Utah Health Project To Analyze Costs, Quality

In an effort to better understand healthcare costs and quality, the Utah Department of Health has a program underway to collect and analyze claims data from all public and private payers in the state who cover more than 200 patients.

The All Payers Database project was launched late last year and so far contains data from about 150 million medical, pharmacy and lab claims pertaining to about 2.6 million uniquely identified people so far. The APD, which is based on Microsoft SQL Server, is expected to grow by 65 million claims annually.

Among other key technologies, part of the project is identity resolution technology provided by Informatica, which enables the DOH to track individual patients and the episodes of care they receive even if a patient is covered by multiple insurers or changes healthcare coverage.

The identity resolution platform, along with the analytic tools being used in the project, allows the state to collect and analyze the cost for episodes of care, such as all the services related to a pregnant patient, regardless of whether the individual’s ultrasound is covered under one health plan, but the delivery of her baby was covered by another payer.

The Informatica identity resolution platform eliminates duplicated data, and can match, link and group data by patient or episode.

For instance, when a patient changes health plans, the individual would like get a new ID number from than insurer, not the same ID number used by the previous insurer to identify that same patient.

However, when claims data for that patient is received by the DOH, the Informatica identification resolution system reconciles the identity of that patient so that appropriate claims data is linked to the individual even if the claims data is coming from multiple or new sources using different ID numbers for the patient, said Ivan Chong, Informatica executive VP of data quality.

Informatica also provides security and encryption technology to protect identifiable data, which the DOH keeps in a "locked server box," said Dr. Keely Cofrin Allen, director, Office of Healthcare Statistics, Utah Department of Health. The identifiable data is later de-identified and moved into a second SQL Server data warehouse for analysis and trend reporting, she said.

Among tools being used by Utah's DOH for data analysis are statistical software from SAS; clinical risk grouping software from 3M; and RP Navigator from CareAdvantage. So far, the APD contains data for 2.6 million uniquely identified people, she said. Utah has a population of 6.27 million people and it's expected that the APD will eventually contain data for 70% of the state’s population.

The 30% not represented in the APD include Medicare patients and individuals who don’t have healthcare coverage when they receive medical services. However, Allen said the state is hoping to develop a plan to capture data related to the cost of services provided by hospitals and others to the uninsured.

Four commercial payers are in "full production" providing data to the APD and six more are expected to be in production soon, she said. Among those payers providing data currently is the state's employee health plan and SelectHealth, the health plan of Intermountain Healthcare.

Among the DOH's goals is to identify areas in the state that have "pockets" of populations that aren’t receiving preventative care and screenings, such as mammograms and colonoscopies, as well as to analyze cost trends for care in various regions of the state, she said. APD data will also be used for quality of care analysis.

Healthcare cost and quality data will be available to Utah consumers, she said.

"Healthcare is one industry where poor care costs more," she said. "By making costs transparent, Utah consumers can go online to see how much care costs." That information could include the cost of particular healthcare treatments, including breakdowns on costs picked up by payers versus patients’ out-of-pocket cost.

Consumers will be able to see how much a particular healthcare service costs based on where they live in the states.

The state can also analyze APD data for trends such as how often patients go to see doctors for particular conditions, whether the availability of preventative care services can help reduce the consumption of more expensive treatments related to complications, and other correlations.

Also, the state's Medicaid program will analyze what the state is paying to provide services to patients versus what that same care costs patients covered under private health insurance.

"The healthcare reform aspect is the impetus behind this," she said.

"You can’t change what you don't measure,” she said. If you don’t know what you're paying for or where the money is going, you can’t control costs," she said.