Virginia Chamber of Commerce 4th Annual Virginia Health Care Conference

1. Virginia Chamber of Commerce 4th Annual Virginia Health Care Conference Michael T. Lundberg, Executive Director June 5, 2014

2. VHI Represents all Health Care Stakeholders • VHI is an independent, nonprofit, 501(c)(3) health information organization established in 1993 • Formed to administer Virginia Health Care Data Reporting Initiatives to benefit Virginians

3. VHI Publishes Business and Consumer Guides, Reports and Information at www.vhi.org

5. Big Data Does Not Know Everything Yet? Philadelphia Inquirer :a member's decision to skip the gym could trigger an auto tweet from the inactive gym shoes to the health insurance network, leading to an increase in premiums.

6. Example: Retail Marketing of Video Games Historically: a fast response to actual demand for services was an advantage Today: Game Changing with Big Data by:

7. Define your Needs and Make a Plan

8. APCD - All Payer Claims DatabaseJCHC Legislation passed in 2012 APCDs are increasing in numbers across the nation Voluntary Bill passed in 2012 CHAPTER 693 • Administered by VDH contracting with VHI • Initial 30 month funding by H.I.C. - 40%, Hospital Association - 40%, VHI - 20% • Health plans and related entities may submit APCD Data • Act specifies types of information to be collected and reported • RFP developed, bids evaluated, Milliman selected as Data Subcontractor • 1st data received November, 2013 • 1st Reports, Spring/Summer, 2014 • Full implementation contingent upon Data Submitters

9. APCDs in Action Wisconsin Health Information Organization Extracted from the Robert Wood Johnson Foundation leaving fee for service behind http://www.rwjf.org/en/research-publications/find-rwjf-research/2014/05/leaving-fee-for-service-behind.html?cid=xsh_rwjf_em

10. Virginia’s APCD will include rates of unnecessary ER visits for employers and others Reducing unnecessary ER visits 25% would save an estimated $29.3 to $43.1 million dollars

11. Accessing Virginia’s APCD Subscription Services Designed for Flexibility

12. MedInsight® Analytic Platform Taming Big Data in Virginia Methodologies Benchmarks • Health Cost Guidelines • Evidence Based Measures • Milliman Advanced Risk Adjustors • Chronic Conditions Hierarchical Groups (Disease Identification) • Global RVUs (Standardized Proxy Reimbursement) • Provider Affiliation into Group Practices • NYU Avoidable Emergency Dept. visits • Episode Grouping - Truven MEGs • Population and benefit driven including: • Age • Gender • Geography • Benefit design • Benchmark detail: • DRG • Procedures • Drugs • Episodes • Chronic conditions • Based on Milliman Health Research Database of 45M members

13. MedInsight® Analytic Platform Milliman's MedInsight® Analytic Platform is a data warehousing, analytics, and performance reporting tool. Aggregates medical and pharmacy claims, as well as eligibility and provider data from multiple sources. Data can be accessed through dashboards, standard reports, a drill down ad-hoc reporting tool, and SQL back end tables. *Courtesy of Milliman MedInsight

14. PCP Dashboard

15. Virginia’s APCD - Your Opportunity for Better Value in Health Care Sign up for updates and data availability at www.vhi.org/apcd