National Committee on Vital and Health Statistics (NCVHS)

Hearing on Claims-based Databases for Policy Development and Evaluation

—— Overview and Emerging Issues——

Meeting Transcript

 Capital Hilton Hotel
1001 16th Street, NW
Washington, DC 20006
Federal A Room

 

Friday, June 17, 2016

Hearing Purposes, Objectives

The purpose of this hearing is to highlight the current state of development, challenges, issues and opportunities faced by Claim-based Databases, including state-based All-Payer Claim Database (APCD) initiatives and private-sector multi-payer claim-based database efforts, with the following priorities:

  • Engage stakeholders on key issues related to claims-based databases
  • Identify priority areas and opportunities for recommendations to the Secretary of HHS and the industry

The objectives of this hearing are to understand:

Public Reporting and Policy Issues:

  • Current status of Claim-based Databases, including APCDs, what’s driving their development, and common challenges states/agencies must address.
  • Public benefits and concerns for consumers, policy makers, researchers and population health programs.
  • Business model benefits and concerns for providers, payers and state/federal programs.
  • Review the technical challenges to Claim-based Database (including APCD) reporting inhibiting value.
  • Role of Claim-based Databases, including APCDs in a reformed health care system: ACOs, PCMHs, MIPS, and Alternative Payment Models

Claim-based Database Standards Issues and Opportunities:

  • Review current formats in use and future opportunities to standardize reporting formats across states (X12, NCPDP, others).
  • Identify benefits, efficiencies and barriers, to the adoption of a common Claim-based Databases and APCD reporting standard.
  • Identify emerging reporting needs to support healthcare transformation and payment reform (e.g., capturing non-claims transactions, data linkage, etc.).
  • Outline a roadmap for achieving standardization and how NCVHS may engage in a supportive role.

Federal-State Issues Panel

  • Identify federal roles and opportunities to advance, improve claim-based databases and APCD developments in states.

Final Agenda

 Unless otherwise specified, each testifier will have 5 minutes to present key points
followed by public comment Committee Q & A at the end of each Session

Written testimony is requested to supplement oral testimony

 Written testimony is welcomed from any other individual or organization

Printable Acrobat Agenda

8:00 – 8:15 AM Welcome and Introductions NCVHS Chair
8:15 – 8:30 AM Opportunities and Challenges related to Claims-based Databases Walter Suarez, NCVHS Chair
Denise Love, NCVHS
PART 1: POLICY AND REPORTING ISSUES
8:30-10:10 AM Panel 1A-Value, Purpose, Structure, Public Reporting and Policy Consideration

  • State Representatives
  • Health Care Cost Institute
  • Blue Cross/Blue Shield Association
 Deb Schiel, MA CHIA
Ana English, CO CIVHC
Eric Barrette
Joel Slackman
Committee Q&A
10:10 – 10:20 AM Break
10:20 – 12:00 PM Panel 1B-Data Suppliers, Users – Policy Consideration

  • State Representatives
  • Health Plan Representatives
  • Health Care Cost Institute
  • Employer Representative
  • ACOs Representative
  

Ben Steffen, MHCC
Karynlee Harrington, ME MHDO
Bernie Inskeep, United Healthcare
Leanne Gassaway, AHIP
Eric Barrette
Kristy Thornton, Pacific Business Group on Health
Jessica Brooks, Pittsburg Business Group on Health
Sheryl Turney, Anthem, Inc.
PART 2: FEDERAL-STATE ISSUES
12:00 – 1:00 PM Panel 2-Federal Panel

  • Medicaid / State
  • Medicaid/National
  • State
 Doris Lotz, NH DHHS 
Jessica Kahn, CMS
Tyler Brannen, NH Insurance Dept.
1:00 – 1:45 PM LUNCH
1:45 – 2:35 PM Panel 2 – Federal Panel – Continued

  • ONC
  • State Representatives
Patricia Mactaggart
Deb Schiel, MA CHIA
Michael Lundberg, VA Health Information
 
Part 3: STANDARDS: BACKGROUND, EMERGING ISSUES AND CHALLENGES
2:35 – 3:30 PM Panel 3- Overview of Reporting Standards and Previous Standards Efforts

  • APCD Council
  • Health Plan Representatives
 Josephine Porter
Sheryl Turney, Anthem, Inc.
Bernie Inskeep, United Healthcare
Committee Q&A
3:30 – 3:45 PM Break
3:45 – 4:20 PM Next Steps for Claim-based Database and APCDs

  • Facilitated discussion with Committee Members and Testifiers
  • Focus on key messages on current state, challenges, opportunities
  • Cover also the role of Claims-based Databases, including APCDs in a reformed health system (ACOs, PCMHs, MIPS, Alternative Payment Models)
  • Possible areas for recommendations
    • To HHS
    • To Industry
 NCVHS Chair
4:20 – 4:25 PM Public Comment
4:25 PM Adjournment

Written only testimony

QUESTIONS FOR PANELISTS

Overall, we would like testifiers to consider the following factors that NCVHS might use in evaluating Claims-based Databases (including APCD) standards, code sets, identifiers and opportunities for standardization:

PART 1:   POLICY AND REPORTING ISSUES

  • Examples of benefits and value of Claims-based Databases, including APCDs in improving health, quality, access, lowering costs
  • Benefits to state, public health, employers, payers, hospitals and providers, consumers
  • Most significant issues in implementing Claims-based Databases and APCDs, including limited populations included; differences between fee-for-service and capitated; lack of identifiers; limitations of claims-based data; differences across states
  • How are Claims-based Databases and APCDs supported; business and sustainability model
  • What are the technical challenges to Claims-based Databases and APCD reporting that inhibits their value
  • What is the role of Claims-based Databases including APCDs in a reformed health care system: ACOs, PCMHs, MIPS, and Alternative Payment Models

PART 2:  FEDERAL-STATE ISSUES

  • Benefits, challenges, role of Claims-based Databases, including APCDs for Medicare; Status and challenges of sharing Medicare data with Claims-based Databases, including APCDs;
  • Benefits, challenges, roles, uses of Claims-based Databases, including APCDs for Medicaid Agencies; Status of sharing Medicaid data with Claims-based Databases, including APCDs
  • Legislative issues with Claims-based Databases, including APCDs, including lack of consistency across state laws, requirements, data collection standards, reporting
  • ERISA considerations regarding Claims-based Databases and APCDs; opportunities and challenges moving forward
  • SAMHSA / 42 CFR Part 2 issues and Claims-based Databases, including APCDs
  • OPM and Claims-based Database efforts

PART 3:  STANDARDS – EMERGING ISSUES AND CHALLENGES

  • Review current formats in use and future opportunities to standardize reporting formats across states (X12, NCPDP, others).
  • Identify benefits, efficiencies and barriers, to the adoption of a common Claims-based Databases/APCD reporting standard.
  • Identify emerging reporting needs to support healthcare transformation and payment reform (e.g., capturing non-claims transactions, data linkage, etc.).
  • Outline a roadmap for achieving standardization and how NCVHS may engage in a supportive role.