wisconsin health information organization...

Wisconsin Health Information Organization

(WHIO) Presentation to the

Group Insurance Board

November 12th, 2013

Wisconsin Health Information Organization 1

WHIO Driving Transparency to Improve

Your Healthcare

• An “All Payer Claims Datamart” (APCD) • Collects healthcare data from payers, aggregates the data

and then distributes HIPAA compliant data to approximately 200 end users

• Formed in 2005 by a multi-stakeholder group of healthcare professionals

• A Non-profit 501 c 3


WHIO Members • Greater Milwaukee Business

Foundation on Health • Humana • The Alliance • United Healthcare of WI • Anthem BC/BS of WI • WEA Trust • WPS Health Insurance • Wisconsin Medical Society • Gundersen Lutheran Health

Plan • Mercy Health Plan • Physicians Plus Insurance

• The Wisconsin Collaborative for Healthcare Quality

• Wisconsin Department of Health Services

• Wisconsin Department of Employee Trust Funds

• Wisconsin Hospital Association

• Group Health Cooperative South Central Wisconsin

• Health Tradition Health Plan • Unity Health Plan • Dean Health Plan • Security Health Plan • Network Health Plan

WHIO Subscribers • Aurora Health • NEWHVN • Aspirus • Bellin Health • ThedaCare • Froedtert Health • Children’s Hospital of WI • Centene/MHS • WIPHCA

Datamart growth and stabilization

Wisconsin Health Information Organization

DMV2 DMV3 DMV4 DMV5 DMV6 DMV7 DMV8 Members Included 1.51 M 2.82 M 3.44 M 3.73 M 3.86 M 3.94 M 3.95 M % WI Population 26.8% 47.1% 58.0% 62.8% 64.9% 65.6% 65.7% Claims Included 72.7 M 136.8 M 207.1 M 233.5 M 247.6 M 249.6 M 247 M

% Commercial Claims 92% 52% 40% 42% 42% 42% 40% % Medicaid FFS Claims 0% 42% 29% 26% 25% 24% 24% % Medicaid HMO Claims 0% 0% 20% 19% 20% 20% 22% % Medicare Claims 8% 6% 11% 13% 13% 14% 14%

Claim $ Included (Std. Cost/ Billed)

$20.7 B / $35.7 B

$28.9 B / $51.6 B

$32.2 B / $59.3 B

$34.4 B / $64 B

$35.7 B / $66 B

$36.8 B / $67.5 B

Episodes of Care 7.3 M 11.1 M 18.8 M 21.5 M 23.1 M 23.7 M 23.9 M Providers Included 133,845 88,171 93,245 95,214 98,278 90,956

10/2006 - 12/2008

10/2007 - 12/2009

4/2008 - 6/2010

10/2008 - 12/2010

4/2009 - 6/2011

10/2010 - 12/2011

4/2010 - 6/2011

Datamart Published: October, 2009

April, 2010 October, 2010

April, 2011 October, 2011

April, 2012 December, 2012

DMV3 DMV4 DMV5 DMV6 DMV7 DMV8Anthem WI Medicaid

(FFS)WI Medicaid

(HMO)Network HP Health

TraditionsThe Alliance No new data

contributors

Humana Gundersen Lutheran

Dean Physicians Plus

Unity

UHC WI Security

WEA MercyCare

WPS GHC-SW

Original Data

ContributorsNew data contributors added

CAUTION! • Please note that these slides are EXAMPLES of the type

of information that can be obtain by analyzing WHIO Administrative Claims Data.

• This type of high level analysis requires “deeper dives” into the details and ultimate causes.

• The analyzes provide directional information as to where to focus further analytic efforts.

• All of the analyzes are based entirely on medical and pharmacy claims submitted to payers by providers for services delivered.


Population Data • WHIO contains a vast amount of health care service data

(~ 250M claims; $66B billed) for Commercial, Medicaid, and Medicare Advantage populations – Condition-specific cost and utilization; Total Cost of Care – Service utilization per 1,000 population by Type of

