1. Florida Health Care Transparency Initiative Niall Brennan Executive Director Health Care Cost Institute June 23, Consumer Health Information and Policy Advisory Council

2. About HCCI HCCI Activities
HCCI is a non-profit, independent, non-partisan research institute dedicated to promoting research and information on the drivers of health care costs and utilization
Founded in 2011 by Aetna, Humana, Kaiser Permanente, and United Healthcare
Payers provide data and limited financial support but HCCI operates independently
Additional support from foundations and other health industry organizations
HCCI Activities
Research and Public Reporting – We currently hold claims, with allowed amounts, for nearly 100 million Americans, from 2007 onward which we make available for academic, non-commercial research and public reporting
Transparency – Guroo.com is an independent, free, user-friendly source of price information for consumers of health care services based on billions of current claims

3. Governing Board
Stephanie J. Carlton, R.N., M.B.A., McKinsey & Company Almeta Cooper, J.D., General Counsel, Morehouse School of Medicine Leemore Dafny, Ph.D., Professor of Management and Strategy, Kellogg School of Management, Northwestern University Robert Town, Ph.D., James L. and Nancy Powell Centennial Professor in American Economic Principles in the Department of Economics at the University of Texas-Austin. Jonathan Gruber, Ph.D., Professor of Economics, MIT Stephen Parente, Ph.D., Professor of Health Finance and Insurance, University of Minnesota Theodore A. Prospect, F.S.A., M.A.A.A., Chief Actuary, UnitedHealth Center for Health Reform and Modernization Dale Yamamoto, F.S.A., M.A.A.A, F.C.A., Independent Actuary Charles Phelps, Ph.D., retired former Provost, University of Rochester 3 3

4. Current and Future HCCI Data
HCCI holds claims data on approximately 100 million Americans per year
2016
2017+
Commercially insured from all 50 states and DC:
Employer-sponsored insurance
Individual insurance
Medicare Advantage (Part C)
Years
Updated annually
Includes enrollment data, medical claims, and Rx claims (~60%)
Medicare population (through Qualified Entity Program):
Years
Part A (100%) - hospital
Part B (100%) - doctors
Part D (~40%) – drugs
Florida
Previous 3 years
Commercially insured (~91%)
Medicaid
More states…
Everything HCCI does is HIPPA and anti-trust compliant

5. A Few More Points . . .
HCCI does not engage in any commercial proprietary research for anyone, including the data contributors
Our commercial data contributors do not gain access to the combined dataset
All research historically is in the public domain and free
We believe we are building out an essential part of the nation’s health services research infrastructure – join the effort

6. HCCI Reports Annually released in November
All HCCI reports are free and available online
Annual cost and utilization reports as well as issue briefs
Academic articles
Cited source of data
Annually released in November

7. Recent HCCI Health Affairs Blogs
Health Care Consumerism: Can The Tail Wag The Dog?
Amanda Frost, David Newman, and Lynn Quincy, March 2, 2016
Reimagining The Consumer Role In Improving Value
David Newman and Amanda Frost
June 10, 2016

8. Academic Research
HCCI established an academic research partnership program to make our data more available to independent academic researchers
HCCI’s current academic partners include:
Dartmouth University of Pennsylvania
University of Minnesota University of Michigan
M. D. Anderson Northwestern University
NBER Weill Cornell
Academy of Actuaries Society of Actuaries
MedPAC Congressional Budget Office
HCCI has also facilitated data access and research support through external funding partnerships:
Laura and John Arnold Foundation funding for State Health Policy Research: 6 research teams funded to conduct research using HCCI data
Robert Wood Johnson Foundation funding for Health Data for Action grants: 183 proposals to use HCCI data were submitted

9. Research Impact
There are approximately 40 research teams actively working on research projects with the HCCI
There have been 20 papers/articles published using HCCI data
There have been numerous presentations at national conferences (e.g. (AcademyHealth Annual Research Meeting, American Society of Health Economists Biennial Conference, American Economics Association Annual Meeting)
HCCI’s reporting and research activities have also grown
There have been over 30 HCCI reports/briefs to date (not including staff research and non-HCCI publications such as Health Affairs Blog posts)
HCCI has received external funding from organizations such as Robert Wood Johnson Foundation and Pew Charitable Trust
HCCI research and reports are increasingly cited by the media
131 media mentions for HCCI internal research in 2016

10. HCCI Data Drives New Insights and Generates National Headlines
NY Times story based on HCCI data (12/15/15)

11. West Health Policy Center/Rand Study
Why Transparency?
Providing patients, physicians, employers and policymakers more information on healthcare prices could reduce U.S. healthcare spending by an estimated $100 billion over the next decade
West Health Policy Center/Rand Study
New insurance plan designs require price and quality information
New insurance products such as those based on reference pricing require information
Desire that consumers purchase “value” in health care – taking into account price and quality
Research shows that transparency can reduce costs
A JAMA study found a 14 percent drop in costs for laboratory tests, a 13 percent decline for imaging and a 1 percent decline in primary care visits, when consumers used a transparency tool.
“The savings will increase as more and more of the estimated 150 million Americans with employer-sponsored insurance gain access to information on prices and quality,”
Dr. Neeraj Sood, author of JAMA study

