Payment and Delivery System Reform: It’s All About the Data, States!

In the new health care world of more accountable care with incentives fashioned to spur higher quality and better value, data forms the backbone for all models and all activities. The first andsecond blog posts in this series explored the policy toolkit and payment reform models states can use to promote better delivery system integration. Making these models a reality requires collecting and using data to support improvements at the provider level, to guide payment policy, and to increase transparency. The Affordable Care Act is fostering a number of new payment models that build on previous investments in data infrastructure, such as health information exchanges, and existing quality reporting strategies. These reforms are prompting states to think about new ways to use the data they have available to support reform of the health care delivery system.
A recent webinar convened by NASHP and supported by Kaiser Permanente Community Benefit examined the existing types and sources of data that states designing multi-payer reforms may leverage:

• Treatment data. States can collect data about patients’ treatments, including clinical outcomes and the process of care, as well as measures of the patient experience receiving care and provider experience delivering it. These data come from different types of providers—including hospitals, physicians, and supportive services providers—through administrative data, patient records, and surveys. The Maine Health Data Organization (MHDO) is collecting information to support multi-payer reforms, including three kinds of hospital data: (1) inpatient and outpatient hospital encounter data; (2) hospital quality and patient data, including information on hospital-acquired infection rates and care transition measures; and (3) hospital financial and organizational data.

• Utilization and cost data. These data include information on services used by patients and payments made.  Used by purchasers to manage their relationships with plans and providers and to develop new payment strategies, these claims come directly from each plan independently. When aggregated, a market-wide view is possible. States that have developed an all-payer claims database find it to be a rich source of information on cost drivers and the opportunities for delivery system improvement. Maine and Vermont both support their multi-payer initiatives with all-payer claims databases.

• Public health data. Public health registries in states may contain specific health data like immunizations, vital statistics, and cancer incidence. These population health indicators can help target multi-payer payment reform initiatives by focusing on areas of highest illness incidence or where rewarding the provision of preventative services would have a large payoff. Vermont’s Blueprint for Health medical home program is supported by a central clinical registry that draws data from practices, Community Health Teams, housing sites, self-management and tobacco cessation programs, and other specialty providers.

These data sources play a key role in facilitating payment and delivery system reform, through mechanisms such as:

• Guiding improvement with physician practice reports. Reports to physician practices participating in payment reform initiatives can show performance on cost and utilization for individual providers or the practice as a whole compared with other practices in the state or nationwide. Maine is supporting its Patient-Centered Medical Home Pilot by generatingphysician-level reports to participating providers that show performance on cost (including cost per patient per year) and utilization metrics, such as overall acute admissions and emergency department visits.

• Supporting payment that fosters accountability for total cost of care and quality.Tennessee is designing an episode-based care payment system that will hold providers accountable for the cost and quality of distinct episodes of care for specific clinical conditions or treatments. The state used data on the cost and illness trends in the state to determine which episodes to address first. When implemented, cost and quality data will not only support risk and gain-sharing payment arrangements, it will be used to inform providers of their performance relative to their peers.

New opportunities to improve care are continuing to emerge. A conversation with state leaders yielded lessons about the importance of data, available data sources, and ways for states to create efficiencies in the use of data. Read more in the full summary of the conversation held during the webinar on this topic. Tell us about your state’s strategies for payment reform by joining State Refor(u)m’s multi-sector payment reform discussion, or in a comment below.
We’re adding documents, reports, and insights as NASHP’s integrated delivery system project continues. The results of this work, along with additional related resources—including NASHP’sState Accountable Care Activity map and Multi-Payer Resource Center—can be found on State Refor(u)m in an Integrated Delivery Systems Toolkit. Also check back here for our final blog post distilling some of the lessons emerging from our work.