Service (e.g. ER visits; MRIs) – Prescription drug utilization and prescribing patterns – Inpatient confinements, days per 1000, ALOS – Compliance with evidence-based quality process

measures – Stratification by geography; clinical condition; risk;

provider affiliation; age/gender; product

12/6/2012 Wisconsin Health Information Organization 7

WHIO Population-based Analysis and Total Cost of Care

Analyzing Populations and Health Risk


WHIO DMV8 Retrospective Risk - Current Year, All Payers

Bayfield

Buffalo

Burnett

Crawford

Florence

Forest

Iron

Lafayette

Marquette

Menominee

Pepin

Rusk

Sawyer Washburn

0.72 La Crosse

0.74 Vernon

0.76 Trempealeau

0.80 Sauk

0.80 Iowa

0.82 Monroe

0.82 Grant

0.82 St Croix

0.84 Columbia

0.84 Green

0.84 Pierce

0.84 Door

0.85 Jefferson

0.85 Dane

0.88 Jackson

0.89 Richland

0.89 Walworth

0.92 Juneau

0.92 Polk

0.92 Washington

0.94 Rock

0.95 Dodge

0.95 Kewaunee

0.95 Dunn

0.95 Ozaukee

0.97 Outagamie

0.98 Waukesha

0.98 Sheboygan

0.99 Eau Claire

1.00 Calumet

1.01 Oconto

1.02 Shawano

1.02 Brown

1.02 Chippewa

1.02 Marinette

1.03 Kenosha

1.06 Fond Du Lac

1.06 Adams

1.06 Portage

1.07 Manitowoc

1.08 Barron

1.08 Green Lake

1.09 Ashland

1.09 Racine

1.09 Marathon

1.10 Taylor

1.10 Waupaca

1.12 Clark

1.13 Winnebago

1.13 Vilas

1.14 Oneida

1.15 Waushara

1.15 Wood

1.16 Langlade

1.16 Milwaukee

1.17 Douglas

1.18 Price

1.19 Lincoln

Retrospective Risk Range 0.72 to 0.90, 17 29.3% 0.90 to 1.00, 12 20.7% 1.00 to 1.05, 7 12.1% 1.05 to 1.13, 13 22.4% 1.13 to 1.20, 9 15.5% No data

WHIO DMV8 Commercial Population Retrospective Risk

Bayfield

Buffalo

Burnett

Crawford

Florence

Forest

Iron

Lafayette

Marquette

Menominee

Pepin

Rusk

Sawyer Washburn

0.59 La Crosse

0.63 Trempealeau

0.65 Vernon

0.70 Monroe

0.74 St Croix

0.78 Grant

0.81 Polk

0.83 Iowa

0.83 Jackson

0.85 Sauk

0.86 Barron

0.86 Pierce

0.88 Douglas

0.90 Eau Claire

0.90 Richland

0.91 Dunn

0.91 Shawano

0.91 Chippewa

0.92 Jefferson

0.92 Sheboygan

0.92 Oconto

0.92 Kewaunee

0.94 Juneau

0.94 Door

0.95 Taylor

0.95 Fond Du Lac

0.95 Brown

0.96 Dodge

0.96 Green

0.97 Walworth

0.97 Washington

0.98 Calumet

0.99 Outagamie

0.99 Columbia

0.99 Manitowoc

1.01 Waupaca

1.01 Adams

1.01 Ozaukee

1.01 Clark

1.02 Rock

1.03 Dane

1.03 Ashland

1.04 Price

1.04 Green Lake

1.04 Waukesha

1.05 Marathon

1.06 Marinette

1.08 Oneida

1.09 Langlade

1.10 Vilas

1.11 Wood

1.11 Winnebago

1.11 Milwaukee

1.12 Portage

1.12 Kenosha

1.13 Waushara

1.17 Lincoln

1.21 Racine

0.58 to 0.88 0.88 to 1.00 1.00 to 1.05 1.05 to 1.12 1.12 to 1.22 No data


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WI: NORTHEASTERN WI: NORTHERN WI: SOUTHEASTERN WI: SOUTHERN WI: WESTERN

0.0

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0.6

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A comparison of Patient Population Relative Risk Using WHIO Datamart v8 Data:

Commercial and Medicaid Patients Age 0 - 17 Relative Risk is a measure of expected resource use derived from

health claims from the preceding 12 months

COM COUNTY RRISK MCD COUNTY RRISK COM 0-17 RRISK MCD 0-17 RRISK


Western Region - Commercial members only

Member CountyNumber of Members

Actual Tota l Bi l led

ERG Retrospective Risk

Risk Index (vs . WI avg)

