Competing Priorities for an All-Payer Claims Database

Allen: The next series of things we’re going to look at are chronic diseases, the heavy hitters. When we look at the top 10 diseases driving costs in Utah, [we find] diabetes, hypertension, hyperlipidemia [at the top]. The list is no surprise to anyone. What we’re going to try to do is drill into those chronic conditions starting with diabetes, since that’s the No. 1 cost driver, and really start looking at where diabetes is occurring. What is the difference between a healthy diabetic and one who has other different chronic conditions, or who has complications that is a result of their diabetes? [We want to show that] diabetes if it’s well cared for, can be relatively straightforward and not that expensive to maintain. It’s when people move into a second chronic condition and develop secondary chronic conditions is when things start getting expensive. When we talk about the burden of chronic disease, we really need to talk about both the cost burden, but also the burden to the person with the disease. For instance, if they have asthma exacerbation, and they spend the night in the ER, or they have to be hospitalized. Not only is that costly, that person’s not available to go to work or whatever that person has to do.

HCI: Who gets the most out of this project? What’s in it for providers?

Allen: I think the policymakers are honestly getting the most out of it right now. I mean policymakers on the hill now looking at reforming healthcare, and policymakers in this specific UDOH building who are looking to improve the health of people in Utah. We haven’t really reached providers yet. We’re engaged with them. I think they’re still learning about what an APCD can do in terms measurement. And that of course is measuring providers, what the policymakers, the public, and the payers want.

I think what the providers want is information that will help them take care of their patient. I am speaking very generally from what I’ve heard speaking to providers, including a representative on the health data committee that oversees the work that my office does. And to the degree that the APCD can help do that, they’re all for it. They’re not terribly interested in being measured, they’re not terribly interested in being incentivized; and I can’t say I blame them. I think the payers and purchasers are more interested in measuring the quality of providers care and incentivizing them based on that. There’s really a bit of disconnect, which is understandable when you look at from each perspective. We really need to look at the APCD through every single lens of each particular stakeholder, and what one stakeholder wants from another is not necessarily what they want for themselves. We have to be cognizant of that.

Going into this project we had very good ideas around hospital measurements and health plan measurements like the AHRQ [Agency for Healthcare Research and Quality] and NCQA [National Committee for Quality Assurance] measures. The biggest hurdle we have to address is the correct assignment of patients to providers. We have a contract in place with HealthInsight our local QIO [Quality Improvement Organization], chartered value exchange, and the holder of one of the Beacon Community grants. HealthInsight and we are in the process of moving our data from the APCD to them so they can do a provider-validation study. Because that is the very first step of making sure the providers are comfortable, so that if we’re going to report on their diabetes care or their immunization rank, we’re looking at the correct patients, so those measures are valid. If they’re not, the providers are going to ignore us.

HCI: What are the estimated cost savings from this project?

Allen: I think the healthcare savings are going to be found in a variety of places. The low-hanging fruit is obviously patient safety, and we’re reaching out to patient safety groups to look at that. Another low-hanging fruit is duplicate tests, and I think we can show evidence of that unnecessary care.

HCI: Will you be providing a Web-based summary database for consumers like other state APCDs? When will it launch?