1. A Payer’s View of All-Payer Claims Data Requests All-Payer Claims Database Conference October 14, 2009

2. 2©2009 Aetna Proposed general principles  Use a consistent set of data elements  Collect data from the source most likely to have it as part of the normal course of business  Weigh the value of the data element collected against the cost involved in payer collection and provision of the data

3. 3©2009 Aetna Proposed general principles  Include all stakeholders in the development of data collection standards and procedures  Establish a standard schedule for data requirement additions/changes  Implement strong privacy and security safeguards to protect against inappropriate disclosure and use of data

4. 4©2009 Aetna Consistent set of data elements  Reduces carrier time/resources needed to begin data submission  Speeds implementation for new states, which benefit from the work done by others  Saves carrier resources/money; possibility of running multiple states at one time  Supports accuracy of data, since issues that are identified and resolved benefit all states  Encourages carriers to refine and improve data – focus is on one data set rather than 10

5. 5©2009 Aetna Data needed for normal course of business Is it needed to:  pay a claim?  enroll a member/subscriber?  bill a member/subscriber? If so, a Payer should have this data. If not, another entity may be a better resource for the data. In some cases, Payers may be interested in serving as an intermediary for another entity because the data is of interest to the Payer. A dialogue among the parties will help identify these opportunities.

6. 6©2009 Aetna Cost/benefit assessment of data elements Costs  Payer systems collect and store data needed to support core business needs; not all data on claim forms may be stored/reportable  Adding data elements to systems can be costly – $1 million or more  Storage costs for data elements not needed for core business can be substantial (183 million claims processed ytd) Benefits  Measurable improvement in quality of care for state residents  Greater transparency in health care  Overall cost savings in the health care system

7. 7©2009 Aetna Stakeholder dialogue  Current efforts by RAPHIC, NAHDO, University of New Hampshire, AHRQ and others are critical  Do we need others at the table – what other entities collect needed data in the normal course of business?  Engage states considering or just beginning their data collection efforts so they benefit from what is already in place and are part of the development of the future state

8. 8©2009 Aetna Why follow a standard schedule for changes/additions? Payers must plan for changes well in advance Payer system release procedures control which system changes are funded and resourced and when changes go into the system Release schedules begin to fill up by June of the prior year – Aetna’s 2010 schedule was largely filled by August 2009 Aggregate funding/resources for 2010 releases were assigned by August 2009 System changes may be frozen during open enrollment periods

9. 9©2009 Aetna Proposed schedule for changes and additions Schedule allows payers to put a placeholder in each year’s release schedule, and reserve the resources and funding needed for the changes to assure timely implementation.  April/May - Stakeholder discussion on possible additions/changes  June 1 st - Formally propose additions/changes for next calendar year  July 1 st – Communicate required changes  January 1 st - Changes effective (for claims processed on or after 1/1)

10. 10©2009 Aetna Privacy and security  Residents rely on state government to protect their personal information  Members rely on payers to handle Protected Health Information as required by state and federal law  Moving vast quantities of data and aggregating data that still may identify individuals is high risk

11. 11©2009 Aetna Other considerations  Penalties for payer non-compliance  Automation of submission process  Anti-trust concerns  Impact of incomplete provider-submitted claims  Vendor-owned systems  Quality check transparency  Accuracy and completeness of historical data  Impact of claim volume for states  Inclusion/exclusion of lines of business, such as limited benefit plans, student plans