1 Puget Sound Health Alliance: a private regional multi-payer database APCD Financing, Governance and Legislative Language Session Natasha Rosenblatt Data Projects Manager Puget Sound Health Alliance

2 Puget Sound Health Alliance is a regional coalition: Private, non-partisan, non-profit 501(c)(3) Purchaser-led: Board comprised of >50% purchasers and chair is purchaser Open to everyone to participate: purchasers, plans, providers, patients Funded by grants and membership (fees based on size and type of organization) Created in 2004; hired staff in 2005 Now ~150 member organizations Focus: 5 counties in Puget Sound region (Seattle, Olympia, Tacoma, Everett) RWJF Aligning Forces for Quality grantee Recognized as HHS Chartered Value Exchange

3 a sampling of who we are: Alaska Airlines The Boeing Company REI Starbucks Coffee Company Puget Sound Energy WA State Health Care Authority County Governments City of Seattle UFCW/Teamsters Group Health Polyclinic Everett Clinic Northwest Physicians Network WA State Medical Association WA State Hospital Association Academy of Family Physicians WA Naturopathic Physicians WA State Nurses Association Virginia Mason Medical Center Swedish Medical Center Providence Health & Services Aetna Health Plans of WA Cigna Premera Blue Cross Regence Blue Shield United Health Care

4 Puget Sound Health Alliance Mission: To build a strong alliance among patients, providers, purchasers, health plans and others to promote health and improve quality and affordability by reducing overuse, underuse and misuse of health care services. Key Strategies: Performance Measurement and Public Reporting: Measure and report variation in quality and cost Consumer Engagement: Consumers make informed decisions Payment Reform: Pay providers for value not volume Performance Improvement: Leverage all strategies to change results and improve value

Alliance data: a Regional Multi-Payer Claims Database Alliance database is not statewide  currently covers 5 county region Alliance database is not an APCD per se  data submission is voluntary: Currently 18 data suppliers that voluntarily supply data Includes large health plans, employers, union trusts and Medicaid. Includes approximately 2 million covered lives  ~65% of the non-Medicare insured population in 5-county region. Examples of data currently outside of database: Non-participating self-insured employers Individually insured members Non-insured individuals Medicare Created to measure and report on health care performance within community Data includes enrollment, providers, and medical and pharmacy claims Does not include any cost (charge, allowed or paid) data

High level overview of Alliance data processes:

Advantages of Private Model Voluntary participation increases stakeholder confidence and lessens resistance Leverages influence of purchasers - including the State - to drive participation Ability to make relatively quick progress in areas of stakeholder agreement: data submitted  st public report  th public report Currently over half a billion records in database, covering 1/2004 – 6/2010 Initial reporting on ambulatory quality of care. Expanding to resource utilization, readmissions and avoidable hospitalization and ER utilization Reports cover relatively willing participants Public reporting of 77 medical groups and more than 250 clinics Region-wide provider roster – information provided by medical groups Alliance serves as a community partner Role in many community initiatives (e.g. medical home pilot, quality initiatives, etc.)

Disadvantages of Private Model Private model relies on data suppliers’ voluntary participation ▼Cannot achieve ALL payer database under voluntary system ▼Under voluntary system data suppliers govern what is submitted and reported No mandate to submit discretionary data elements that payers resist No public reporting of claims data results by health plan (aggregate only) ▼Legal complexities accessing data Alliance is not a covered entity or business associate  limits data access ▼Limitations of using and accessing data Alliance can shepherd but not fulfill requests for secondary uses of data  cost, legal and contractual issues frequently prohibit expanded use of data (e.g. research requests)

Considerations in moving to a public/private model Potential advantages of moving to a public/private model: Could capture cost data: public reporting on cost information that could support payment reform initiatives Could capture all (or most) insured data across the state Could improve access to data Performance reporting staff could gain better access  reduced cost of reporting Additional uses of the data Key Issues: Data suppliers willingness to participate Avoid duplication of efforts – should build on existing success Prevent slowing or halting of process Data access, privacy and security requirements under new legislation Open records requirements concerns Need clear project goals (e.g. transparency alone could result in price increases)