12. Transparency Is Not A Cure All
Price transparency can raise prices depending on local markets
Consumers need more than prices at CPT code level – episodes or bundles for complex services
And, only a subset of services are shoppable, discretionary and schedulable
Generally low rates of consumer take-up of price transparency tools
Sick consumers want to get better, not shop around on price
No matter what, unless we change payment models, transparency tools are generally imperfect estimates

13. What Should Transparency Do?
Support consumers that want to shop
Support providers who want to engage on value
Remove/reduce unjustified price variation
Remove surprises
Improve public policy

14. HCCI and Transparency: Guroo
Launched November 2015
Search functionality includes geography (e.g. state) or treatment or condition (e.g. asthma or MRI)
Updated March 2016 to include:
Additional content
Quality metrics (6 total: High Blood pressure (2), Diabetes (2), Asthma, Readmission)
Body image search

15. Florida Transparency Initiative
Requires each health insurer and each health maintenance organization that participates in the state group health insurance plan or Medicaid managed care to contribute all claims data from Florida policyholders held by the insurer and its Affiliates to the contracted vendor
91% of covered lives in Florida
AHCA controls all aspects of the transparency initiative
State Action Doctrine
Goal is to leverage existing HCCI expertise and data, and Guroo features and capabilities

16. Care Bundles
There are 295 care bundles of which ~ 40 have been identified with hospital/facility level outpatient services and ~ 20 with hospital/facility level inpatient service
The broad categories are:
Primary Care Visits
Specialist Visits
Wellness Visits
Women’s Health
Medical Evaluations
Vaccines
Diagnostic Studies and Procedures
Lab Tests
Imaging
Physical Therapy
Surgery

17. Example Care Bundle Knee Replacement A B A X B TOTAL $35,770 A B
A X B
Care Path ID
Step ID
Service Code
Code Type
Revenue Code
Health Service Type
Service Name
Service Quantity/ Day(s) of Therapy
Length of Stay (Inpatient)
Unit Cost Example
Total Cost
TK001
Step 1
99203
CPT
Specialist Consultation
Office Visit - New Patient - Moderate Complexity 1 $ $
73560
Radiology Services - Minor X-ray
X-ray - Knee (1 or 2 Views) $ $
Step 2
36415
Laboratory Services
Collection of Blood by Venipuncture $ $
85025
Complete Blood Count - CBC Test $ $
85610
PT Blood Test
85730
PTT Blood Test
86900
ABO Blood Typing Test
86901
RH Blood Typing Test
86850
Antibody Screening Blood Test $ $
00470
DRG
0120
Hospital Facility - Inpatient
Major Joint Replacement 4
$ 30,000
$ ,000
01402
Anesthesia Services
Anesthesia for Total Knee Replacement
$ 1,500
$ ,500
27447
Surgical Care
Total Knee Replacement (TKR)
$ 2,000
$ ,000
99223
Physician Evaluation
Initial Inpatient Physician Evaluation (High Complexity) $ $
99232
Follow-Up Inpatient Physician Evaluation (Moderate Complexity) 3 $
Step 3
97001
Physical Therapy
Physical Therapy Evaluation $ $
97110
Exercises 12 $ $
97140
Massage and Traction 7 $
Step 4
99213
Office Visit - Established Patient - Moderate Complexity 2 $
TOTAL
$35,770
Step 1: An office visit with a specialist for a detailed evaluation and treatment of your symptoms
Step 2: Inpatient surgery to replace a diseased or damaged knee joint with manmade parts
Step 3: A guided physical therapy exercise program to reduce stiffness and improve range of motion in the knee
Step 4: Two follow up office visits after you have left the hospital
Trade secret, Confidential and Proprietary
HCCI March 6, 2017

18. Homepage
1: Upon locating to Florida Guroo, this URL will be displayed in the browser bar:
2: Cobranded logo updated to the new FloridaHealthFinder.gov version; clicking on the logo will navigate the user to the FloridaHealthFinder website.
3: Mountain background replaced with a more Florida-appropriate beach and wave background.
4: Data Insights icon updated with new image. 1 2 3 4
9/21/2018

19. Homepage - Scroll Down View
1: Cobranded logo updated on the sticky header bar with the new FloridaHealthFinder version; clicking on the logo will navigate the user to the FloridaHealthFinder.gov website.
2: White reverse AHCA logo remains in the Powered By section to communicate to users the relationship of the Agency to the State of Florida. Clicking on this log will navigate the user to the Agency’s website. 1 2
9/21/2018

20. Care Bundle Overview Page – Default 5-Facility Display
1: Cobranded logo updated on the sticky header bar with the new FloridaHealthFinder version; clicking on the logo will navigate the user to the FloridaHealthFinder.gov website.
2: Mountain background replaced with a more Florida-appropriate beach and wave background.
3: Button to access Florida facility quality information provided to navigate user to URL provided.
4: This default view will show the 5 lowest priced facilities; clicking the Show All County Facilities button will expand to next view. 1 2 3 4
9/21/2018

21. Care Bundle Overview Page – All County Facility Display
1: This view shows all counties in the county; a scroll bar will be displayed or a see more option in the case the number of facilities for the detected or selected count is large.
2: Facilities without a price to show will have N/A in the cost section; N/A message below the facilities list can be modified to best describe N/A scenario. 1 2
9/21/2018

22. Questions?