Steven J. Korzeniewski, PhD-Candidate, MSc, MA, Director, Statistical Analysis Resource Group (SARG) & Chief Scienti

1. Steven J. Korzeniewski, PhD-Candidate, MSc, MA, Director, Statistical Analysis Resource Group (SARG) & Chief Scientific Officer, 22670 Haggerty Rd Ste. 100, Farmington Hills, MI 48335 Telephone: (248) 465-7365, Email: skorzeniewski@mpro.org

2. Most US hospitals are unable to identify their patients that readmit to other hospitals. [Jencks SF, Williams MV, Coleman EA. Rehospitalizations Among Patients in the Medicare Fee-for-service Program. N Engl J Med. 2009;360:1418-1428.] • Hospitals lacking access to data on their patients that readmit elsewhere are unable to: • Calculate their total readmission rates • Investigate trends • Evaluate performance • National interest in reporting is mounting, particularly following the recent and historic passage of healthcare reform legislation. • CMS now reports risk standardized rates for selected conditions, but these represent a minority of overall readmissions • An infrastructure capable of such reporting did not exist in Michigan, • Until NOW…. Background:

3. Coordinate multi-payer data sharing to construct readmission profiles for Michigan hospitals and assist them in evaluating intervention effectiveness. • Structure: • Led by MPRO’s Statistical Analysis Resource Group Director, includes: • -analysts from many of Michigan’s health plans • -representatives from hospitals, universities and the Michigan Health & Hospital Association. • -Dr. Stephen Jencks, IHI Consultant, participates at times as well. Mission:

4. During bi-weekly meetings, the data workgroup has devised both a data extract procedure and readmissions reporting template. • Data extract procedure • Standardized program for pulling member-level data that defines and categorizes readmissions. • Readmissions Reporting Template • Presents a wealth of readmissions information within a single page layout. Accomplishments:

5. Health plans extract member-level data for all acute care admissions from their respective systems. • Admissions are sorted sequentially and categorized as ‘at risk’ or ‘not at risk’ of readmission. • Admissions not at risk of rehospitalization include: • Transfers to another inpatient facility (i.e., rehabilitation, skilled nursing or hospice), • those ending in a patient’s death or in the patient leaving the hospital against medical advice, and • admissions occurring within 30 days of the end of the data period. • Remaining admissions are considered at risk of readmission. Data Extract Procedure:

6. Data Extract Procedure:

7. Data are currently transmitted in summary form to MPRO whom aggregates the information to populate the final readmissions report template. • The next slide depicts the 2008 calendar year data. • Disseminated reports include technical specifications and a detailed narrative describing data accompanied in the report. Reporting Template:

8. Reporting Template: Information Otherwise Unavailable

9. Reporting Template:

10. Current Activities: • Pilot reports have been disseminated. • Plans are reporting aggregate data by calendar year quarter from 2006-2010 • Initial reports due to be disseminated shortly will include a facility level crude trend analysis • Statewide profiles will also be disseminated for comparative purposes • We are drafting data use agreements to facilitate claim-level data sharing • Most plans have verbally agreed to share these data, although full approval has yet to be received. • Some have already processed letters of commitment to do so • We are seeking external funding to engage the ReWaRD towards evaluation of existing and newly implemented MI STA*AR interventions given that no other data source in Michigan can support such analyses.

11. Member Level Data Sharing: • Allows for development of a comprehensive analytic file of virtually all readmissions in Michigan. • Facilitates exploration of • Risk standardization methods • Methods of defining ‘preventable’ readmissions • Evaluation of interventions (Provider and Payer level)

12. Overall Conclusions: • The Rehospitalization Workgroup for Reporting Data is a subcommittee tasked with facilitating multi-payer data sharing • While the original mission was to provide readmission reports to all Michigan hospitals, it is now expanding to include evaluation of readmission reduction initiatives through application of epidemiologic methods. • Barriers and other considerations include funding, HIPPA concerns, and data access issues. • QUESTIONS?