Transcript 2 Why hospital claims data? - Camden Coalition of Healthcare

Hotspotting with
Claims Data
Camden Coalition of Healthcare Providers
Agenda
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Hotspotting: the Coalition’s data strategy
Why claims data?
Camden findings
Hotspotting in action
How a hospital visit becomes a claim
Variables in the data
Planning for hotspotting
Camden Coalition of Healthcare Providers
§1 Hotspotting:
the Camden
Coalition’s
data strategy
Camden Coalition of Healthcare Providers
The mission of CCHP is to improve the health of
all Camden residents by increasing the capacity,
quality, and accessibility of the city’s healthcare
delivery system.
A core value of CCHP is to be data-driven
Where’s the data in the mission?
Camden Coalition of Healthcare Providers
Providers
Government
Switzerland
Residents /
Community
Camden Coalition of Healthcare Providers
Social Services
“Building a Citywide, All-Payer, Hospital Claims
Database to Improve Health Care Delivery in a
Low-Income, Urban Community”
Kennen Gross PhD, MPH, Jeffrey C. Brenner, MD, Aaron Truchil, MS, Ernest M. Post,
MD, and Amy Henderson Riley, MA CHES
Camden Coalition of Healthcare Providers
a data driven process for the timely identification
of extreme patterns in a defined region of the
healthcare system
used to guide targeted intervention and follow up
to better address patient needs, reshape
ineffective utilization, and reduce cost.
Camden Coalition of Healthcare Providers
§2 Why
hospital claims
data?
Camden Coalition of Healthcare Providers
US healthcare spending is equivalent to the world’s
fifth-largest economy, the GDP of France.
7%
34%
($882 billion)
10%
Rx
20%
Other (e.g.
Home health,
Nursing,
D.M.E.)
Hospitals
Professional
Services
Camden Coalition of Healthcare Providers
29%
$2.63 Trillion
National Health Expenditures
(CMS Estimates)
continuous
high-stakes
Camden Coalition of Healthcare Providers
Claims
≈ behavioral
Integrated
Data
Warehouse
Claims
Health Data
Camden Coalition of Healthcare Providers
the observed world
Social Service Data
Public Data
Other Data
?
Housing
School
Census
Justice
Child Services
Property
Health Plan
EMR
Claims
Health Data
Camden Coalition of Healthcare Providers
Integrated
Data
Warehouse
the observed world
§3 Camden Analysis
Camden Coalition of Healthcare Providers
Camden Hospital Utilization
2011 Snapshot
• Total hospital revenue: $108,000,000
• Total patients with a hospital visit: 43,710
• Patients visiting multiple hospitals in a year: 41%
Camden Coalition of Healthcare Providers
the Camden Cost Curve
of accounted
patients
=
10%10%
of patients
for 74%
of receipts
74%
of receipts
1% of patients = 30%
of receipts
Camden Coalition of Healthcare Providers
Several buildings
(e.g.) annually generate $1$3 million in hospital costs.
6% of city blocks account for
18% of patients and 37% of
receipts.
Spatial Analysis of Camden
Hospital Costs
January 2002 – June 2008
Camden Coalition of Healthcare Providers
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Who are Camden’s High Inpatient Utilizers?
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Avg.
>5 chronic conditions
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~1% of population
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Camden Coalition of Healthcare Providers
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• Respiratory Abnormality
• Chest Pain
• Abdominal Pain
• Septicemia
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Top Diagnoses
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2011 AVERAGES:
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4.5 ED, 5.3 INP U
54 days in hospital
$673k charges
$73,143 receipts
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Copyright: ©2012 Esri, DeLorme, NAVTEQ
• Acute Renal Failure
• Urinary Tract Infection
• Pneumonia
• Chronic Systolic Heart Failure
Why We Don’t Predict:
• Present: known but misunderstood. Future: changing.
