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  • 1. Camden Coalition ofCamden Coalition of Healthcare Providers Healthcare Providers Hospital Claims Data 101 Webinar Kennen S. Gross, PhD, MPH Director, Research & Evaluation Camden Coalition of Healthcare Providers www.camdenhealth.org
  • 2. "What we have before us are somebreathtaking opportunities disguised asinsolvable problems." -John Gardner Secretary of Health, Education and Welfare 1965-1968
  • 3. Questions to be addressed• What are hospital claims data?• Why do we need it?• What hospitals do I need it from?• How do you get claims data?• Once you get claims data what do you do with it?
  • 4. What are hospital claims data?• Collected by hospitals for billing purposes• Patient information• Diagnosis information• Billing information• Lag in the completeness of data• Does not include claims for pcp visits, specialist visits, pharmacy
  • 5. What are hospital claims data? Patient Patient Patient A B B Emergency RoomEmergency Room Inpatient Stay Inpatient Stay ED Claim IP Claim IP Claim Patient name Patient name Patient name Address Address Address Date Date Admitted Date Admitted Diagnosis codes Date Discharge Date Discharge Insurance Diagnosis codes Diagnosis codes Charity care Insurance Insurance Charges Charity care Charity care Receipts Charges Charges Receipts Receipts
  • 6. Why do we need hospital claims data? Identify and Develop engage Evaluate theUnderstand interventions patients impact ofthe problem to target the needing the solutions problem intervention www.camdenhealth.org
  • 7. Why do we need hospital claims data? If its going to be, its up to me! www.camdenhealth.org 7
  • 8. Why do we need hospital claims data? Existing population health databases are not sufficient www.camdenhealth.org 8
  • 9. Why do we need hospital claims data? Claims data from payers is not feasible www.camdenhealth.org
  • 10. From which hospital(s)?• What patients are you targeting with your intervention?• Where do those patients live?• At what hospitals do those patients receive care?• One hospital
  • 11. From which hospital(s)? Camden Example www.camdenhealth.org 11
  • 12. How do you get claims data? Business Intelligence Issues START WITH WHY Legal Issues Data Access Issues
  • 13. How do you get claims data?
  • 14. How do you get claims data? Quality Assurance Process Improvement Research Project Business Associates Institutional Review Agreements (BAAs) Boards • • • • • •
  • 15. What do you do with claims data?• Store the data• Clean the data• Reorganize the data• Link the data• Calculate variables• Map the data• Activate the data• Share the activated data
  • 16. Store the data
  • 17. Clean the data•••••
  • 18. Link the data
  • 19. Map the data
  • 20. CCHP Solution:Camden Health Database Data processing/cleaning Yearly Clams Data Data Use Agreements Probabilistic matching IRB Agreement Geocoding Camden Residents All-Payer Claims Longitudinal Dataset  Demographics  Inpatient and Emergency visits  Diagnosis codes  Charges/receipts  Insurance Understand the problem www.camdenhealth.org
  • 21. Hospital Costs – Camden Residents, 2011 Total hospital revenue $108 million $1,396 per capita Total inpatient revenue $79 million $1,021 per capita Total Emergency Department revenue $29 million $375 per capita Understand the problem
  • 22. Camden Hospital Utilization, 2011 Understand the problemwww.camdenhealth.org
  • 23. Camden Hospital Inpatient and Emergency Revenue, 2011 Understand the problem www.camdenhealth.org
  • 24. Camden Cost Curve, 2011 Understand the problemwww.camdenhealth.org
  • 25. Camden Hospital Utilization Typology Inpatient visits, 2011 ED visits, 2011 0 1 2 3 to 4 5+ 0 44,728 (85%) patients 5,210 Inpatient visits 63,489 ED visits 1 $28,000,000 (50%) IP payment $25,800,000 (59%) ED payment 2 to 3 985 (2%) patients 1,856 IP visits 503 (1%) patients 4,129 ED visits 2,026 Inpatient Visits 4,144 ED Visits 4 to 5 $10,000,000 (17%) IP 1,563 (3%) patients payment $10,900,000 (20%) in IP payment 1,239 IP visits $1,700,000 (4%) ED $1,700,000 (4%)in ED payment 6 to 7 4,961(9%) patients 6,962 ED visits payments 28,447 ED visits $6,700,000 (18%) in IP $11,500,000 (27%) in payment 8 to 9 ED payment $2,800,000 (6%) in ED payment 10 + Understand the problem www.camdenhealth.org 25
  • 26. Camden ED use by diagnosis, 2011 “Ambulatory Care Sensitive Conditions” and are often amenable to outpatient management Understand the problemwww.camdenhealth.org
  • 27. Camden Inpatient use by Diagnosis, 2011 “Ambulatory Care Sensitive Conditions” and are often amenable to outpatient management Understand the problemwww.camdenhealth.org
  • 28. Camden High Utilizers, 2011 Understand the problemwww.camdenhealth.org
  • 29. Camden Spatial Analysis of Hospital Costs Identify and Understand engage the patients problem needingwww.camdenhealth.org intervention
  • 30. Hospital Visits - Camden Residents, 2005- 2011 Understand the problem
  • 31. Patient utilization profile 14 12 10 Length of Stay 8 6 4 2 0 1/3/2011 2/3/2011 3/3/2011 4/3/2011 5/3/2011 6/3/2011 7/3/2011 8/3/2011 9/3/2011 10/3/2011 11/3/2011 12/3/2011 C ED IP Evaluate the impact of the www.camdenhealth.org solutions 31
  • 32. 1 year pre-enrollment Post-enrollment Charges = $745,018; Receipts: $95,358; Charges = $0; Receipts= $0 Inpatient days: 55; ED visits: 1 Inpatient days: 0; ED visit=0 12 10 8Length of Stay 6 4 2 0 C ED IP Evaluate the impact of the www.camdenhealth.org solutions
  • 33. Data access is a necessary but not sufficient step towards innovative delivery reforms. Data Quality is essential Measurement is essential Statistical Literacy is essential Effective Dissemination in essential Maintaining partnerships is essential
  • 34. Thank you for your timeQuestions/comments please contact me atken@camdenhealth.org www.camdenhealth.org