Creating and Using an All-Payer Database: Kansas Experience .


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Developing and Using an All-Payer Database: Kansas’ Experience. State Coverage Institute Meeting Albuquerque, New Mexico July 31, 2009. Andy Allison, PhD Executive Director Kansas Health Policy Authority. Overview. Origins of Kansas’ All-Payer Database New data regime initiated in 2005
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Creating and Using an All-Payer Database: Kansas\' Experience State Coverage Institute Meeting Albuquerque, New Mexico July 31, 2009 Andy Allison, PhD Executive Director Kansas Health Policy Authority

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Overview Origins of Kansas\' All-Payer Database New information administration started in 2005 KHPA\'s arrangements to oversee and utilize the information Challenges and obstacles Lessons learned Next strides and expected turning points

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Origins of Kansas\' All-Payer Database

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Created in 1994 in the Wake of Clinton Health Reform Era Statutory object is to gather data from state-controlled transporters "… in such shape and detail as might be important to … determin[e] whether rates and rating frameworks… deliver premiums and supporter charges… that are sensible in connection to the formal gave and to distinguish any… .protection benefits that might be unduly impacting the cost." Named the Kansas Health Insurance Information System (KHIIS) Funded by a little premium appraisal Dataset is the property of the Kansas Insurance Department, yet the state\'s wellbeing organization was relegated in statute as the measurable operator

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First Ten Years\' Experience Limited utilization of information for evaluations of protection orders No distributed investigations of premiums nor its determinants Data oversaw by state office staff as an accumulation of records as opposed to a database Reporting irregularities and inadequate information in center fields, for example, month to month premiums Limited and relentless access to information Eroding support among bearers for the managerial premium evaluation and compulsory accumulation

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KHIIS\' Contents Data from the significant medical coverage bearers in Kansas (Commercial gathering protection arranges) Health advantage, enlistment and cases information Payment information incorporates charges and discounts, copays and deductibles 700,000+ individuals spoke to Examples of total reports shared freely: Payment Summaries for Providers by Specialty Payment Summaries for Hospitals by Service Claims & Charges for Services Affected by Mandates

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New Data Regime Initiated in 2005

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Reorganization of Kansas\' Health Programs KHPA made in 2005 Legislative Session Built on Governor Sebelius\' "Official Reorganization Order" Combine organization of state health care coverage projects and state wellbeing databases To be housed in semi autonomous bureau office Modified by State Legislature to: Create a nine part administering Board Executive Director reports to Board Added a particular concentrate on organizing state wellbeing strategy, wellbeing advancement and information driven approach making Assumed administration for Medicaid, SCHIP and state worker wellbeing arrangement in July 2006

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Broad Legislative Intent for Health Data .." dire need to give medicinal services shoppers, outsider payers, suppliers and social insurance organizers with data in regards to the patterns being used and cost of human services benefits in this state for enhanced basic leadership "it is the goal of the council to require that the data vital for a survey and examination of use examples, cost, quality and amount of health awareness administrations be provided to [KHPA] by all suppliers of medicinal services administrations and outsider payers" Source: KSA 65-6801

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KHPA\'s Responsibilities: Collect, Govern, and Use "… [collect and compile] a uniform arrangement of information and build up components through which the information will be scattered "… create or receive wellbeing markers "… may name a team or teams … with the end goal of considering specialized issues identifying with the gathering of medicinal services information "… create approach in regards to the gathering of social insurance information "… facilitate … investigation of wellbeing information for the condition of Kansas as for [its] wellbeing programs" Source: KHPA Authorizing Statute, 2005

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Summary of Statutory Framework for Management of Public Health Care Data Broad authoritative expectation Public administration through free board-run office Clear responsibility for KHPA Huge load of accessible information in one office: Medicaid/SCHIP State Employee Health Plan (SEHP) Private gathering protection information from real transporters (KHIIS) Licensure data from 8 sheets Hospital Inpatient Claims

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KHPA\'s Plans to Manage and Use the Data

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Description, documentation, and control Description, documentation, and control Increasing interest Initial arrangement + Consumer application (encourage understanding) Policy & Consumer application Data improvement Data improvement Addl. arrangement + Consumer application (encourage decision) Guiding Model of Data Use and Development