• Wrong time horizon for savings & quality improvement
• Existing models don’t work well
• More resources to reach fewer patients
Camden Coalition of Healthcare Providers
§4 Hotspotting
in Action
Camden Coalition of Healthcare Providers
Health Information Exchange
Camden Coalition of Healthcare Providers
• 2+ hospitalizations in 6 months
• 2 or more chronic conditions
• 5+ outpatient medications
• Indicators of social instability
Camden Coalition of Healthcare Providers
§3 How
a hospital
visit becomes a
claim
Camden Coalition of Healthcare Providers
Institutional
Camden Coalition of Healthcare Providers
Physician
As clinicians interact with the patient throughout the
hospitalization, the patients conditions are documented &
then entered into Electronic Medical Records.
Camden Coalition of Healthcare Providers
Camden Coalition of Healthcare Providers
Camden Coalition of Healthcare Providers
§4 Variables
in claims
data
Camden Coalition of Healthcare Providers
Demographics
Patient Name
MRN
Visit ID
DOB
Address
City
Zip
Race
Ethnicity
Language
Visit
Facility
Admit Date
Admit Time
Admit Source
Discharge Date
Discharge Time
Disch. Disposition
Disch. Description
Diagnosis
D
X
Primary Diagnosis
Secondary Diagnoses
Procedural Codes
DRG Code
Note: different hospitals may have different names for the variables
Camden Coalition of Healthcare Providers
Financial
Visit Type
Total Charges
Total Payments
Ins. Payments
Patient Payments
Financial Class
Insurance 1
Insurance 1 Class
Insurance 2
Insurance 2 Class
Using patient identifiers
Patient Name
Medical Record Number
Visit ID
DOB
Address
City
Zip
Race
Ethnicity
Language
Name
Many nuances changes, misspellings, twins
Address
Quality varies considerably across institutions and
geographies
Demographics
a
Camden Coalition of Healthcare Providers
Using facility data
Facility
Admit Date
Admit Time
Admit Source
Discharge Date
Discharge Time
Discharge Disposition
time
quality varies considerably
across institutions
source / disposition
effort to untangle across hospitals
Visit
Camden Coalition of Healthcare Providers
D
X
Primary Diagnosis
Secondary Diagnoses
Procedural Codes
DRG Code
Using diagnosis code
primary
high degree of accuracy (~96-100%)
secondary
window into comorbidities tends to have more error
accuracy varies by diagnosis & events
Diagnosis
Camden Coalition of Healthcare Providers
Using Charges v. Receipts
Visit Type
Total Charges
Total Payments
Ins. Payments
Patient Payments
Financial Class
Insurance 1
Insurance 1 Class
Insurance 2
Insurance 2 Class
charges
exaggerate costs
more uniform across payers
includes charity care
receipts
reflect what hospital received
don’t include cost of charity care
Financial
Camden Coalition of Healthcare Providers
D
Camden Coalition of Healthcare Providers
D
§5 preparing
to hotspot
Camden Coalition of Healthcare Providers
Where?
Camden Coalition of Healthcare Providers
PHILADELPHIA
CAMDEN
CITY
CAMDEN COUNTY
Where?
Camden Coalition of Healthcare Providers
§ 1 of 4: What is Healthcare
Camden County vs
City
$62,320
49.9%
45.4%
38.6%
19.4%
12.1%
15.3%
Median
Below
Houshold
FederalIncome
Poverty
BlackHispanic
Level
Where?
Camden Coalition of Healthcare Providers
Who is on your
hotspotting team?
Who are your
clinical champions?
Who are your
administrative champions?
Camden Coalition of Healthcare Providers
Who?
Camden Coalition of Healthcare Providers
How?
How?
Camden Coalition of Healthcare Providers
How?
Camden Coalition of Healthcare Providers
HealthcareHotspotting.com
Camden Coalition of Healthcare Providers
Getting Data
Camden Coalition of Healthcare Providers
Constructing your database
Camden Coalition of Healthcare Providers
Patient and Address-Level Analysis
Camden Coalition of Healthcare Providers