The Vermont Healthcare Claims Uniform
Reporting & Evaluation System
VHCURES
Putting the APCD to Work: To Date and Future
All-Payer Claims Database Workshop
Salt Lake City, Utah
October 14, 2010
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What’s included in VHCURES?
Eligibility and Medical and Pharmacy Claims:
Comprehensive Major Medical including TPAs and PBMs
Medicare Part A
(Medicaid data integration is under way)
Current consolidation spans incurred period Jan 2007- December 2009
and paid claims run-out through March 2010
340,000 members or 90% commercial market for VT residents.
Eligibility and Pharmacy Claims:
Medicare Part D
Eligibility only:
Medicare Supplement
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Vermont APCD Mandate for Use
Overarching Framework (1992): 18 V.S.A. § 9410. Health care database
The commissioner shall establish and maintain a unified health care data base to:
• Determining the capacity and distribution of existing resources.
• Identifying health care needs and informing health care policy.
• Evaluating the effectiveness of intervention programs on improving patient
outcomes.
• Comparing costs between various treatment settings and approaches.
• Providing information to consumers and purchasers of health care.
• Improving the quality and affordability of patient health care and health care
coverage.
VHCURES Claims Data Mandate (2007) within Overarching Framework:
“To the extent allowed by HIPAA, the data shall be available as a resource for
insurers, employers, providers, purchasers of health care, and state agencies to
continuously review health care utilization, expenditures, and performance in
Vermont.”
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Vermont Prohibitions on APCD Use
Statute: 18 V.S.A. § 9410. Health care database
Notwithstanding HIPAA or any other provision of law, the comprehensive
health care information system shall not publicly disclose any data
that contains direct personal identifiers.
Rule: H-2008-01, Section 8
No person shall disclose the identity of patients, employer groups or
purchaser groups from information contained in the limited use data
set.
The publication, dissemination or disclosure of any information that could
be used to identify providers of abortion services shall be prohibited.
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Vermont APCD Use To Date (Slide 1 of 3)
Go to:
http://www.bishca.state.vt.us/health-care/health-insurers/vermonthealthcare-claims-uniform-reporting-and-evaluation-system-vhcure
1. Standard Report Series on Commercial Population Under 65:
Aggregate and by Major Insurer, Hospital Service Area Basis
• Vermont Healthcare Expenditure & Utilization Report
Based on CMS NHEA model for categorization of spending and
utilization
• Vermont Healthcare Utilization Profile Report
Aggregate and by Major Insurer, Hospital Service Area Basis
Enrollment detail; adjusted pmpm; counts and rates for conditions, types
of service and procedures
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Vermont APCD Use To Date (Slide 2 of 3)
2. Tri-state Regional Comparison of Age-adjusted Commercial
Utilization
Legislative mandate to report on variation in utilization and expenditures
Comparative utilization rates on hospital/health service area basis for VT,
NH, and ME by types of service and specified procedures
3. Blueprint for Health Medical Home Evaluation
Participating insurers are flagging members enrolled in medical home
primary care practices
Used initial standard report series (see 1.) for Blueprint members to
evaluate expenditures and utilization at baseline for implementation
and moving forward.
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Tri-State Utilization
Potentially Avoidable Outpatient ED Visits
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Vermont APCD Use To Date (Slide 3 of 3)
4. Approved Uses for Limited Use Healthcare Claims Data Sets
Accountable Care Organization Modeling
Legislative Study of Health Care Reform Options for Vermont
Catamount Health Study (State subsidized premium assistance for
coverage through participating insurers)
5. Administrative Support for Other State Programs
Paid Claims Report as basis for HIT Reinvestment Surcharge on Insurers
(Office of Health Care Reform)
Immunization Pilot (Dept of Health)
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Vermont APCD Future Direction (1 of 2)
1. Enhancement of Standard Report Series
Separate categorization of psychotropic prescription drug expenditures
and services
Enhanced Vermont Report Card with risk and episode grouping; counts
and rates for more procedures, HEDIS measures
2. Blueprint Medical Home Evaluation
Matched cohort study to compare Blueprint members and non-Blueprint
members
Blueprint expansion to more insurers and service areas
3. Health Insurance Rate Review
Develop model and methods for using APCD to measure trends in claims
experience by insurer and product types
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Vermont APCD Future Direction (2 of 2)
3. Develop In-house Reporting
Decrease dependence on outsourcing and increase flexibility for
supporting ad hoc queries supporting department programs and policy
discussions
4. Develop Agreements and Partnerships for Inter-agency and Interorganization Data Sharing and Research
Health Informatics Platform at Center for Clinical Translational Studies at
University of Vermont
Agency of Human Services: Dept VT Health Access, Dept Health, Dept
Mental Health
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Thank you for providing me this opportunity to share our experience
and plans for VHCURES. I look forward to collaboration with
other states and government entities, research organizations,
providers, purchasers, and the insurers providing the data to
improve the collection and use of this data resource as we all work
to improve health care.
Dian Kahn
Director of Analysis and Data Management
VHCURES Program Director
VT Dept. of Banking, Insurance, Securities and Health Care
Administration
[email protected]
(802) 828-2906
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