Minnesota All Payer Claims Database
Public Use File Meeting 1: Framework
November 5, 2015
Kris Van Amber
Senior Management Consultant
Management Analysis &
Development
Minnesota Management & Budget
Linda Green
Vice President, Programs
Freedman HealthCare
Agenda
Welcome, Introductions
15 minutes
Meeting Scope and Purpose
15 minutes
MN Public Use Files: Authority, History and Principles
20 minutes
Overview of National APCD PUF Activity
10 minutes
Principles for the March 2016 PUF
50 minutes
Public Comment
5 minutes
Next steps & Adjourn
5 minutes
2
Introductions
Around the room
Please say your name, organization and role
Briefly: What is your interest in a Public Use File based on the MN APCD?
3
MEETING SCOPE AND PURPOSE

Welcome, Introductions
15 minutes
Meeting Scope and Purpose
15 minutes
MN Public Use Files: Authority, History and Principles
20 minutes
Overview of National APCD PUF Activity
10 minutes
Principles for the March 2016 PUF
50 minutes
Public Comment
5 minutes
Next steps & Adjourn
5 minutes
4
Scope and Goals of the Meeting
Scope
• Legislature created specific parameters and timelines
• Task is to align user-desired data with those parameters
Goals of the Meeting
• To begin an iterative development process
• To obtain insight into building a framework and ground rules
for file development
5
Development Process and Role of this Group
Obtain input from diverse sources
Establish guiding principles for creation of such
files within the Legislature’s framework
Today’s
Discussion
Winter 2016: Develop proposed formats for “version 1;” discuss with this group
Going forward:
• Obtain statistical audit to confirm alignment with MN Data Practices
• March 2016: Meet Legislature’s deadline for first round of summary tables
• Summer 2016: Start planning for Version 2.0 and beyond
6
Discussion: Value of PUFs
What does the group see as the value of PUFs? Examples include:
Provide data while:
• maintaining de-identification of individual information (birth date, name address)
• protecting other sensitive data (provider name, health plan, etc.)
Offer insight on an important topic
Data democratization – freely accessible
Show results from state’s investment in data collection
What would you add?
7
MN APCD PUBLIC USE FILES: AUTHORITY,
HISTORY AND PRINCIPLES

Welcome, Introductions
15 minutes
Meeting Scope and Purpose
15 minutes
MN Public Use Files: Authority, History and Principles
20 minutes
Overview of National APCD PUF Activity
10 minutes
Principles for the March 2016 PUF
50 minutes
Public Comment
5 minutes
Next steps & Adjourn
5 minutes
8
Data Source for MN APCD PUF
Analytic database includes data for 2009 through 2015
• 4.2 million records of Minnesota covered lives
• 70 million medical claims
• 60 million prescription drug claims
Information about diagnoses, procedures, duration of treatment, as well as
de-identified demographic information (age, gender, geography) and highlevel health plan product information
Direct identifiers are encrypted using a standardized, one-way process that
does not allow re-identification
Database includes payer, provider and payment information
9
Data Uses to Date
Chronic Pain Procedures: January 2015
Potentially Preventable Health Care Events: July 2015
Forthcoming Studies
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•
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MN Atlas of Chronic Diseases
Pediatric Health Care Use
Use of Low-value Health Care Services
Spending for Prescription Drugs in MN: Use in Retail and Medical Settings
Other uses in statute:
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•
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Health Care Homes
Readmissions
Variations by Geography
State Innovation Model Testing
Assessment of Data for Risk Adjustment
Assessing Projected/Actual costs associated with chronic disease, risk factors
10
History of the APCD Advisory Group
Legislatively directed to consider uses of the APCD
Seven meetings in 2014 to weigh in on future directions for the MN APCD
• Diverse stakeholders
• Created a shared understanding of MN APCD structure and process
• Final report: January 2015
Areas of general agreement
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•
•
•
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Start with access to Public Use files and summary tables
Transition to more ‘high stakes’ uses
Follow MN Data Practices law on de-identification
Minimize data request process
Minimize any data access fees
Divergent opinions
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•
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Identifying payers and providers
Reporting paid amount
Utility of highly de-identified data
Path forward
11
Legislature’s Response to the 2015 Report
Established parameters for data file development
MDH to compile one or more public use files of summary data or tables that
must:
(i)
(ii)
(iii)
(iv)
(v)
be available to the public for no or minimal cost by March 1, 2016, and available by
Web-based electronic data download by June 30, 2019;
not identify individual patients, payers, or providers;
be updated by the commissioner, at least annually, with the most current data
available;
contain clear and conspicuous explanations of the characteristics of the data, such
as the dates of the data contained in the files, the absence of costs of care for
uninsured patients or nonresidents, and other disclaimers that provide appropriate
context; and
not lead to the collection of additional data elements beyond what is authorized
under this section as of June 30, 2015.
12
Principles for the PUF Development Process
Develop useful files for meaningful analysis
Engage users at all stages
Seek out and incorporate user feedback
Build an iterative process for further development
Anything else?
13
OVERVIEW OF NATIONAL PUF ACTIVITY