Actual Bi l led PMPM

Member Months

Risk Adj bi l led PMPM

LA CROSSE 51,438 $168,617,935 0.62 0.59 $300 561,949 $480

EAU CLAIRE 18,944 $88,218,334 0.95 0.90 $518 170,367 $546

CHIPPEWA 11,425 $64,834,500 0.97 0.91 $584 110,966 $603

CLARK 9,457 $60,190,133 1.07 1.01 $580 103,785 $541

MONROE 11,596 $45,257,263 0.74 0.70 $372 121,575 $500

BARRON 7,691 $41,523,981 0.91 0.86 $528 78,613 $582

TREMPEALEAU 10,566 $39,235,320 0.67 0.63 $351 111,812 $526

JACKSON 6,139 $33,039,177 0.88 0.83 $499 66,265 $564

ST. CROIX 8,063 $30,029,812 0.78 0.74 $447 67,202 $570

DUNN 5,782 $29,110,593 0.96 0.91 $532 54,688 $555

PIERCE 5,620 $27,902,124 0.91 0.86 $542 51,445 $595

POLK 4,892 $21,696,822 0.86 0.81 $477 45,530 $553

DOUGLAS 3,210 $13,320,571 0.93 0.88 $425 31,310 $455

Region total 154,823 $662,976,565 0.79 0.75 $421 1,575,507 $532

Southeastern Region - Commercial members onlyMILWAUKEE 200,043 $1,512,074,550 1.18 1.11 $749 2,018,291 $635

WAUKESHA 128,252 $944,325,530 1.11 1.04 $710 1,330,397 $642

RACINE 48,209 $413,448,371 1.28 1.21 $834 495,637 $650

WASHINGTON 43,661 $296,229,552 1.03 0.97 $650 455,589 $632

KENOSHA 29,468 $243,984,339 1.19 1.12 $816 299,028 $686

OZAUKEE 32,346 $239,594,349 1.07 1.01 $701 341,954 $655

JEFFERSON 32,380 $177,489,109 0.97 0.92 $554 320,364 $569

WALWORTH 26,663 $175,661,735 1.03 0.97 $670 262,104 $652

Region total 541,022 $4,002,807,534 1.13 1.07 $725 5,523,364 $640

Wiscosin Total 1,801,300 $11,301,546,514 1.06 1.00 $606 18,651,864 $572

Racine County: Drill down to Practice Level


Family Practice LocationNumber of Providers

Number of Imputed Members

Overall Resource Use Index

Overall Quality Index

BURLINGTON 10 3,371 1.16 0.86

RACINE - EAST 7 3,301 1.12 0.89

SPRING STREET 7 3,242 1.02 0.77

UNION GROVE 3 1,369 1.20 0.96

FOUR MILE RD 3 1,046 1.16 0.97

RACINE - NORTH 2 702 1.08 0.91

BANKERS RD 2 688 1.12 0.89

WATERFORD 2 683 1.14 0.93

DRS SC 2 458 1.11 0.84

Drill down to Service Categories: Overall Resource Use Index


ERHospital Services Laboratory Pharmacy

Primary Care Core Radiology

Specialty Care Summary

DR. A 1.55 1.89 1.44 1.00 1.18 2.17 1.41 1.49 DR. B 1.26 1.17 1.04 1.06 1.17 1.61 1.08 1.16 DR. C 1.15 1.36 1.13 1.26 1.13 1.28 1.11 1.21 DR. D 0.94 1.01 1.05 1.50 0.92 0.91 0.86 1.02 DR. E 1.02 1.38 0.99 1.09 1.09 1.26 1.22 1.21 DR. F 0.51 1.06 1.22 0.66 0.88 1.90 1.46 1.19 DR.G 1.62 1.11 0.74 0.66 0.89 1.37 0.99 0.98 DR. H 1.44 1.11 1.15 0.56 0.93 1.26 1.18 1.04 DR. I 0.57 1.11 1.23 2.20 0.81 1.66 1.21 1.32 DR. J 0.90 1.44 1.45 1.36 0.98 1.64 1.18 1.30 DR. K 0.54 1.54 1.41 1.47 0.84 1.56 1.28 1.33

1.11 1.35 1.20 1.14 0.99 1.49 1.17 1.21

BURLINGTON

BURLINGTON

DRIVERS OF HEALTH CARE COSTS



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TOTAL BILLED AMOUNT WISCONSIN PATIENTS AGE 0 - 17

TOP 20 DISEASE/CONDITION-RELATED TREATMENT CATEGORIES

WHIO DATAMART v8

COM - TOTAL BILLED MCD - TOTAL BILLED

$1.5

B

$1.4

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$2.3

B

$1.8

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$851

M

$840

M

$105

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$530

M

$351

M

$702

M

$494

M

$425

M

$628

M

$304

M

$255

M

$211

M

$423

M

$301

M

$247

M

$264

M

$275

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TOTAL STANDARD COST BY MAJOR PRACTICE CATEGORY

COMMERCIAL MEDICAID MEDICARE

$190,924,001

$154,224,186

$101,762,540 $91,695,383 $82,138,289

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TOTAL STANDARD COST FOR PSYCHIATRY ETGs MEDICAID ONLY, BY TYPE OF SERVICE

