Technical Resource for Measurement of Total Cost of Care Using Multi-Payer Data Sets

Overview: 

In the pursuit of advancing payment reform, the Network for Regional Healthcare Improvement (NRHI) is leading a multi-regional innovation initiative focused on the production, sharing and use of information about the total cost of care. With funding from the Robert Wood Johnson Foundation, five pioneering regional health improvement collaboratives (RHICs) who participated in the pilot phase of the initiative are now joined by six additional regions in a unique approach to standardizing how they report cost information. Balancing local customization with alignment to national efforts makes the information consistent, relevant, and actionable. This initiative is known as NRHI Getting to Affordability and this Technical Resource is a major component of this effort. One of the key objectives of this work is national spread. All-Payer Claims Databases (APCDs), which already exist or are planned in many states, represent a golden opportunity to enable that expansion (to build upon, coordinate and ultimately establish a national standard model). NRHI partnered with the APCD Council to understand the strategy for using APCDs for this purpose. Together, these entities worked to translate the standardized technical specifications and lessons learned from the pilot regions into a more formal how-to guide for measuring and reporting total cost of care. This effort uses the HealthPartners National Quality Forum endorsed Total Cost of Care and Resource Use framework (TCOC). The purpose of this Technical Resource is to give other users of APCDs the benefit of experience gained by project participants in creating TCOC on multi-payer commercial claim data. It addresses data preparation, quality assessment, and suggestions for getting the best results from the HealthPartners Standard Analytic Package. It offers guidance/best practices on:

  • Initial data quality checks

  • Preparing the data

  • Minimum data requirements

  • Selection of members and claims data

  • Evaluating the quality of the data to be analyzed

  • Assigning risk scores

  • Assessing the output of the HealthPartners software

This Technical Resource is intended to provide step-by-step instructions, along with tips drawn from the experiences of the pilot project participants, to provide entities wanting to report TCOC using a multi-contributor data source with a smoother path while increasing measurement standardization and alignment nationally. To continue conversations, share best practices and get peer support around measurement of Total Cost of Care using multi-payer data sets, we encourage you to join the Getting To Affordability Community, an NRHI-led social learning platform designed to connect peers and stakeholders across the healthcare spectrum with the larger community. To learn more and to register, email: gettingtoaffordability@nrhi.org. For questions for the APCD Council or to join the APCD Council Learning Network, please contact  info@apcdcouncil.org.

Publication Date: 
October, 2016
Author(s): 
Network for Regional Healthcare Improvement, APCD Council
Citation: 

Network for Regional Healthcare Improvement, APCD Council, Technical Resource for Measurement of Total Cost of Care Using Multi-Payer Data Sets, Network for Regional Healthcare Improvement, APCD Council, October 2016.