HCCI and the Florida Transparency Initiative - PowerPoint Presentation

Slide1

HCCI and the Florida Transparency InitiativeHealth Care Cost Institute (HCCI)December 2017

1Slide2

OutlineHCCI OverviewHCCI ResearchFL Specific Data FindingsNational Guroo

FL Transparency InitiativePre-Rule Site

Post-Rule Site

Requesting Care Bundle Details

2Slide3

Why was HCCI founded?Prior to HCCI’s formation:Access to payer data was piecemeal with researchers primarily relying on Medicare data for research and analysisThere was little to no transparency in health care pricing/prices

HCCI was founded to:Promote independent, nonpartisan research and analyses on the causes of the rise in U.S. health spending

Inform

the public

policy process and assist in developing new solutions

to long-term problems confronting the health care system

3

Any informed debate about health care reform relies on access to data from commercial payersSlide4

HCCI Data HoldingsCommercial Claims Years 2008-2015~50 million individuals per yearEmployer-sponsored, individual and Medicare Advantage (Part C)

All 50 states and D.C.Updated annually

De-identified, HIPAA and anti-trust compliant

Medicare fee-for-service claims (via the Qualified Entity Program)

Years 2012-2015

Parts A & B (100%)

Part D (~40%)

Additional years of current contributors’ data

2016 data is currently being constructed and is expected to be available in January 2018

2016 Medicare claims will be available in February 2018

Administrative data from additional payers

State APCDs

Medicaid and CHIP

Current

FutureSlide5

Using HCCI’s Data5

August 31, 2017

HCCI reports and issue briefs

are

free

and available

onlineSlide6

HCCI’s current academic partners include:

HCCI has also facilitated data access and research support through external funding partnerships:

Academic

Research

6Slide7

Florida Specific DataWhat can HCCI’s claim data tell us about spending and utilization in Florida?HCCI data include 3 million covered employer sponsored insurance lives in Florida (38% of total)HCCI data include approximately 27% of the national ESI population

7Slide8

ESI Per Capita Spending in FloridaFlorida has slightly above average health care spending for commercially insuredFrom 2012-2015, health care spending in FL averaged 3% more than national spending, but varied by service Outpatient spending lower than national average

8

FL – National Spending Difference in 2015Slide9

ESI Per Capita Spending TrendsPer capita spending growth in FL was consistent with national trendFrom 2012 to 2015, US total spending rates increased by 10%, FL increased 9%But trends for FL and US varied when comparing service categories

FL saw greater inpatient spending growth and lower physician spending growth

9

Change in per capita Spending since 2012Slide10

Health Care Price VariationTrends in per capita spending are influenced by many factors including the underlying population, prices, and utilizationResearch has shown substantial geographic variation in commercial spending, driven largely by differences in price rather than utilization IOM 2013, Cooper et al 2016

HCCI’s Healthy Marketplace Index (HMI) reports price indices for 3 service categories at the local level

Indices allow users to compare a common weighted average price across geographic areas and over time (2012-2014)

FL CBSAs

: Cape Coral-Fort Myers

, Deltona-

Daytona Beach

-Ormond Beach, Jacksonville,

Lakeland-Winter Haven, Miami-Fort Lauderdale-West Palm Beach, North Port-Sarasota-Bradenton, Orlando-Kissimmee-Sanford, Palm Bay-Melbourne-Titusville,

Tampa

-St. Petersburg-Clearwater

10Slide11

Healthy Marketplace Index (HMI)Healthy Marketplace Index (funded by Robert Wood Johnson Foundation) developed measures of the economic performance of health care markets across the country: price, productivity, and competitionFuture work on high spenders will investigate differences in demographics and types of health care expenditures between persistent vs. new high spendersMeasures were presented in a series of issue briefs and interactive mapping tool on the HCCI website

11Slide12

Florida Health Care Price Variation - InpatientInpatient prices varied widely across the Florida CBSAs, but price increases within CBSAs were similar to the national growth ratesLakeland has the lowest average inpatient prices (9% below the national average), while Orlando had the highest (21% higher)7 of the 9 Florida CBSAs had inpatient growth rates between 8-15%, generally aligning with the national inpatient growth rate of 11%

12

2014 Inpatient Price IndicesSlide13

Florida Health Care Price Variation - OutpatientOutpatient prices grew faster than national rate In 7 of the 9 CBSAs studied, outpatient price levels rose at the same or higher rate compared to the national growth level of 14%Largest increase was in Tampa - outpatient prices went from 9% below to 14% above the national average between 2012 and 2014

13

2012

2014Slide14

Florida Health Care Price Variation – Professional ServicesProfessional services prices were well below the national average in all FL CBSAs Ranging from 0% to 12% below average in 2014No CBSA had a growth rate higher than 7%, and 6 of the 9 CBSA’s had growth rates ≤ 1%

