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Virginia Health-Care Claim Data Expected to Reveal Treatment Effectiveness

Tuesday, November 10, 2015  
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As reported on, the idea behind collecting huge piles of data is that, if you can sort it the right way, you’ll learn something. Now that option is available to anyone with a stake in Virginia’s health-care sector, from providers to employers to consumers.

Working with the Virginia Department of Health, the nonprofit group Virginia Health Information has prepared the state’s first All-Payer Claims Database (APCD). It represents “hundreds of millions of paid claims” from 2011 to mid-2015, says Michael Lundberg, VHI’s executive director.

There are lots of possible uses of the data, Lundberg says. Self-insured businesses can study the outcome of the health care their employees are getting and figure out what works and what doesn’t work. Accountable care organizations — which can be groups of doctors, hospitals or other health-care providers — can measure the health outcomes for the population they are treating.

Health departments at the regional and state level can evaluate the needs of specific population groups, and insurers can evaluate the effectiveness of treatments and the costs. Consumers might get less direct benefits from the database, but they presumably will benefit when providers and insurers find some new efficiencies in how health care is delivered and priced.

“The variety of different ways that somebody could use it is pretty much endless,” says Doug Gray, executive director of the Virginia Association of Health Plans (VAHP), which helped fund the data project launch. “For any health-care question that deals with the volume of services, this database can help us.”

For example, the data can show how many prescriptions are being filled for a particular drug. “I’ll be interested in looking at a report on how many name-brand drugs are being prescribed versus generic,” Gray says. “So, we can figure out whether advertising campaigns are influencing those drug purchases.”

The data also can be used to measure whether providers are succeeding in their treatment of a certain population. “This is the kind of thing Medicare is after, to incentivize hospitals and nursing homes to make sure that people don’t end up right back” in the hospital after being discharged, Gray says.

There are, however, limits to the data. The information won’t, for example, include the actual costs of services agreed to by providers and insurers. So it won’t allow direct price comparisons, the kind that might create a competitive advantage.

The first batch of data became available in May, and the cost for accessing it varies depending on the user, Lundberg says. Marketing of the data is just beginning. VHI is using a marketing plan based on work by students at Virginia Commonwealth University’s School of Business. Subscribers will get training from VHI on how to access the data and regular suggestions “on how they can effectively use this,” Lundberg says.

Virginia’s APCD effort was launched in 2012 with legislation from the General Assembly. The state’s Health Department contracted with VHI to implement the project. The initial $3.2 million cost for the project’s launch was shared by the Virginia Hospital and Healthcare Association, VHI and the VAHP.

Christopher Bailey, VHHA executive vice president, says the impact of big data is still in the early stages, as providers and insurers navigate what the data means for them, and state and local-level health agencies learn more about the populations they serve.

Another piece of the puzzle is the growing use of electronic medical records (EMR). If providers use EMR technology, the results of treatment decisions can be accessed even more quickly. That will likely raise even more questions. “What this data does is just give you insight into variations and identifies opportunities” to cut costs or improve care, or both, Bailey says.

Bailey says all the major health systems in the commonwealth eventually will be subscribing to VHI’s service. “It just takes time.”

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