Developing and Using an All-Payer Database: Kansas

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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
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Overview

• Origins of Kansas All-Payer Database
• New data regime initiated in 2005
• KHPAs plans to manage and use the data
• Challenges and hurdles
• Lessons learned
• Next steps and expected milestones

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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 purpose is to collect information from
  state-regulated carriers
• in such form and detail as may be necessary to
  determine whether rates and rating
  systemsproduce premiums and subscriber
  chargesthat are reasonable in relation to the
  benefits provided and to identify any.insurance
  benefits that may be unduly influencing the
  cost.
• Named the Kansas Health Insurance Information
  System (KHIIS)
• Funded by a small premium assessment
• Dataset is the property of the Kansas Insurance
  Department, but the states health agency was
  assigned in statute as the statistical agent

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First Ten Years Experience

• Limited use of data for estimates of insurance
  mandates
• No published studies of premiums nor its
  determinants
• Data managed by state agency staff as a
  collection of files rather than a database
• Reporting inconsistencies and incomplete data in
  core fields such as monthly premiums
• Limited and laborious access to data
• Eroding support among carriers for the
  administrative premium assessment and mandatory
  collection

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KHIIS' Contents

• Data from the major health insurance carriers in
  Kansas (Commercial group insurance plans)
• Health benefit, enrollment and claims data
• Payment data includes charges and write-offs,
  copays and deductibles
• 700,000 members represented
• Examples of aggregate reports shared publicly
• 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 created in 2005 Legislative Session
• Built on Governor Sebelius Executive
  Reorganization Order
• Combine administration of state health insurance
  programs and state health databases
• To be housed in quasi-independent cabinet agency
• Modified by State Legislature to
• Create a nine member governing Board
• Executive Director reports to Board
• Added a specific focus on coordinating state
  health policy, health promotion and data-driven
  policy making
• Assumed management for Medicaid, SCHIP and state
  employee health plan in July 2006

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Broad Legislative Intent for Health Data

• ..urgent need to provide health care consumers,
  third-party payers, providers and health care
  planners with information regarding the trends in
  use and cost of health care services in this
  state for improved decision-making
• it is the intent of the legislature to require
  that the information necessary for a review and
  comparison of utilization patterns, cost, quality
  and quantity of health care services be supplied
  to KHPA by all providers of health care
  services and third-party payers
• Source KSA 65-6801

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KHPAs Responsibilities Collect, Govern, and Use

• collect and compile a uniform set of data
  and establish mechanisms through which the data
  will be disseminated
• develop or adopt health indicators
• may appoint a task force or task forces for
  the purpose of studying technical issues relating
  to the collection of health care data
• develop policy regarding the collection of
  health care data
• coordinate analysis of health data for the
  state of Kansas with respect to its health
  programs
• Source KHPA Authorizing Statute, 2005

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Summary of Statutory Framework for Management of
Public Health Care Data

• Broad legislative intent
• Public governance through independent board-run
  agency
• Clear accountability for KHPA
• Huge stock of available data in one agency
• Medicaid/SCHIP
• State Employee Health Plan (SEHP)
• Private group insurance data from major carriers
  (KHIIS)
• Licensure information from 8 boards
• Hospital Inpatient Claims

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KHPAs Plans to Manage and Use the Data
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Guiding Model of Data Use and Development
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Principal Strategies for Managing and Using Data

• Establish public governance of health data
• to create statewide health indicators
• to develop guidelines for the use of data
• to drive expanded collection and use of data
• Make existing data accessible and informative
• User-friendly interface with core datasets
• Combined administration of core datasets to
  enable comparisons across payers
• Make use of available data for policy and
  programs
• Produce data-intensive program evaluations to
  drive policy
• Tie data sources to program management and public
  expenditures
• Organize agency to emphasize outcomes and
  facilitate use of data
• Create venues for dissemination to the public

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Public Governance through the new Data
Consortium

• Chartered by the Board in April 2006 to
• Guide KHPA in the management of programmatic and
  non-programmatic health data
• Advise the Board as to the appropriate collection
  and use of health data
• Ensure continued public and private stakeholder
  investment in the use of data to advance health
  policy
• Disseminate Agencys wealth of data in
  partnership with stakeholders

