23 May Analytics software, public pressure lead to doctor evaluation tool
Madison, Wis. – Thanks to the improving capabilities of analytical software and growing public pressure for healthcare providers to report quality measures, Wisconsin employers and individuals who purchase health insurance soon will have another technology enabled way to measure the value of doctors and health systems.
The Wisconsin Health Information Organization has entered a three-year contract with the state Department of Health and Family Services and the Department of Employee Trust Funds to establish a data mart for the collection and analysis of health claims data.
The $1.5 million, three-year contract will be funded by annual assessments that are part of the physician licensing process. Five health plans that do business in Wisconsin will join DHFS as data-submitters, with the goal of monitoring how closely physicians adhere to national guidelines for the treatment of disease and health conditions.
“I think what it will do is help us reduce the variation in healthcare,” said John Foley, vice president of health services for Anthem Blue Cross Blue Shield, one of the health plans that will submit data.
Under the contract, WHIO will develop a comprehensive data mart of healthcare administrative claims data. From that data, it will develop reports for providers to assess their qualitative performance, starting with a pilot that will launch in the first quarter of 2009, a full-fledged rollout after April 2009, and eventually consumer-level reports about quality at the group (not individual physician) level.
However, there is some concern about the Internet as a public reporting format. WHIO members are still leaning toward providing “both public and hard copy, given that the web activity is not in it’s mature state,” Foley stated.
“Frankly, there’s a need for what WHIO is doing,” he added. “It’s taking a little longer than quite a few people would expect, but that’s because it’s a collaborative approach and we’re trying to perfect this so that it doesn’t put inappropriate data into the marketplace and have people make inappropriate judgments based on the information. It has to be credible, it has to be vetted. It’s important for both the payers and the providers to be able to present this in a quality manner to the market place.”
Julie Bartels, executive director of WHIO, said eventually all medical care delivered in Wisconsin will be captured within the data mart. That will take some time, however, because WHIO still has to work with the Center for Medicare and Medicaid Services to collect data on Medicare patients, and would like to bring other health plans into the mix. At the end of the three-year contract, Bartels said the data mart would have at least 67 percent of the claims data generated in Wisconsin, more than enough for a representative sampling.
Initially, the data mart also will not receive data from Veterans Administration patients, and it will not have any data from the uninsured because they are not part of the claims data.
WHIO’s agreements with the five health insurance carriers call for them to contribute medical claims and pharmaceutical claims data. In time, WHIO also may collect dental data, patient satisfaction data, and other data sets, Bartels said.
In addition to DHFS, which will submit Medicaid claims data starting in 2009, and Anthem Blue Cross Blue Shield, data submitters will be Humana, United Healthcare of Wisconsin, WEA Trust, and WPS Health Insurance. All are WHIO member organizations, as is the Wisconsin Collaborative for Healthcare Quality, which has facilitated public reporting of hospital performance.
Business intelligence is produced with the help of analytical software tools designed to transform data into “actionable” information that drives executive decision-making.
At WHIO, the claims data will be mined with the help of Ingenix, an Eden Prairie, Minn. company that provides software analytics and builds data warehouses for qualitative healthcare information. Bartels said WHIO has entered into a contract with Ingenix for consulting and application services, so it will provide data aggregation, storage, and analytics.
Larry Rambo of Humana said the health plan has used Ingenix in the past for some of its small business programming evaluations, but this time he expects the first production of a significant data set for physician practice patterns in Wisconsin.
Reports produced by WHIO will be comparative reports that focus on quality of the process, not health outcomes. They will compare treatment provided by providers for various health conditions relative to national standards for care that have been endorsed by organizations like the National Quality Forum, the National Committee for Quality Assurance, and AQA (formerly the Ambulatory Care Quality Alliance).
The standards are predicated on evidence-based medicine in which providers are expected to follow care protocols for various disease types, including which tests are procedures should be ordered. For example, WHIO will take all doctor-patient encounters for diabetes and group them so that providers and eventually consumers can analyze whether providers were giving the right kind of treatment. With this data set, providers and consumers will be able to determine whether caregivers are correctly tracking established workflows.
“I think what’s happened over the years is that groups like the Wisconsin Collaborative for Healthcare Quality and health plans themselves have looked to better understand physician practice patterns,” Rambo said. “We’ve realized that just using our own [health plan] data has limited usefulness because we don’t have enough for episodes of care with any given physician to do as good a job as we would like of evaluating their performance.”
Foley (Anthem Blue Cross Blue Shield) said a number of factors have converged to make quality reporting possible. “I think it’s a combination of the fact that in the state of Wisconsin, there is more public pressure from employer groups, so they are be coming more engaged than they have ever been before,” he said. “There is a willingness among the providers and payers to acknowledge and come together for a solution.
“The analytical tools, which have been there, have gotten to a point where they can sustain quite a bit of questioning and they are valid. The physician groups and providers have been able to use the drill-down capability to show that this specific information validates their practice.”
Bartels said WHIO will examine data over 27-month periods to see if patients are getting the proper care, and the data mart will be refreshed every six months with the most current 27 months worth of data.
“The data can be used to improve care, and we’ll attack that from two directions,” Bartels explained. “First, we’ll work with providers to give them information so they can compare their performance to national standards. We want to give providers an opportunity to see the data and understand it and change practices accordingly to make sure they are aligned with national standards.
“The second step is to provide it to consumers,” she added. “We haven’t decided yet how to do that.”
Legislation passed in 2006 amended Wisconsin law and helped pave the way for the state’s partnership with WHIO.
“This is an extremely important initiative for Wisconsin to achieve transparency in healthcare and promote better health care outcomes for the people of Wisconsin,” said DHFS Secretary Karen Timberlake in a statement issued by the department. “We are fully committed to working in partnership with the other healthcare stakeholders across the state through the Wisconsin Health Information Organization.”
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