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Strategic Application of Maine’s All Payer Database for System Management and Development

Strategic Application of Maine’s All Payer Database for System Management and Development. August 9, 2012. Overview for LD1818 Stakeholder Workgroup Andrea D. Patstone Vice President, Strategic Initiatives. Practical Applications for Public Data: Current Uses and Challenges. Current

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Strategic Application of Maine’s All Payer Database for System Management and Development

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  1. Strategic Application of Maine’s All Payer Database for System Management and Development August 9, 2012 Overview for LD1818 Stakeholder Workgroup Andrea D. Patstone Vice President, Strategic Initiatives

  2. Practical Applications for Public Data: Current Uses and Challenges Current • Geographic / organizational variation analysis • ACO attribution modeling and network development • Network and hospital service area leakage analysis Future • All of the above, plus ACO Quality and Efficiency Management Challenges • Data complexity: Limited in-house capacity for management & analysis • Consistency: • Changes in MHDO submission requirements and require complicated “cross-walking” that may compromise year over year trending • Reporting of pharmacy and behavioral health claims inconsistent across payers – compromises comparison • Timely Availability

  3. Example: Geographic Variation Analysis: Downward Trend in Imaging Utilization. Can we do better? Standardized Values: 2009-2011 average per Commercial Enrollee under 65 Standard Advanced Maine Portland Augusta Waterville Lewiston Biddeford Brunswick Rockland Norway Belfast Boothbay/ Damariscotta # of Commercial Enrollees < 65 (Average 2009-2011): Maine 582,291; Augusta 30,742; Belfast 7,322; Biddeford 38,874; Boothbay/ Damariscotta 7,116; Brunswick 35,095; Lewiston 52,176; Norway 11,069; Portland 145,557; Rockland 20,128; Waterville 28,533 3

  4. Example: ACO Patient Population Analysis: Cost and Quality of Care for Medicare Patients Attributed to the MaineHealth ACO.

  5. Example: ACO Development: Assessing Network Composition Scenarios

  6. Practical Applications for Public Data: Current Uses and Challenges Current • Geographic / organizational variation analysis • ACO attribution modeling and network development • Network and hospital service area leakage analysis Future • All of the above, plus ACO Quality and Efficiency Management Challenges • Data complexity: Limited in-house capacity for management & analysis • Consistency: • Changes in MHDO submission requirements and require complicated “cross-walking” that may compromise year over year trending • Reporting of pharmacy and behavioral health claims inconsistent across payers – compromises comparison • Timely Availability

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