Welcome, Introductions
15 minutes
Meeting Scope and Purpose
15 minutes
MN Public Use Files: Authority, History and Principles
20 minutes
Overview of National APCD PUF Activity
10 minutes
Principles for the March 2016 PUF
50 minutes
Public Comment
5 minutes
Next steps & Adjourn
5 minutes
14
Nationally, what is an APCD public use file?
Aggregate/summary tables
• Tables, files or reports containing aggregated data, rather than claim-level data sets
• May be aggregated at the demographic, procedural, diagnostic, and/or geographic
levels
• May allow for some user manipulation the data and aggregate fields to a higher level
• Do not require a formal application process or fee to access them
Claims-level, de-identified data sets
• Most state APCD PUFs are available by request as claims-level files.
• De-identified according to the HIPAA Privacy Rule and Safe Harbor guidelines
• May contain limited or no provider information
• Examples of excluded provider or payer information may include provider NPI, provider names,
and payer names. Certain other fields may also be aggregated or masked in some way.
• States often require a formal application process
• May require a Data Use Agreement
• Usually have an associated fee though less than the fee for limited, restricted or
identifiable data sets.
15
Overview of APCD Public Use Files
NM
CT
NY
Summary
Files
WA*
WV
Detailed
Files
RI
AR
CO
MN
UT
ME
MA
NH
APCD
Law/
Authority Collecting
Data
Using
Data in
State
Reports
MD
KS
OR
VT
*State mandated effort not yet started; current voluntary system does not collect payment information.
16
APCD Public Use Files: Utah
Payers included:
Commercial, TPA
Years of data:
2010-2012
Number of covered lives: TBD
Yes
Charges a fee:
Random sample
Use cases based on experience with the hospital discharge data; outreach to
user community regarding needs and price sensitivity
Types of files:
• Claims-centric: cannot be linked to an individual patient; supports research on service
seasonality
• Patient-centric: provides patient identifier
Year of service and an integer indicating the order of services; no date of
service
Requires a data use agreement
17
APCD Public Use Files and Tables: Rhode Island
Payers included:
Years of data available:
Number of covered lives:
Charges a fee:
Commercial, TPA, Medicaid
2011-2014
900,000
Yes for file; no for summary data on website
Files will be available in 2016
Payer and provider information will not be broadly available
Requires a data use agreement
Medicare data will be included in summary tables and not in data extracts
Formal launch in late 2015 will include publicly-available summary data tables
and maps
18
Public Use Summary Tables: Colorado
Payers included:
Years of Data:
Number of covered lives:
Charges a fee:
Commercial, Medicaid (Medicare in progress)
2010-2012
3.5 million
Not for website data
Sources: https://www.comedprice.org/GetFile.ashx?FileType=StaticReports&FileName=APCD_Static_Report_TotalImagingServices.pdf;
https://www.comedprice.org/#/map
19
CMS Public Use Files
Basic Stand Alone Medicare Claims Public Use Files
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Claims level information based on a sample of 5% of Medicare FFS beneficiaries
One file per type of service: Inpatient, Outpatient, DME, etc.
Each file’s sample is independently created (without replacement)
Some data suppressed or coarsened to preserve confidentiality
Download from CMS Website with a disclaimer; no DUA required; no fee
Use Cases:
• Snapshot of care in specific year (no trend)
• Analysis of claim selected for each file (no cross file linkages)
CMS Public Use File -- Medicare Geographic Variation File
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•
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•
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Aggregated data (no claim line or person level detail)
No permissions or data use agreement needed
State, County, patient demographics conditions, cost incidence
Medicare FFS only
Potential Uses: Population health trend reports on cost, utilization for condition types and
types of service.
Note: CMS provides fully identifiable files to the MN APCD for use in analysis and reporting,
with restrictions on the level of detail that can appear in the outputs.
20
Summary of National Activity
PUFs are still evolving and picking up steam
Driving to initial reporting needs
At the intersection of HIPAA and FTC Safe Harbor
CMS
• Expanding its own summary data tables and reporting from Medicare data
• Allows states to analyze identifiable Medicare data to include in the state’s reports and
analysis
• Continuing discussion about expanding the states’ use of Medicare data to support
health care reform projects
21
DISCUSSION:
PRINCIPLES FOR MARCH 2016 PUFS

