244312 Leveraging an all-payer claims database to improve health care

Tuesday, November 1, 2011: 9:10 AM

Julie Bartels, BS University of Wisconsin, Business Administration, Registered Health Underwriter , CEO, Wisconsin Health Information Organization, De Pere, WI
Paul Wallace, MD , Center for Comparative Effectiveness Research, The Lewin Group, Falls Church, VA
Background: Many states are beginning to develop all-payer claims databases (APCD) which will allow for consistent and accurate interstate/national comparisons using a large volume of data. The Wisconsin Health Information Organization (WHIO) is a member-based, non-profit 501(c)3 organization that believes a more transparent health care market is the most effective way to improve quality, affordability, safety, and efficiency of health care in Wisconsin. WHIO has brought together public and private health care stakeholders in Wisconsin to develop an APCD that provides a complete picture of care in Wisconsin.

Objective/Purpose: The objective of this presentation will be to showcase how leveraging this statewide APCD as a shared information utility can bring together community resources to understand their population health and health care delivery challenges and build programs to address them.

Methods: WHIO's APCD contains claims data from the major health insurers and Medicaid in WI. The APCD is refreshed every six months and contains nearly 3.5 million lives and over 200 million claims. The APCD offers a variety of analytics and a decision support platform to support provider performance evaluation including episode treatment grouping, risk attribution and severity adjustments.

Results: This presentation will include the following examples of how the APCD is being leveraged in communities today to support Comparative Effectiveness Research: 1) the Wisconsin Medical Society Physician Study Groups use the APCD to motivate change within specialty areas such as cardiac and orthopedics and 2) the Wisconsin Public Health Department uses the APCD to measure disease prevalence and understand variation of care in chronic conditions to support public health policies.

Conclusions: By the end of the session, the participant will be able to explain how an APCD can be leveraged to trigger healthy community programs that contribute to providing improved health care to patients.

Learning Areas:
Planning of health education strategies, interventions, and programs

Learning Objectives:
Explain how an all-payer claims database can be used to develop healthy community programs that contribute to providing improved health care.

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am qualified to present because I oversee programs utilizing claims data from multiple sources for analytic, quality improvement and research purposes.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.