Commonwealth Conversations: Public Health

Mass Health Care has moved!

Hello everyone: please note that our blog category "Mass Health Care" has moved to new space within the Executive Office of Health and Human Services. Please visit and bookmark us at  http://hhs.blog.state.ma.us/blog/health-care/.

APCD Community Engagement

DHCFP is hosting a series of public forums on May 2nd, May 13th, and May 20th regarding the all-payer claims database (APCD) to engage in candid discussions and seek specific feedback that will help us refine our work and develop additional policies.  I encourage you to register today.

While we hope each of you will join our discussion, we also invite you to send us your comments and questions about the APCD in advance of our forums to help us structure the discussion.  We want to make sure that these conversations are as useful and meaningful to you as they are to us.  Please feel free to email your questions and comments to Young Joo (young.joo@state.ma.us) or simply leave a comment in our blog.

Please note that our blog has moved to a new space within the Executive Office of Health and Human Services. To read this post in its entirety, please visit and bookmark the Health Care section of the Commonwealth Conversations: Health and Human Services blog.

Moving Forward with Relative Prices

 

Last week, DHCFP began collection of total medical expenses data.  This week, we prepare for our second major data collection effort under Chapter 288: relative prices.    

Relative price can be a deceptively complex measure.  Relative prices compare how much a carrier would pay each provider for a standard mix of services across a standard mix of insurance products relative to other, similar providers in a carrier’s network.  However, because these are relative prices, they are expressed as ratios within each carrier’s network.  DHCFP finalized its relative price regulation this past Friday, after months of collaboration and discussion with carriers and other stakeholders.  In June, DHCFP will be collecting relative price data for nine distinct provider groups, including hospitals, physician groups, community health centers, and skilled nursing facilities, among others.

In order to ensure the smooth processing of relative price data, DHCFP will be hosting a technical workshop at 1 p.m. on Thursday, April 7.  During the workshop, DHCFP will review the data specifications for the relative price submission and address any outstanding carrier questions and concerns.  Input from this session will allow us to better refine our data specifications and ensure that the highest quality data is received in June.

We would like to thank carriers for their continued assistance and partnership with respect to total medical expenses and relative prices.  Both of these measures will provide valuable information regarding health care costs and variation in provider payment levels in the Commonwealth and are important tools for transparency.

 

 

Collection of Total Medical Expenses Starts Today

 


This week, the Division prepared for an important event – the first filing of total medical expense data as required by Chapter 288.  Of all the new data our agency is collecting, total medical expenses (TME) may be the most interesting with respect to tracking medical spending and the Commonwealth’s cost containment efforts. 

What is TME?  Roughly speaking, TME represents the total cost of care to health plans for the patient population they cover.  This number includes not only payments for medical claims, but also payments such as pay-for-performance and provider care management.  TME may help to identify providers who are especially good at managing care, as well as geographic areas with unusually high or low spending on health care.  TME may also help indicate which medical services are contributing the most to health care costs; and reveal whether managed care patients have higher or lower overall costs than non-managed patients.  Over time, TME data will allow the Commonwealth to track the success of cost containment efforts and growth rate in medical spending by provider group, geographic region, and statewide.

Since last fall, DHCFP has been working with payers and other stakeholders to develop regulations related to the calculation of TME and to ensure the smooth reporting of this data.  We convened a technical advisory group, elicited feedback regarding our proposed methodology in a consultative session, and received testimony during the public hearing process.  All of this input was invaluable in developing and refining our methodology and data specifications.  We would like to thank payers for their assistance as we become the first state in the nation to collect this data. 

Similarly, we would like to thank payers for their collaboration in developing regulations for relative prices, which will be yet another tool contributing to health care cost transparency.  We anticipate finalizing these regulations shortly.

We look forward to receiving our inaugural TME filings today and sharing our analysis with the public in the months to come.

Upcoming APCD Forums

 

Back in April 2010, when DHCFP first proposed regulations to create an all-payer claims database (ACPD), certain aspects of the proposal were intentionally left broad in order to allow for further future refinement.  This coming May, DHCFP will receive health care claims data filings for 2008, 2009, and part of 2010.  As we approach this milestone, DHCFP recognizes the need for community discussion relating to APCD data uses, data governance, and data release.

