This document summarizes a webinar presented by Kennen Gross on hospital claims data. It discusses what hospital claims data is, why it is needed, how to obtain it, and what can be done with it once obtained. Specifically, claims data can be used to understand health problems in a population, develop interventions to address those problems, and evaluate the impact of solutions by analyzing costs, utilization rates, diagnoses, and individual patient profiles over time.

1. Camden Coalition of
Camden 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 some
breathtaking opportunities disguised as
insolvable 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 Room
Emergency 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 the
Understand interventions
patients impact of
the 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
problem
www.camdenhealth.org

23. Camden Hospital Inpatient and Emergency Revenue, 2011
Understand
the
problem
www.camdenhealth.org

24. Camden Cost Curve, 2011
Understand
the
problem
www.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
problem
www.camdenhealth.org

27. Camden Inpatient use by Diagnosis, 2011
“Ambulatory Care Sensitive Conditions” and
are often amenable to outpatient
management
Understand
the
problem
www.camdenhealth.org

28. Camden High Utilizers, 2011
Understand
the
problem
www.camdenhealth.org

29. Camden Spatial Analysis of Hospital Costs
Identify and
Understand engage
the patients
problem needing
www.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
8
Length 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 time
Questions/comments please contact me at
ken@camdenhealth.org
www.camdenhealth.org