Ancillary Facility Inpatient Facility Outpatient Pharmacy Professional Services

Ancillary $57.0 M

7%

Facility Inpatient $185.1 M

22%

Facility Outpatient $43.9 M

5%

Pharmacy $201.9 M

24%

Professional Services $358.3 M

42%

TOTAL STANDARD COST FOR ALL PSYCHIATRY ETGs MEDICAID ONLY, BY TYPE OF SERVICE

Behavioral Health 43%

Other Providers 17%

Home Care 10%

Other Professional

Providers 8%

Psychiatry 7%

Primary Care Specialties

6%

Rehabilitative Services

2%

Nursing Service

Providers 2%

Emergency Medicine

2%

Laboratory 1%

Physicians Assistant

1%

Neurology 0%

All other professionals

1%

TOTAL STANDARD COST FOR ALL PSYCHIATRY ETGs MEDICAID ONLY, BY SERVICE PROVIDER SPECIALTY

Wisconsin Medicaid population (all ages) Disease Prevalence Total Billed cost of care and condition-related treatment

Facility Inpatient

Facility Outpatient Ancillary

Professional Services Pharmacy Total

Depression115,557 $3.2 B

Total Billed PMPM $584 $487 $148 $834 $329 $2,382Disease-related $67 $41 $8 $142 $107 $366 15%

Diabetes65,350 $2.5 B

Total Billed PMPM $1,065 $773 $293 $980 $319 $3,431Disease-related $90 $68 $30 $110 $98 $395 12%

Hypertension81,512 $3.8 B

Total Billed PMPM $1,346 $987 $324 $1,219 $220 $4,096Disease-related $26 $67 $10 $85 $18 $206 5%

Asthma40,023 $977.0 M

Total Billed PMPM $436 $512 $153 $777 $218 $2,097Disease-related $30 $70 $24 $80 $66 $271 13%

Back and Spine, pain or condition54,160 $1.7 B

Total Billed PMPM $580 $689 $165 $1,098 $239 $2,772Disease-related $85 $151 $9 $279 $37 $562 20%

# of Members with Condition

Total Billed - all care for Member

Disease-related Billed Amount% of Billed that is Condition-

related



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INCIDENCE PER 1,000 POPULATION PATIENTS AGE 0 - 17 WITH INDICATION OF ASTHMA

WHIO DATAMART v8

COM MCD COM - REGION MCD - REGION

COM - STATEWIDE MCD - STATEWIDE STATEWIDE AVG


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WI: NORTHEASTERN WI: NORTHERN WI: SOUTHEASTERN

WI: SOUTHERN WI: WESTERN

INCIDENCE PER 1,000 POPULATION PATIENTS AGE 0 - 17 WITH INDICATION OF DEPRESSION

WHIO DATAMART v8

COM MCD COM - REGION MCD - REGION

COM - STATEWIDE MCD - STATEWIDE STATEWIDE AVG

Compare Standardized Total Cost of Care PMPMs by Condition Patient County to Statewide Average

Member County Hypertension

Back & Spine, pain or condition Diabetes Depression Asthma

WI, Milwaukee $4,547 $3,362 $4,634 $3,363 $2,005 WI, Kenosha $4,585 $3,602 $3,979 $2,645 $2,523 WI, Waukesha $4,550 $3,403 $3,368 $2,471 $2,532 WI, Walworth $4,911 $2,747 $3,647 $2,453 $2,042 WI, Brown $4,356 $2,830 $3,477 $2,310 $2,437 WI, Racine $3,859 $3,068 $3,389 $2,507 $2,218 WI, Dane $4,525 $2,654 $3,312 $2,220 $2,090 WI, Waushara $4,099 $3,061 $2,617 $1,903 $2,845 WI, Marinette $4,337 $2,868 $2,696 $2,252 $2,352 WI, St. Croix $4,264 $2,706 $2,481 $2,144 $2,780 ***WI, Monroe $3,273 $1,695 $2,646 $1,848 $1,944 WI, Waupaca $2,759 $2,316 $2,317 $1,930 $1,892 WI, Trempealeau $3,044 $2,059 $2,412 $1,870 $1,620 WI, Grant $2,898 $2,122 $2,233 $1,618 $1,740 WI, Door $3,168 $1,470 $2,200 $1,506 $1,776 Summary $4,096 $2,772 $3,431 $2,382 $2,097