We would like to convene a wide audience with which to engage in candid discussion and garner feedback that will inform our policy development in this area.  As such, we will host a series of three forums on May 2, May 13, and May 20 – all from 2:00 p.m. to 4:00 p.m.  You are invited to attend any and all of these events, but registration is required. Please RSVP online by Monday, April 25, 2011.

As you know, the availability of the APCD will afford a deeper understanding of the Massachusetts health care delivery system by providing access to timely and accurate data essential to improving quality, reducing costs, and promoting transparency.  We look forward to your thoughts on how to maximize the utility of this powerful resource.

An Update on the Financial Performance of Massachusetts Hospitals

 

Earlier today, we released our quarterly report on the financial performance of Massachusetts hospitals.  This edition includes the first three quarters of fiscal year 2010. 

Overall, hospitals did well.  More than three-fourths of the Commonwealth’s sixty-five acute hospitals earned a profit during the period, and the number of hospitals with non-operating losses (17%) fell by half from fiscal year 2009 (34%).  The median total margin – the amount of surplus relative to a hospital’s revenue – rose to 2.5%.

As the primary hospital monitoring agency in the state, DHCFP collects annual and quarterly data that allow us to monitor the financial health of Massachusetts’ hospitals.  Hospitals are an integral part of our health care system, an engine of economic growth in this state, and often a significant employer in the community.  Therefore, it is critical that we understand how each hospital is performing. 

Because Massachusetts hospitals are so different – from large teaching hospitals to small critical-access hospitals – we review how peer groups of teaching hospitals, community hospitals, and disproportionate share hospitals, serving predominately low-income government-sponsored populations, perform relative to each other.  For instance, the agency conducts geographic analyses to identify regional differences in profitability.

In addition to the quarterly reports, we produce individual hospital fact sheets that allow for a much finer analysis of the data.  These fact sheets include several years of financial information and other indicators not found in the reports.

To view the reports and the fact sheets, visit our website at www.mass.gov/dhcfp.

 

APCD: An Example of Engagement and Transparency

The all-payer claims database (APCD) is a good example of our commitment to transparency and engagement. At our May 2010 public hearing to discuss the draft APCD regulations for both the collection and release of health care claims data, we heard testimony from dozens of stakeholders.  Our promulgated regulations, adopted the following July, addressed virtually every issue raised during the hearings and included numerous changes proposed by stakeholders.

In preparation for the original January 31st start of the claims reporting period, DHCFP convened a daily Technical Assistance Group (TAG) conference call to support payers with data submission issues.  I invite you to visit our website to read highlights from each daily call.  Also on our website, you will find a wide array of resources related to APCDs in Massachusetts and other states.

As a result of the lessons gleaned from these open and ongoing discussions, DHCFP extended the reporting deadline for submission of data for November 2010, December 2010, and January 2011.  On February 28th, we received more than 2,260 files from almost 90 registered payers, and we continue to hold daily TAG calls to address technical issues that emerge.

By May of this year, when payers will submit claims data for 2008, 2009, and the remainder of 2010, we expect to receive thousands of additional files.

In preparation and anticipation of this significant milestone, we recognize that certain aspects of the APCD merit further discussion.  Starting in April, DHCFP will host a series of forums to explore issues relating to data governance, data release, and collaboration on data uses.

Ultimately, the purpose of these forums is to make sure we engage a wide audience (comprised, hopefully, of payers, providers, employers, researchers, consumers, and government entities) to facilitate candid discussion and garner feedback that will inform our work moving forward.  You are invited – and encouraged – to participate in these forums.

We share the common goal of quality and affordable health care for all residents of the Commonwealth. The APCD is a powerful tool towards that end.

 

Update on Recent Activities

 

As I mentioned in my previous entry, DHCFP’s endeavors are meant to spark discussion, create transparency, and inspire innovation.

For example, we recently hosted an educational symposium on bundled payments for payers, providers, and other interested parties. With over 150 attendees, the event provided participants with technical assistance as well as practical advice from organizations and individuals who have designed and implemented bundled payments.

The symposium materials, including a report that describes several models of bundled payments, are available on DHCFP’s website. In the coming months, DHCFP will publish additional reports aimed at assisting providers and payers who are considering bundled payment strategies. In addition, the symposium marked the official launch of the agency’s YouTube channel. The initial video features Assistant Commissioner for Health Research and Policy Stacey Eccleston’s overview of bundled payments.