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Principal Strategies for Managing and Using Data Establish open administration of wellbeing information to make statewide wellbeing pointers to create rules for the utilization of information to drive extended gathering and utilization of information Make existing information open and instructive User-accommodating interface with center datasets Combined organization of center datasets to empower correlations crosswise over payers Make utilization of accessible information for approach and projects Produce information concentrated program assessments to drive strategy Tie information sources to program administration and open consumptions Organize office to underline results and encourage utilization of information Create settings for spread to the general population

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Public Governance through the new "Information Consortium" Chartered by the Board in April 2006 to: Guide KHPA in the administration of automatic and non-automatic wellbeing information Advise the Board with regards to the proper accumulation and utilization of wellbeing information Ensure proceeded with open and private partner interest in the utilization of information to propel wellbeing arrangement Disseminate Agency\'s abundance of information in association with partners

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Consortium\'s Progress to Date December 2007 – First meeting of Data Consortium December 2007 to October 2008 – Development of statewide wellbeing marker suggestions November 2008 – Recommendations displayed to and affirmed by Board January 2009 – Kansas Health Indicators Document distributed on the web (1 st Release – Tier I) March 2009 – Unsolicited reports utilizing private protection information shared freely for first time

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Elements of Successful Management of KHIIS Respond to systematic inquiries and solicitations for data from various partners Access to information by staff with various levels of need and aptitude Rapid reaction to extensive variety of inquiries and information demands User-accommodating, instinctive access to Data-sharing (with appropriate security controls) with other state offices and outer specialists Modern investigative devices Episode groupers Record linkage to make ace patient/supplier file Built-in computation of broadly acknowledged measures for intense/long haul social insurance quality Allow benchmarking of Kansas information to different states and payers

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Solution: " Data Analytic Interface" (DAI) Repository for three information sets Medicaid-400,000+ enrollees every year State Employee Health-90,000+ enrollees Private Insurance - 700,000+ enrollees Additional information as accessible Web based interface with information Easily got to by most staff Quick reaction time User benevolent Accurate reporting with capacity to change and spare questions Meet needs of overseers, program staff, scientific staff Training for every level of staff

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DAI Timeline and Status First proposed to KHPA Board in August 2006 Funded by Legislature in 2007 Procured by KHPA in 2008 – Contract to Thomson Reuters (Medstat) Currently in testing and usage stage Anticipated Go-Live dates November 2009 - Medicaid and state representative information accessible to staff February 2010 – First portions of private protection information accessible to some staff

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Challenges and Hurdles

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Challenges of the New Environment in Kansas another economy Large diminishments in office assets Large basic deficiency in state spending Large basic shortfall in government spending plan Increasing levels of requirement for access to care and medical coverage scope New political initiative in Kansas Limited accomplishment for far reaching wellbeing change motivation Legislative originators no more extended in authority part Some authoritative enthusiasm for returning to KHPA\'s administration demonstrate KHPA reaction: refocus assets on center program operations Scale back correspondences, effort and arrangement limit, and official administration limit Accelerate concentrate on information driven, results situated administration Develop new reserve funds and efficiencies through program assessment process and revamp the office to take part in ceaseless survey and change Data is no lace!

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Hurdles in Developing and Using the KHIIS Data quality and honesty issues Resource and spending confinements Political boundaries Provider-arranged state Optimizing the administration demonstrate for powerful multi-partner information approach advancement Inertia being used of cost and quality information Obtaining partner purchase in and tending to security and prized formula insurance concerns Identifying supported interest for data

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Lessons Learned

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Key Success Factors Successful administration of KHIIS and other wellbeing information Clear authoritative command Clear vision for proposed utilizes Inclusive process through the Data Consortium Public administration of KHPA gives maintained force Successful administration of KHIIS Requires methodology for utilizing information Recruitment of key staff to a main edge exertion Requires ability to screen, comprehend and impart data Adequate and managed subsidizing Successful utilization of KHIIS Fostering interest for new information Public scene for sharing and enhancing information Political responsibility to the utilization of wellbeing information Application of information to administration of citizen financed programs

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Next strides and expected points of reference

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Next Steps in Management and Use of KHIIS Implement new information accommodation necessities �

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