Healthcare Transformation Learning Session August 22, 2014 Improving Healthcare Transparency in Greater Columbus …exploring the opportunities and challenges for consumers, providers, and purchasers Upcoming Learning Sessions 9/24/14 Webinar 1:00 - 2:00p Topic: Consumer Reports - Better Health Care - Changes to Learn About Now 10/22/14 Webinar 1:00-2:00p Topic: Pharmacists expanded roles in value-based healthcare 12/5/14 In-Person, 8:30-11:30a Topic: Annual showcase of best practices and lessons learned featuring our pubic-private partners Register today! www.hcgc.org/registration Patient surveys …experiences Clinical data …electronic medical records Medical claims …Commercial, Medicare, Medicaid Improved healthcare transparency
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Healthcare Transformation Learning Session August 22, 2014
www.hcgc.org
Improving Healthcare Transparency in Greater Columbus
…exploring the opportunities and challenges for consumers, providers, and purchasers
Upcoming Learning Sessions
9/24/14 Webinar 1:00 - 2:00p Topic: Consumer Reports - Better Health Care - Changes to Learn About Now
10/22/14 Webinar 1:00-2:00p Topic: Pharmacists expanded roles in value-based healthcare
12/5/14 In-Person, 8:30-11:30a Topic: Annual showcase of best practices and lessons learned featuring our pubic-private partners
Objectives • AWARENESS on All-Payer Claims Database (APCD) – transparency area with the most activity and learning available
• EXPLORE opportunities and challenges for consumers, providers, purchasers • LEARN from diverse perspectives of participants
8:30-8:50a Welcome & Briefing • Krista Stock & Jeff Biehl, Healthcare Collaborative of Greater Columbus
8:50-10:50a APCD Overview • APCD -- What and Why • Usage Examples – How are APCDs being used? Featured Speaker • Jo Porter, MPH, Deputy Director for the Institute for Health Policy and
Practice at the University of New Hampshire and the co-chair of the national All-Payer Claims Database (APCD) Council.
Discussion Panel • Tom Hadley, Senior Vice President, Wells Fargo Insurance Services • Kevin Hinkle, Regional Vice President, Anthem Blue Cross and Blue Shield • Isi Ikharebha, MPH, Executive Director, Physicians Care Connection • Bill Wulf, MD, CEO, Central Ohio Primary Care
10:50-11:00a Next Steps
Healthcare Transformation Learning Session August 22, 2014
www.hcgc.org
The Healthcare Collaborative of Greater Columbus is a non-profit, public-private partnership. We serve as a catalyst, convener, and coordinator of healthcare transformation & learning in Greater Columbus.
Healthcare Transformation Learning Session August 22, 2014
www.hcgc.org
… please introduce yourself to someone you do not know and share why you joined us today!
Overview August 2014
www.hcgc.org
…exploring and catalyzing best \practices to strengthen engagement between consumers, providers, and purchasers
SHARED RESPONSIBILITY HEALTHCARE DELIVERY
COLLABORATIVE LEARNING HEALTHCARE TRANSPARENCY
…improve engagement between consumers, providers, and purchasers
…improve the value of healthcare
…improve access to price and quality information
…improve the application of learning in Greater Columbus
Collaborative Transformational Activities
www.hcgc.org
…exploring and catalyzing best practices to strengthen engagement between consumers, providers, and purchasers
SHARED RESPONSIBILITY HEALTHCARE DELIVERY
COLLABORATIVE LEARNING HEALTHCARE TRANSPARENCY
emerging active
Choosing Wisely®
Patient Engagement Education & Training
Open Notes®
emerging active
emerging active
emerging active
Patient-Centered Medical Home (PCMH)
Medical Neighborhood Pilot
Physical-Behavioral Integration Pilot
Primary Care Quality Reporting Pilot
Public-Private Board of Directors
Healthcare Improvement Collaboratives
Transformation Learning Sessions
Speaking Engagements
Learning Groups
Healthcare Transformation Learning Session August 22, 2014
www.hcgc.org
Improving Healthcare Transparency in Greater Columbus …exploring the opportunities and challenges
for consumers, providers, and purchasers
Patient surveys …experiences
Clinical data …electronic
medical records
Medical claims …Commercial, Medicare, Medicaid
Improved healthcare
transparency www.hcgc.org
Healthcare Transformation Learning Session August 22, 2014
www.hcgc.org
Improving Healthcare Transparency in Greater Columbus …exploring the opportunities and challenges
for consumers, providers, and purchasers
Patient surveys …experiences
Clinical data …electronic
medical records
Medical claims …Commercial, Medicare, Medicaid
Improved healthcare
transparency
current activity
with patient-centered medical homes
www.hcgc.org
Primary Care Quality Reporting Pilot • Based on national standards • Clinical measures from electronic
medical records • A good place to start demonstrating
meaningful use of health information technology
Adult Measure • Diabetes: Hemoglobin A1c Poor
Control • Diabetes: Low Density Lipoprotein
(LDL) Management • Diabetes: Blood Pressure
Management • Controlling High Blood Pressure
Current Pilot Participants (65 sites)
• Central Ohio Primary Care (35 practice sites)
• Mount Carmel Medical Group (17 practice sites)
• The Ohio State University Wexner Medical Center (13 practice sites)
Primary Care Quality Reporting Pilot
www.hcgc.org
EMERGING NEXT STEPS – TO BE ANNOUNCED IN SEPTEMBER 2014
Healthcare Transformation Learning Session August 22, 2014
www.hcgc.org
Improving Healthcare Transparency in Greater Columbus …exploring the opportunities and challenges
for consumers, providers, and purchasers
Patient surveys …experiences
Clinical data …electronic
medical records
Medical claims …Commercial, Medicare, Medicaid
Improved healthcare
transparency
Today’s Focus:
All-Payer Claims
Database (APCD)
www.hcgc.org
All-Payer Claims Database
Featured Speaker • Josephine Porter, MPH, Deputy Director for the Institute for Health Policy
and Practice at the University of New Hampshire and the co-chair of the national All-Payer Claims Database (APCD) Council. The APCD Council is learning collaborative of government, private, non-profit, and academic organizations focused on improving healthcare transparency.
Definition of APCDs • Databases, created by state mandate,
that typically include data derived from medical, pharmacy, and dental claims with eligibility and provider files from private and public payers: – Insurance carriers (medical, dental, TPAs,
Typically Not Included Information – Services provided to uninsured – Denied claims – Workers’ compensation claims – Referrals – Test results from lab work, imaging, etc. – Provider affiliations – Premium information – Capitation fees – Administrative fees – Back end settlement amounts – Back end P4P or PCMH payments