“JEN Associates Approach to QA and Initial Recommendations: Part II”

1. “JEN Associates Approach to QA and Initial Recommendations: Part II” September 25, 2012

2. Objectives for today’s meeting • Welcome and Introductions • Preliminary Data Release: Status • JEN Associates • Open Discussion

3. Preliminary Data Release Data Review Committee (DRC) meets this week at DHCFP Thursday, September 27th, 3:00 PM – Open to the Public Five NEW applications from DPH posted on DHCFP website for comment period: Health Care Reform and Disparities in the Care and Outcomes of Trauma Patients 2.   Surveillance of Congenital Heart Defects (CHDs)

4. Preliminary Data Release DPH Applications (continued) 3. STD, HIV, and Viral Hepatitis Testing, Treatment, and Screening Trends 4. Evaluation of Mass in Motion and Community Transformation Grants Evaluation of Mass in Motion and Community Transformation Grants

5. JEN Associates • “JEN Associates, Inc. was founded in 1985 with a single purpose: To enable state, federal and private policy makers to make better health care policy and operational decisions through the use of data and information” • National practice in health care analytics and research data hosting • JEN Associates provided software, reports, and consulting services to the Division to further QA efforts

6. JEN Associates Logical progression in data quality analysis proceeds from: • Individual field checking, • In-record reconciliation, • Cross record structural analytics, • Cross file integration JEN Associates performed ‘stress testing’ to check cross file integration

7. JEN Associates

8. JEN Associates • JEN Associates ran a series of analyses to answer the following • questions: • What is the disease rate in a specific demographic strata? • What is the rate of drug use in a specific demographic strata? • What is the rate of full term deliveries in a population with a pregnancy diagnosis by age and sex? • What is the rate of use of oral anti-glycemics under diabetes in a specific demographic strata?

9. JEN Associates CY 2011 Pregnancy and Delivery in 18-29 Women with Medical Coverage Draft report is based on preliminary data submissions as of February, 2012. DHCFP is actively working on remediation and compliance updates and has received multiple updates to APCD since this data.

10. JEN Associates CY 2011 Diabetics Oral Anti-Diabetics Use Rate in 30-64 Year Old Females with Diabetes and Medical and Pharmacy Coverage (Draft) Draft report is based on preliminary data submissions as of February, 2012. DHCFP is actively working on remediation and compliance updates and has received multiple updates to APCD since this data.

11. Dial in Test Statistics: Annual Diagnoses and Therapies Flags, Monthly Eligibility and Payment Measures (Draft) Draft report is based on preliminary data submissions as of February, 2012. DHCFP is actively working on remediation and compliance updates and has received multiple updates to APCD since this data.

12. JEN Associates Open Discussion • Challenges • Next Steps

13. Next Steps in QA Process Intake Edits: 1.) Reviewing intake edits for adds, updates, deletes 2.) Review prioritization of data elements (A, B, C, Z) and consider recategorization 3.) Add elements necessary to enhance QA process (Drafting Admin Bulletin) 4.) Develop, test, and implement intake edit updates

14. Next Steps in QA Process Focus QA measures on requirements for: 1.) Master Member 2.) Master Provider 3.) Product Reference table 4.) Master Claims* *Standardized for various grouping with reportable outcomes (clean, version, and apply master ids)

15. Next Steps in QA Process Refine Data Linkage Measures: 1.) Review and prioritize linkages 2.) Collect submitter relationship data for cross organization Id linkage and implement a process for maintaining it. 3.) Focus on two-factor linkages (Product to Eligibility, Eligibility to Claims, Claims to Provider) 4.) Begin with the priority linkages: measure linkage rates and report back to carriers

16. Next Steps in QA Process Report on Data Continuity: 1.) Design and implement measures for submission trends (volume of lines, types of claims, member count by product) 2.) Report trends based on service dates and adjudication methodology. 3.) Establish remediation process for outliers

17. Next Steps in QA Process Clinical Grouping: Group claims to obtain National Correct Coding Initiative and Outpatient Code Edits which will validate appropriate service setting on facility claims Risk Grouping: Group data using Verisk DXCG software and utilize output reports to report quality of data – begin by using continuously enrolled member and medical claims for twelve months of data. Episodic Grouping: Group claims into appropriate episodes of care and identify orphan treatment / services for remediation

18. Next Steps in QA Process Outreach to Carriers : 1.) Currently working with carriers on ‘versioning’ methodology 2.) Currently enhancing QA Profile reports and running on more recent data 3.) Schedule review sessions with a select group of carriers to discuss data compliance and integrity – may expand to all carriers 4.) Work with carriers to align and finalize variance requests – certification by end of 2012 5.) Work to improve distribution of reportable values on elements with APCD and / or external code list.

19. Next Steps in QA Process More Internal QA Activities: 1.) Clean and standardize provider specialties for analysis and grouping activity – map carrier-specific data to standard code list accepted by standard grouping applications 2.) Use taxonomy to validate standardization of specialties because the Division is collecting both 3.) Cleanse and standardize addresses for geocoding activity 4.) Need master files to ensure ultimate QA objective

20. APCD Resources for Payers Updated APCD Website - www.mass.gov/dhcfp/apcd

21. For more information: • Send questions and feedback to dhcfp.apcd@state.ma.us • For more information, including important updates and events, please visit: www.mass.gov/dhcfp/apcd 20