1. Healthcare Pricing Transparency
Helping Consumers Compare the Cost of Care
Michael T. Lundberg, Executive Director
Kyle Russell, APCD Program Manager
September 27th, 2016

2. VHI Represents all Health Care Stakeholders
VHI is an independent, nonprofit, 501(c)(3) health information organization established in 1993
Formed to administer Virginia Health Care Data Reporting Initiatives to benefit Virginians
Today’s Presentation
Who we are
Background on VA’s APCD
VHI Healthcare Pricing Report

3. VHI Publishes a Variety of Health Information

4. All Payer Claims Databases (APCD)
Includes: Office Visits Outpatient Emergency Inpatient Episodes Benchmarks
Eligible Members
Pharmacy Claims
Providers
Medical Claims
Aggregation of paid health insurance claims
Provides wider view of healthcare than currently available
A tool for public health, policymakers, health plans, providers, employers and consumers
Existing in 14 states, implementing in 5, strong interest in 19, voluntary in 4 (APCD Council, August 2015)
Virginia’s voluntary APCD was established in 2012

5. APCD—All Payer Claims Database Planning in 2012 Building in 2013 Reporting began in 2015
APCD Funding July 1, 2015-June 30, 2018
General Assembly also approved $25,000 for
FY 2016
9 plans participating in submission and funding Commercial, Medicaid and some self-insured data included
APCD Advisory Committee assisted in implementation and now operations
Over 200 users of de-identified APCD data
VHI works under contract to VDH

6. APCD In Action: Understanding the Opiate Crisis
Virginia’s APCD provides a baseline understanding on pharmacy use across the state with comparisons to national and Virginia benchmarks

7. Healthcare Pricing Transparency
Developed in 2008 with multi-stakeholder workgroup input
Includes 31 commonly performed procedures.
Details average costs (allowed amounts) by site of care including physician office, surgical centers, hospital inpatient and outpatient facilities provided by health plans.
APCD will be used to update and enhance VHI’s 2016 report
Current information at vhi.org

8. VHI Healthcare Pricing Website

9. VHI Healthcare Pricing Website
VHI goes beyond costs to help consumers understand what the service is, why have it, the risks, benefits, recovery and where to go for more information

10. Current information at vhi.org
VHI Healthcare Pricing Report: Colonoscopy
Current information at vhi.org

11. Current information at vhi.org
VHI Healthcare Pricing Report: Rotator Cuff Surgery
Current information at vhi.org

12. Current information at vhi.org
VHI Healthcare Pricing Report: Arthrocentesis
Current information at vhi.org

13. How the APCD improves Price Transparency
Consistency- VHI calculates healthcare costs using a methodology developed with businesses, providers and health plans
Specificity- the APCD allows VHI to report medical service costs on a regional basis
Flexibility- VHI intends to add to the 31 services already reported on in future years

14. Closing Remarks
VHI has put healthcare data in the hands of Virginia consumers for over 23 years
The Virginia APCD continues to further healthcare transparency in the Commonwealth
Later this Fall the new VHI Healthcare Pricing report, powered by the APCD, will give consumers free access to regional comparisons of 31 common medical procedures