Utah All Payer Database (APD)

1. Utah All Payer Database(APD) Introduction to the Reporting Capabilities of the Utah All Payer Database Mark Gaskill, MFT MGaskill@Utah.gov Keely Cofrin Allen, PhD KCofrinallen@utah.gov Utah Department of Health Office of Health Care Statistics

2. History On July 8, 2008 the Utah Health Data Committee unanimously approved a health data plan outlining the creation of an APD. Funding for the APD was provided via House Bill 133, Health Care Reform (2008). The Utah Department of Health (UDOH), Office of Health Care Statistics (OHCS) is responsible for building and managing the APD. Other states have APDs; however, Utah is now the first state in the country to have an All Payer Database that can analyze episodes of care (EOC) derived from statewide – cross payer – health insurance claims.

3. The Utah APD now provides the capability of reporting: • Medically, what happened? (by EOC) • When and where did it happen? • How much did it cost? • Greater Degrees of • Healthcare • Transparency • 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? • How do healthcare consumers migrate between commercial plans; between commercial and public plans?

4. Where the Utah APD Stands Today: • $1,847,869,396 - Utah Health Care Dollars Represented in the Utah APD • 1,079,270 - Unique Utah lives identified, linked and grouped • 48,567,000- Medical Claims processed and parsed in the APP primary data warehouse • 67,989,000 - Pharmacy Claims process and parsed in the APD primary data warehouse • Second Phase Pilot will be competed February 2010 (initial APD reporting will commence during Second Phase Pilot); • Third Phase Pilot Completed Summer 2010 (APD fully operational)

5. Sample Data For discussion and demonstration purposes only

6. Sample Data For discussion and demonstration purposes only

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8. Sample Data For discussion and demonstration purposes only

9. Top Ten Diseases Driving Cost Analysis Period Ending: 2008-12 * Unique members with the disease Sample Data For discussion and demonstration purposes only

10. Top Five Conditions Driving Cost Sample Data For discussion and demonstration purposes only

11. Top Ten Therapeutic Classes by Volume Sample Data For discussion and demonstration purposes only

12. Top Ten Therapeutic Classes by Cost Sample Data For discussion and demonstration purposes only

13. Pharmacy Statistics Top Twenty Drugs by Cost - Retail Sample Data For discussion and demonstration purposes only

14. Generic Utilization Total Prescriptions Sample Data For discussion and demonstration purposes only

15. Health Status and Cost Drivers Sample Data For discussion and demonstration purposes only

16. Average PMPM Distribution by Health Status Sample Data For discussion and demonstration purposes only

17. Sample Data For discussion and demonstration purposes only

18. Member Distribution and BOI by Demographics and Age Sample Data For discussion and demonstration purposes only

19. Top Twenty-Five Drugs by Volume - Retail Sample Data For discussion and demonstration purposes only