COMPLIANCE WITH EVIDENCE-BASED STANDARDS OF CARE



0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0% N

OR

THEA

STER

N

NO

RTH

ERN

SOU

THEA

STER

N

SOU

THER

N

WES

TER

N

NO

RTH

EAST

ERN

NO

RTH

ERN

SOU

THEA

STER

N

SOU

THER

N

WES

TER

N

NO

RTH

EAST

ERN

NO

RTH

ERN

SOU

THEA

STER

N

SOU

THER

N

WES

TER

N

NO

RTH

EAST

ERN

NO

RTH

ERN

SOU

THEA

STER

N

SOU

THER

N

WES

TER

N

NO

RTH

EAST

ERN

NO

RTH

ERN

SOU

THEA

STER

N

SOU

THER

N

WES

TER

N

NO

RTH

EAST

ERN

NO

RTH

ERN

SOU

THEA

STER

N

SOU

THER

N

WES

TER

N

NO

RTH

EAST

ERN

NO

RTH

ERN

SOU

THEA

STER

N

SOU

THER

N

WES

TER

N

Pt(s) 5 - 40 yrs of age that had an OV for asthma care in

last 12 rpt mos.

Pt(s) betw the ages of 10 and 17 w/

presumed persistent asthma using an inhaled corticosteroid or

acceptable alternative.

Pt(s) between the ages of 5 and 9 with presumed

persistent asthma using an inhaled corticosteroid or

acceptable alternative.

Pt(s) compl w/ presc inhaled

glucocorticoids (minimum

compliance 70%).

Pt(s) compl w/ presc leukotriene

modifier (minimum compliance 70%).

Pt(s) exhibiting problematic asthma

control who had pulmonary or

allergy consult in last 12 rpt mos.

Pt(s) w/ an asthma related hosp or ER encounter in last 3

rpt mos or freq using SABA

inhalers that had an OV in last 3 rpt

mos.

ASTHMA PROCESS QUALITY MEASURES BY PATIENT REGION WISCONSIN COMMERCIAL AND MEDICAID PATIENTS AGE 0-17

WHIO DATAMART v8

COMMERCIAL MEDICAID


88.4%

37.7%

79.8% 81.5% 82.4%

41.4%

72.6% 69.7%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

Pt(s) 18 - 75 yrs of age that had a HbA1c test in last 12

reported mos.

Pt(s) 18 - 75 yrs of age that had an annual screening test

for diabetic retinopathy.

Pt(s) 18 - 75 yrs of age that had annual screening for

nephropathy or evidence of nephropathy.

Pt(s) 18 - 75 yrs of age with a LDL cholesterol in last 12

mos.

Comparison of Compliance with Diabetes Managment National Standard Measures

COMMERCIAL MEDICAID

Comparison by County


WI, Taylor 78.0% WI, Monroe

75.6%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

Compliance Rates - Diabetes Management Measures by Member County

• Compliance with evidence-based standards of care for Diabetes varies across both Commercial and Medicaid populations

• In some counties, Medicaid members are overall more compliant than Commercial members for these Diabetes Management measures