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Consortiums Progress to Date

• December 2007 First meeting of Data Consortium
• December 2007 to October 2008 Development of
  statewide health indicator recommendations
• November 2008 Recommendations presented to and
  approved by Board
• January 2009 Kansas Health Indicators Document
  published online (1st Release Tier I)
• March 2009 Unsolicited reports using private
  insurance data shared publicly for first time

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Elements of Successful Management of KHIIS

• Respond to analytic questions and requests for
  information from diverse stakeholders
• Access to data by staff with different levels of
  need and skill
• Rapid response to wide range of questions and
  data requests
• User-friendly, intuitive access to information
• Data-sharing (with suitable privacy controls)
  with other state agencies and external
  researchers
• Modern analytic tools
• Episode groupers
• Record linkage to create master patient/provider
  index
• Built-in calculation of widely-accepted measures
  for acute/long-term healthcare quality
• Allow benchmarking of Kansas data to other states
  and payers

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Solution Data Analytic Interface (DAI)

• Repository for three data sets
• Medicaid-400,000 enrollees annually
• State Employee Health-90,000 enrollees
• Private Insurance -700,000 enrollees
• Additional data as available
• Web based interface with data
• Easily accessed by most staff
• Quick response time
• User friendly
• Accurate reporting with ability to change and
  save queries
• Meet needs of administrators, program staff,
  analytical staff
• Training for each 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 implementation phase
• Anticipated Go-Live dates
• November 2009 - Medicaid and state employee data
  available to staff
• February 2010 First installments of private
  insurance data available to some staff

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Challenges and Hurdles
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Challenges of the New Environment in Kansas

• A new economy
• Large reductions in agency resources
• Large structural deficit in state budget
• Large structural deficit in federal budget
• Increasing levels of need for access to care and
  health insurance coverage
• New political leadership in Kansas
• Limited success for comprehensive health reform
  agenda
• Legislative founders no longer in leadership role
• Some legislative interest in revisiting KHPAs
  governance model
• KHPA response refocus resources on core program
  operations
• Scale back communications, outreach and policy
  capacity, and executive leadership capacity
• Accelerate focus on data-driven,
  outcomes-oriented management
• Develop new savings and efficiencies through
  program evaluation process and remake the agency
  to engage in continual review and improvement
• Data is no frill!

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Hurdles in Developing and Using the KHIIS

• Data quality and integrity issues
• Resource and budget restrictions
• Political barriers
• Provider-oriented state
• Optimizing the governance model for effective
  multi-stakeholder data policy development
• Inertia in use of price and quality data
• Obtaining stakeholder buy-in and addressing
  privacy and trade-secret protection concerns
• Identifying sustained demand for information

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Lessons Learned
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Key Success Factors

• Successful governance of KHIIS and other health
  data
• Clear legislative mandate
• Clear vision for intended uses
• Inclusive process through the Data Consortium
• Public governance of KHPA provides sustained
  impetus
• Successful management of KHIIS
• Requires strategy for using data
• Recruitment of key staff to a leading-edge effort
• Requires capacity to monitor, understand and
  communicate information
• Adequate and sustained funding
• Successful use of KHIIS
• Fostering demand for new data
• Public venue for sharing and improving data
• Political accountability to the use of health
  data
• Application of data to management of
  taxpayer-funded programs

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Next steps and expected milestones
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Next Steps in Management and Use of KHIIS

• Implement new data submission requirements
  Summer 2009
• Overcome questions of the use of proprietary data
  and successfully share data with external
  researchers- Summer 2009
• Receive legislative requests for information from
  the all-payer database Spring 2010
• Implement web-based, user-friendly data warehouse
  to enable comparisons of public and private
  payers 2010
• Compile regular report of insurance benefits --
  2010 or 2011
• Use comparative data to develop cost-saving
  program initiatives in Medicaid or the state
  employee health plan Summer 2011

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• http//www.khpa.ks.gov/