14

2014 Professional Services Price IndicesSlide15

Procedure Spending - FLHMI reported demographically adjusted spending per 1000 people for 3 knee proceduresGenerally, FL had average to below average spending on Knee Injections and consistently below average spending on ACL Repairs

Wide variation across FL CBSAs for spending on Knee ReplacementsSpending in Miami was less than 1/3rd

the national average, while spending in Fort Meyers was 50% greater

15

Knee Injections

ACL Repairs

Spending per 1000 people by CBSA

Knee ReplacementsSlide16

Procedure Specific Utilization - FLHMI reported demographically adjusted utilization rates per 1,000 people for the same 3 proceduresSimilar to spending, most FL CBSA Knee Injection utilization rates were around or below the national average and were below to substantially below for ACL Repairs

There was more variation for Knee Replacement utilization with Fort Meyers again having the highest use rate and Miami the lowest

16

Knee Injections

ACL Repairs

Knee Replacements

Utilization Rates per 1,000 people by CBSASlide17

Procedure Specific Price Index - FLHMI reports a price index with 1.00 being the national averageConsistently below average Knee Injection prices also helped lead to below average Knee Injection spending across FL CBSAsLakeland -> slightly above average utilization, but below average prices

Outside of average prices in Fort Meyers, FL had below average ACL Repair prices

Palm Bay had the highest

Knee Replacement

prices of FL CBSAs, potentially explaining their above average spending with below average utilization

17

Knee Injections

ACL Repairs

Knee Replacements

Price Indices by CBSASlide18

Medicare FFS Spending TrendsTotal Medicare spending per capita in FL grew slower than the national rate between 2008 and 2015

Home Health spending had notable decline in FL

18

Hospice

Total

SNF

Home

Health

E&M

Inpatient

Florida

National

OutpatientSlide19

Medicare vs ESI spendingVery different patterns of geographic variation in spending per capitaLow cost Medicare states don’t necessarily have low costs in the ESI populationFlorida has

average spending on commercially insured, but very high Medicare spending

19

Commercially

Insured

Spending per capita

Medicare FFS

Spending per capitaSlide20

HCCI Transparency Initiative: Guroo20

Guroo

launched

February 2015

Number of Care Bundles: Initially – 78; Currently –

295

Geographical

Searches

National, State,

Local (

town/city/ZIP)

Updated

March 2016 to include:Additional content, Quality metrics (6 total: High Blood pressure (2), Diabetes (2), Asthma, Readmission), Body image searchSlide21

Florida Transparency InitiativeBegan taking in FL Medicaid Data July 1, 2017Pre-Rule site launch November 28, 2017

Co-branded, MSA level sitePost-Rule site

launch (4 – 6 weeks after the Rule is

finalized)

Displays HCCI’s United,

Aetna,

and Humana data at the facility

level

Onboard FL Blues and Avmed in year 1 of the contract (timing contingent upon Rule being finalized); this data will be displayed after the 2nd refresh (TBD)

With FL Blues,

Avmed

, United, Aetna, and Humana HCCI will hold ~ 90% of the commercially insured data in FL

Other payers’ data will be displayed after the 3rd refresh (TBD)21Slide22

Pre-Rule MSA Site The Pre-Rule site shows progress on the initiative Facility-level pricing cannot be displayed until the Rule is finalizedPlatform is National Guroo

Co-branded site (FL logo and content)

FL data

is the same as for National

Guroo

22Slide23

Pre-Rule MSA Site DataData from Aetna, Humana, and UnitedBased on about 758 million claims 24 month data period: 7/1/2013 – 6/30/2015

Estimates trended to and considered valid through July 1, 2017

Data will be refreshed March 2018

295 Care Bundles

23Slide24

Accessing the Pre-Rule MSA SiteYou can access the site 3 different ways:From Florida Health Finder - Access the site by clicking on the FloridaHealthPriceFinder link in the middle of the home page(http://

www.floridahealthfinder.gov/index.html)From guroo.com –

Change

your location to a Florida

cityFrom the new URL designated by Florida

https://pricing.floridahealthfinder.gov

24Slide25

Website Demo25Slide26

26

Post-Rule Site

Data from

Aetna,

Humana,

and

United

Based on

about 58.8

million

claims

24

Month Data Period: 7/1/2014 – 6/30/2016

Members must have a Florida zip code

Providers

must have evidence of a

Florida zip

code

Note: There

are no reliable indicators for whether or not a provider zip code represents a billing or servicing location.

L

ogic

is applied to estimate provider servicing zip code.

Providers

must have both member zip codes in Florida and also a provider zip code in Florida from at least one

payer.

