other influences impact outcome (disease burden, co-morbidities, demographics, environmental issues, access to specialists, etc.)? • What impact does preventive care, or lack there of, have on outcome? • Were relevant standards of care met? • Migration between commercial plans; between commercial and public plans.

  4. The Utah APD is one of the first datasets of its kind requiring precise longitudinal linking of statewide healthcare data across payers. • The OHCS recognizes the sensitivity associated with collecting healthcare and enrollment data on this magnitude and has taken extraordinary steps to ensure privacy is guaranteed. • The precautions and procedures established by the OHCS to protect both individual and intellectual privacy that will serve as a model for other initiatives where combining large and disparate healthcare data is a necessity.

  5. EOC – Maternity w/ Cesarean Section Delivery by Carrier

  6. EOC – Knee Replacement: By Facility Burden of Illness (BOI) - The BOI, or burden of illness score, provides a relative weight for comparing conditions and individuals in terms of the relative burden of disease - allows for better apples to apples comparisons. For example, patients with early stage or well-managed diabetes will be assigned a lower mean severity score than a diabetic with complications, given the same age and gender. The Clinical Risk Groups (CRGs) from 3M Health Information Systems categorize members into a unique, clinical category that provides a high degree of severity leveling and transparency that enables a credible comparison of populations for disease burden, cost and utilization. EOC – Knee Replacement: Carrier and CRG

  7. Burden, Cost and Risk Factors for Common Diseases in Utah: Combining Individual-Level and Population-Level Data Mark Gaskill, MFT Office of Health Care Statistics Utah Department of Health Janet M. Shaw, PhD, FACSM Associate Professor, Department of Exercise and Sport Science College of Health, University of Utah Jim VanDerslice, PhD Associate Professor & Associate Division Chief Division of Public Health Department of Family & Preventive Medicine Daniel P. Williams, PhDAssistant Professor, Department of Exercise and Sport Science College of Health, University of Utah Will be linking Utah APD data with the Statewide Behavioral Risk Factor Surveillance System data (BRFSS) to address important, policy-relevant questions for three common diseases: coronary artery disease (CAD), type II diabetes and asthma.

  8. Utah's Traffic Corridors Utah's 61 Small Areas

  9. Percutaneous Transluminal Coronary Angioplasty (PTCA)

  10. Use of CRG and BOI – Using the Care Advantage RPNavigator

  11. HEDIS An APD can be utilized to gather administrative HEDIS data for an entire state utilizing one vendor, which would substantially lower the cost to all health plans involved. The APD can also be used to help facilitate chart reviews for the health plans that are required to do so for NCQA certification. CVE The Utah Partnership for Value-Driven Healthcare (UPV) became an AHRQ-designated Chartered Value Exchange (CVE) in 2008. The UPV/CVE promotes health information technology adoption and meaningful use, public reporting of quality and cost information, and use of that information to realign incentives. When it is fully developed, a core function of the Utah Health Exchange will to be a one-stop shop for all information related to health care & financing.  As part of that vision, we plan to provide consumers with cost and quality information.  In the near future the CVE envisions an interface where consumers can query the APD from the Exchange to get answers to simple questions about cost and quality.  For example, how much does a hip replacement cost?  Which hospitals are the best at hip replacements? Heart & Stroke Evaluate data relating to quality of care and cost of care for stroke patients being treated at all Utah hospitals. Currently, we have data for hospitals using the American Heart Association's Get with the Guidelines programs. These data are incomplete as many hospitals do not participate in this program. Quality of care would be measured by analyzing the proportion of eligible stroke patients receiving certain procedures that represent the stroke standards of care.

  12. Mark Gaskill, MFT Utah APD Program Manager Utah Dept of Health Office of Health Care Statistics MGaskill@Utah.gov 801-538-6482

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