1. Data Strategy
Joel Cantor, Rutgers Center for State Health Policy
Ken Gross, Camden Coalition of Healthcare Providers
October 5, 2012

2. Session Overview
• Overview of required data & purposes
• CMS reporting requirements
• Plans for benchmarking
• Care management process
– Demo: TrackVia
• Next steps
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3. Required Data & Purposes
Hospital Care Mgn’t Patient Staffing
Encounter Process Outcome and Budget
Purpose Data Data Data Info
Patient identification
X
and triage/risk assm’t
Care management X X X
Benchmarking X ?
CMS quarterly
X X X X
reports
CMS evaluation X ? X ?
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4. CMS Quarterly Reporting Requirements
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Process & Outcome Measures
Standard measures:
- Required for all 107 awardees
- Begins in January 2013
- Requirements being compiled by RAND; to be released at the end of 2012
Project-specific patient-level measures:
- Hospital inpatient / ED use & costs
- Hospital Dx (primary and secondary)
- Chronic conditions, social co-morbidities
- Staff-assessed health status
- Satisfaction
- Care management encounters (types and length of interactions) & referrals
- Demographic
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5. CMS Quarterly Reporting Requirements
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Organizational & Operational Measures
Quality improvement e.g., - CQI process
- Data used and review process
- Specific efforts during reporting period
Participants (patients) - Counts by age, gender, race/ethnicity, payer
- % deviation from projection
- # encounters by type and delivery mode
Data capability checklist - Patient identifiers (SSN, or combination of name,
(i.e., assuring CMS that DOB, home address)
these variables are - Provider tax IDs
collected) - Service types and dates
- Practitioner NPIs
- Payer IDs (Medicare, Medicaid, other)
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6. CMS Quarterly Reporting Requirements
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Organizational & Operational Measures (Continued)
Staffing, paid e.g., - FTEs funded by HCIA (by type, new/existing)
- Clinical FTEs (by licensure and prescribing
authority)
- % deviation of actual FTEs from projection
Staffing, volunteers - # individual volunteers
- # volunteer hours
- Functions
Staff training - Training program duration (hours)
- Audience type
- # individuals
Budget - Actual expenditures: Itemized by personnel,
fringe, travel, equipment, supplies, contractual,
construction, indirect, total
- Forecasted expenditures: % deviation
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7. CMS Evaluation Requirements
• Little information has been provided to us yet
• Anticipate that identified patient data will be required
• Interviews and site visits possible
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8. Benchmarking
• Document how care management “bends the hospital cost curve”
• Costs of high-utilization patients may “regress to the mean”, so
simple trend data will not tell credible story
• Benchmarking will compare care management patients to matched
non-intervention patients (by demographics, utilization history,
diagnoses/comorbidities, payer)
– Comparison data from state all-payer billing databases (NJ, CA, FL)
– Outcome metrics: total resource use, readmissions, return to ED
– Statistical risk adjustment
• Will require de-identified hospital billing records (or similar data) for
enrolled patients
– Before, during, and after enrollment
– Will work with each clinical partner to see what is feasible
– Refinements possible if linked to care management process data
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9. Care Management Process
TrackVia Demonstration
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10. Next Steps
• Data Committee
– Representative(s) from each partner
– Committee call (first call within 2-3 weeks)
• CMS reporting on personnel & budget
– Focus of next project director call
• CMS reporting on patient-level measures
– Details forthcoming soon
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11. Site Breakout Questions
• How has this session changed your operational plan?
• How should the Camden tools (including Track Via) be
incorporated into your workflow?
• What assistance do you need to move forward?
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