Welcome, Introductions
15 minutes
Meeting Scope and Purpose
15 minutes
MN Public Use Files: Authority, History and Principles
20 minutes
Overview of National APCD PUF Activity
10 minutes
Discussion: Principles for the March 2016 PUF
50 minutes
Public Comment
5 minutes
Next steps & Adjourn
5 minutes
22
Discussion Topics
Guard Rails and Principles: Are these the right components?
Iterative process: What are the important considerations?
Summary tables: Are there other ways to achieve the legislative goals?
User input and feedback: Who should we consult about using this data?
How should their feedback be incorporated on an ongoing basis?
What should be included in explanatory data?
23
Guardrails and Principles for MN PUFs
Legislative Direction:
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•
•
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Summary data must be made available to the public
Data about patients, providers and payers requires continuing protection
Data must be available by March 1, 2016
Files should be available at no (or minimal cost) to the user
Starting Point for Developing MN APCD PUFs
• Summary data only
• Use Medicare as the minimum granularity for aggregated data
Do the following represent the sense of the group on the principles to be followed
when developing MN APCD PUFs?
• Data should be meaningful and provide insight into health care use, disease burden and
spending
• Data in the summary tables should be as rich and detailed as possible, while protecting
sensitive information
• Data use request process should be streamlined
24
Iterative Process
The 2014 Advisory Group recommended an iterative process.
The Legislature also envisioned an iterative process, with data tables evolving
between 2016 and 2019.
Characteristics of the first PUF iteration:
• Not claims level
• Meets Medicare cell size suppression rules
• data must be based upon 11 or more unique beneficiaries
• Zip code aggregation
• Ages of over 80 grouped into a single age band
• Not identify patients, payers, or providers
March 2016 PUF is first step; number and type of PUFs or summary tables will
grow based on user experiences, resources, and needs.
What is the group’s advice about the:
• Timeline for further iterations?
• Highest priority items to include in the first PUF?
• Criteria for deciding what to add?
25
User Input and Feedback?
Development of PUFs needs to be guided by the needs of users.
Potential users:
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•
•
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Academics and students
Public and private sector health system analysts
Provider systems
Payer systems
Outside of the group, we are soliciting feedback from:
• Health care economists
• Medical researchers
• Health systems analysts
Who else should be consulted in the development process? Is this the same
to consult when the files become available?
26
Summary Data vs. Specific Topics
The Legislature has requested analysis on important topics such as chronic pain,
costs of chronic disease, and pediatric health care.
MDH is also conducting a series of studies internally, with research partners or
with contractors.
Selected output from these studies could be made available as summary tables
such as:
• Rates of treated chronic disease by county or region
• Costs associated with chronic disease treatment by county or region
• Utilization of services by selected populations by county or region
Summary tables have limitations
• No claims lines or person level detail, so no outcomes research
• Limited geographic information
• Values are sums, frequencies or rates
What are the strengths and weaknesses of generic summary data compared to
publicly accessible tables that address a particular health topic?
27
Explanatory Materials
The Legislature directed that the public use files should be accompanied by
appropriate supporting documentation.
MDH currently provides the following materials for other data sets:
• Data dictionaries
• Meta-data
• Summary analysis from its ongoing policy research
Other state APCDs provide data dictionaries describing the particular data
elements.
CMS provides documentation including:
• Geographic File: Methodological Overview; Standardization Methodology for Allowed
Amounts
• Basic Stand Alone Files: Data dictionary, codebook, users guide with metadata
What kinds of explanatory materials should be available to users?
28
PUBLIC COMMENT

Welcome, Introductions
15 minutes
Meeting Scope and Purpose
15 minutes
MN Public Use Files: Authority, History and Principles
20 minutes
Overview of National APCD PUF Activity
10 minutes
Discussion: Principles for the March 2016 PUF
50 minutes
Public Comment
5 minutes
Next steps & Adjourn
5 minutes
29
NEXT STEPS AND ADJOURN

Welcome, Introductions
15 minutes
Meeting Scope and Purpose
15 minutes
MN Public Use Files: Authority, History and Principles
20 minutes
Overview of National APCD PUF Activity
10 minutes
Discussion: Principles for the March 2016 PUF
50 minutes
Public Comment
5 minutes
Next steps & Adjourn
5 minutes
30