We also held a public hearing to discuss the agency’s proposed amendments to regulations pertaining to health care payer reporting of total medical expenses and relative prices. Assistant Commissioner for Health Care Finance Steve McCabe heard testimony from more than two dozen interested parties. We will carefully review each idea prior to the adoption of the regulation, which is tentatively scheduled for April 1st.  Information about these and other regulations is available on our website.

We similarly engaged stakeholders on the all-payer claims database (APCD) when Assistant Commissioner for Health Data Analytics Dave Wessman presented recently at an event hosted by the New England Employee Benefits Council. At this event, Mr. Wessman provided an overview of the APCD, delved into its many potential uses, and emphasized the critical need for ongoing employer participation.

In the coming weeks, DHCFP will host a series of symposiums to explore issues relating to data governance, data release, and collaboration on data uses. We recognize that certain aspects of the APCD merit further community discussion. Stay tuned for an invitation.

As I seek to make clear at every opportunity, the agency’s efforts are most successful when we receive your input.

Engaging You in 2011

 

It’s full steam ahead at the Division of Health Care Finance and Policy (DHCFP).  Last week’s successful launch of the all-payer claims database embodies one of many important initiatives that DHCFP has undertaken to further its ongoing mission to provide reliable, objective health care information.
 
We all share the goal of achieving quality, affordable health care. Toward this end, DHCFP is here to work with you, to field your questions, to discuss your ideas, and to facilitate this process by providing you with a solid understanding of our role.
 
DHCFP collects a broad and diverse array of data from across the Massachusetts health care landscape—vital resources encompassing claims data, provider cost reports, and hospital case mix records. Using this wealth of information, DHCFP produces trusted analyses to help demystify the Commonwealth’s health care delivery system. Our work already spans many key health care issues, and we are always looking to explore new topics that will inform the development of a more rational, systemic, and effective approach to ensuring health care value, containing health care costs, and providing high quality care. 
 
For these efforts to become truly meaningful, however, we seek to engage every stakeholder, including the public. Our endeavors are meant to spark discussion, create transparency, and inspire innovation.  We value your insight, we want to hear your thoughts, and we will endeavor to answer any questions you may have. I invite you to participate actively in our work by reading our reports, following our blog, attending our events, and reaching out to us.  I hope you find that our work merits attention, and I encourage you to spread the word about this unique state resource.   
 
Working together, in partnership with your engagement and your ideas, we can better position Massachusetts to contribute its unique experience to the national discussions on health care reform—both its successful implementation and sustainability.

 

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As a part of our commitment to transparency, the Massachusetts Division of Health Care Finance and Policy uses several social media tools to keep you informed about our work and to garner feedback. You can follow us on Twitter, and you can learn more by visiting the Commonwealth Conversations: Mass Health Care blog.

Another Step Forward with APCD

 

 

This past Monday, the Division’s all-payer claims database (APCD) began collecting health care claims data from all registered payers in the Commonwealth.

I am pleased to report that - to date - the APCD has registered almost 90 health care payers and third party administrators and has received approximately 2,260 files.  This represents a tremendous success for several reasons.

First, these files represent the vast majority of carriers offering health insurance in Massachusetts (including the major carriers), as well as pharmacy and third party administrators.

Second, the Massachusetts APCD collects more information and claims files than similar data collection efforts in other states.  In fact, other states are actively consulting with the Division for assistance on their APCD processes, as well as in developing national standards for all APCDs.

Third, the Division has successfully worked with the health payer community routinely (and on a real-time basis) to address virtually all of their technical issues associated with submissions and data specifications.  Our collaboration with carriers has helped us to ensure successful data testing submissions, as well as improved data completeness and quality.

Fourth, while much more work remains, working closely with carriers has helped us to enhance our data specifications and files to better meet the needs of sister agencies in the future.  The progress to date has gone far better than expected, and we believe our efforts in the next phase will be just as successful as we move toward administrative simplification.

We are very proud of this milestone and look forward to taking transparency of health care cost and quality to a whole new level in Massachusetts.

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As a part of our commitment to transparency, the Massachusetts Division of Health Care Finance and Policy uses several social media tools including Twitter, blogs, and RSS feeds. We use these tools to keep you informed about the work we are doing and as a way to get feedback.You can follow us on Twitter, and you can learn more by visiting the Commonwealth Conversations: Mass Health Care blog.