Analysis of claims data is still in its early days. Frequently, it is necessary to develop brand-new methodologies in order to access actionable information. Additionally, new uses for claims data are continually being imagined, requiring analysts in the field to be agile and innovative. Below are summaries of some of CIVHC’s recent groundbreaking feats of analytics.
Project Brief: Cost savings from medically-tailored meals for the chronically ill
High-level How: Using a list of Project Angel Heart’s clients, CIVHC analysts found them in the CO APCD and pulled their claims from before, during, and after they received meals. They also created a control group of individuals who had similar conditions and situations to the Project Angel Heart clients but did not receive medically-tailored meals.
In order to account for the varying timeframes during which clients received Project Angel Heart services, analyses were based on Per Member Per Month (PMPM) outcome and cost calculations. This methodology allowed for direct comparison between the clients in the Project Angel Heart cohort and the control group. Results of this study will be published soon and have some pretty eye-opening findings, watch civhc.org for more info.
Project Brief: CIVHC provides analytics to participating employer members of CBGH each quarter, helping them to lower health costs and improve the health of their employees.
High-level How: Participating employers submit claims data to the CO APCD and CIVHC analysts use the state of the art analytic platform PROMETHEUS to study chronic condition prevalence within the employer’s employee population. This information identifies potentially avoidable complications for each condition and allows employers negotiate and design health insurance plans that help their employees get the care they need at the lowest cost.
Project Brief: Investigating cost and utilization in Colorado provider practices
High-level How: First, CIVHC analysts pull Payer-level data from all commercial payers and conduct extensive quality checks, looking for those that are most complete. Technical Advisors assigned by the Network for Regional Healthcare Improvement helps CIVHC determine what payers will be included in the analysis, taking into consideration the need to match the data with information from other states.
Once the data set is determined, the analyst uses total cost of care measures from HealthPartners to slice and dice the CO APCD information, separating it out into different buckets such as facility fees and pharmacy costs. These results form the basis of the customized reports that participating providers receive annually; detailing how patients in their practice use health care resources and how much the care they provide costs.
If providers are interested in participating in the Total Cost of Care project, please email firstname.lastname@example.org.
Project Brief: Transforming the health care system through primary care interventions.
High-level How: Claims from primary care practices participating in the SIM project have special identifiers, allowing CIVHC analysts to gather a preliminary data set. This data set is then analyzed in order to attribute patients to the correct primary care provider. The data set is finalized into a cohort once attribution is complete; the current SIM cohort is nearly 311,000 Coloradans.
Based on nationally accepted specifications, methodologies were established using health insurance claims across Medicare, Medicaid and commercial payers in the CO APCD to create claims-based quality measures. These quality measures allow benchmarking between payers and providers across the entire state to identify opportunities to create targeted, meaningful interventions that improve population health, improve care, and lower costs for Colorado.