295

Care BundlesSlide27

27

Data Scrubbing

Data

Trended

to

7/1/2018

Trend

assumption rates vary by Inpatient, Outpatient &

Physician

Claims

which cannot

accurately

estimate costs are removedExamples: Low outliers, Providers missing an NPI

number

Historical costs for the facility component of a surgery are aggregated by caseSlide28

28

Masking Rules

Code

level estimates are calculated by

provider/payer

Provider - at

least 5 “clean/scrubbed” claims per code and payer over the 24 month data

period

Code level estimates are calculated by county/state/provider (all payers)

2

Payers

2 Providers per payer for non-identifiable providers

1 Provider per payer for identifiable providers

Rollup Care Bundles

Subtotals by code (code level estimate X volume of service)Subtotals by care bundle step

Totals by care bundleSlide29

29

Care Bundle Estimates

National

National level

price estimates are sourced from

Guroo.com

County

County

is based on provider zip

code

Zip

codes which cross county lines are mapped to the county of majority

residence

Facility Providers

Providers and Provider Type of Hospital vs

ASC defined

by

AHCA

C

are

bundles with a primary step performed at a facility are reported at a facility

level

Costs

for supporting steps are calculated at either the county or state

levelSlide30

Requesting Care Bundle DetailsTo request the Care Bundle details, please send an email to: carebundledownloadfl@guroo.comIndividuals will need to sign a Request Form and acknowledge the Care Bundle LicenseThe license will be sent along with the Request FormUsage Requirements

Entity/Individual will use the Care Bundle Details document solely to further the purpose of, and in a manner consistent with, Florida’s Act Relating to Transparency in Health Care (2016 FL House Bill 1175) and the regulations that may be

promulgated

thereunder

30Slide31

Example of Care Bundle Details

A

B

A X B

Care Path IDStep IDService Code Code TypeRevenue Code

Health Service TypeService Name

Service Quantity/Day(s) of Therapy

Length of Stay

(Inpatient)

Unit Cost

Example

Total Cost

TK001

Step 1

99203

CPT

Specialist Consultation

Office Visit - New Patient - Moderate Complexity

1

$ 100

$ 100

TK001

Step 1

73560

CPT

Radiology Services - Minor X-ray

X-ray - Knee (1 or 2 Views)

1

$ 50

$ 50

TK001

Step 2

36415

CPT

Laboratory Services

Collection of Blood by Venipuncture

1

$ 5

$ 5

TK001

Step 2

85025

CPT

Laboratory Services

Complete Blood Count - CBC Test

1

$ 10

$ 10

TK001

Step 2

85610

CPT

Laboratory Services

PT Blood Test

1

$ 5

$ 5

TK001

Step 2

85730

CPT

Laboratory Services

PTT Blood Test

1

$ 10

$ 10

TK001

Step 2

86900

CPT

Laboratory Services

ABO Blood Typing Test

1

$ 5

$ 5

TK001

Step 2

86901

CPT

Laboratory Services

RH Blood Typing Test

1

$ 5

$ 5

TK001

Step 2

86850

CPT

Laboratory Services

Antibody Screening Blood Test

1

$ 15

$ 15

TK001

Step 2

00470

DRG

0120

Hospital Facility - Inpatient

Major Joint Replacement

1

4

$ 30,000

$ 30,000

TK001

Step 2

01402

CPT

Anesthesia Services

Anesthesia for Total Knee Replacement

1

$ 1,500

$ 1,500

TK001

Step 2

27447

CPT

Surgical Care

Total Knee Replacement (TKR)

1

$ 2,000

$ 2,000

TK001

Step 2

99223

CPT

Physician Evaluation

Initial Inpatient Physician Evaluation (High Complexity)

1

$ 250

$ 250

TK001

Step 2

99232

CPT

Physician Evaluation

Follow-Up Inpatient Physician Evaluation (Moderate Complexity)

3

$ 100

$ 300

TK001

Step 3

97001

CPT

Physical Therapy

Physical Therapy Evaluation

1

$ 75

$ 75

TK001

Step 3

97110

CPT

Physical Therapy

Exercises

12

$ 70

$ 840

TK001Step 397140CPT Physical TherapyMassage and Traction7  $ 50 $ 350 TK001Step 499213CPT Specialist ConsultationOffice Visit - Established Patient - Moderate Complexity2  $ 75 $ 150 TK001Step 473560CPT Radiology Services - Minor X-rayX-ray - Knee (1 or 2 Views)2  $ 50 $ 100          TOTAL $35,770 Step 1: An office visit with a specialist for a detailed evaluation and treatment of your symptoms     Step 2: Inpatient surgery to replace a diseased or damaged knee joint with manmade parts     Step 3: A guided physical therapy exercise program to reduce stiffness and improve range of motion in the knee    Step 4: Two follow up office visits after you have left the hospital                 Trade secret, Confidential and Proprietary       HCCI March 6, 2017         

31

Knee ReplacementSlide32

Questions?32