• In 16 counties the difference in compliance rates was 3 points or less

Medicaid Diabetics are Higher Risk


20%

6%

29%

20%

0%

5%

10%

15%

20%

25%

30%

35%

Lowest risk Highest risk

Diabetic Members Risk Distrubtion

Commercial Diabetics Medicaid Diabetics

Both populations have incidence of Diabetes with Depression


10,052 14,691

0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

COM Diabetics MCD Diabetics

Diabetes with Depression

no indication of Depression also has Depression

• 15% of COM diabetics have indication of depression

• 23% of MCD diabetics have indication of depression

$0 M

$20 M

$40 M

$60 M

$80 M

$100 M

$120 M

Dia

bete

s

Moo

d di

sord

er, d

epre

ssed

Atte

ntio

n de

ficit

diso

rder

Ast

hma

Hyp

erlip

idem

ia, o

ther

Hyp

erte

nsio

n

Mul

tiple

scl

eros

is

Moo

d di

sord

er, b

ipol

ar

Join

t deg

ener

atio

n, lo

caliz

ed

Psy

chot

ic &

sch

izop

hren

ic …

Infla

mm

atio

n of

eso

phag

us

Adu

lt rh

eum

atoi

d ar

thrit

is

Infla

mm

ator

y bo

wel

dis

ease

Isch

emic

hea

rt di

seas

e

Epi

leps

y

Pso

riasi

s

Con

trace

ptiv

e m

anag

emen

t

Oth

er n

euro

psyc

holo

gica

l or …

Acn

e

Mig

rain

e he

adac

he

Chr

onic

obs

truct

ive

pulm

onar

y …

Chr

onic

sin

usiti

s

Anx

iety

dis

orde

r or p

hobi

as

AID

S

Hem

ophi

lia

TOP 25 ETG FAMILIES IN PHARMACY COST RANKED BY COMBINED STANDARD COST

COMMERCIAL MEDICAID

LEVERAGING VALUE-BASED PURCHASING


Family Practice

0.9

0.95

1

1.05

1.1

0.8 0.85 0.9 0.95 1 1.05 1.1 1.15 1.2

OVE

RAL

L Q

UAL

ITY

IND

EX

OVERALL STANDARD COST INDEX

PROVIDER NETWORK ASSESSMENT FAMILY PRACTICE PEER GROUP DATAMART RELEASE OCTOBER 2011

MILWAUKEE, RACINE, AND WAUKESHA COUNTY HEALTH SYSTEM PROVIDERS

WHEATON FRANCISCAN HEALTHCARE - SOUTHEAST WISCONSIN INC AMG AURORA MEDICAL GROUP CORPORATE OFFICE AURORA ADVANCED HEALTHCARE INC COLUMBIA ST MARYS INC - COLUMBIA CAMPUS FROEDTERT HEALTH PROHEALTH SOLUTIONS LLC

Internal Medicine

0.90

0.95

1.00

1.05

1.10

0.80 0.85 0.90 0.95 1.00 1.05 1.10 1.15 1.20

OVE

RAL

L Q

UAL

ITY

IND

EX

OVERALL STANDARD COST INDEX

PROVIDER NETWORK ASSESSMENT INTERNAL MED PEER GROUP DATAMART RELEASE OCTOBER 2011

MILWAUKEE, RACINE, AND WAUKESHA COUNTY HEALTH SYSTEM PROVIDERS

WHEATON FRANCISCAN HEALTHCARE - SOUTHEAST WISCONSIN INC AMG AURORA MEDICAL GROUP CORPORATE OFFICE AURORA ADVANCED HEALTHCARE INC COLUMBIA ST MARYS INC - COLUMBIA CAMPUS FROEDTERT HEALTH PROHEALTH SOLUTIONS LLC

Wheaton Family Practice Peers by Location

0.80

0.85

0.90

0.95

1.00

1.05

1.10

0.80 0.90 1.00 1.10 1.20 1.30 1.40 1.50 1.60

WHIO DATA MART RELEASE OCTOBER 2011 PROVIDER NETWORK ASSESSMENT

Bubble size relates to # of Episodes at the location

METRO PHYSICIANS WHEATON FRANCISCAN HEALTHCARE WHEATON FRANCISCAN MEDICAL GROUP

Wheaton Franciscan Medical Group – Rawson Medical Clinic

Wheaton Franciscan Healthcare – All Saints Spring Street Campus

Rawson Medical Clinic - Quality

0.90

0.95

1.00

1.05

1.10 P

t(s) t

akin

g an

NS

AID

med

.

Pt(s

) tha

t had

a s

erum

cr

eatin

ine

in la

st 1

2 rp

t mos

.

Pt(s

) tha

t had

an

annu

al

phys

icia

n vi

sit.

Pt(s

) tha

t had

a s

inus

CT

or

MR

I tes

t.

Pt(s

) tha

t had

a s

inus

ra

diog

raph

ic te

st.

Pt(s

) w/ a

HD

L ch

oles

tero

l te

st in

last

12

rpt m

os.

Pt(s

) w/ a

LD

L ch

oles

tero

l te

st in

last

12

rpt m

os.

Pt(s

) w/ a

trig

lyce

ride

test

in

last

12

rpt m

os.

Pt(s

) 18

- 75

yrs

of a

ge th

at

had

an a

nnua

l scr

eeni

ng

test

for d

iabe

tic re

tinop

athy

.

Pt(s

) 18

- 75

yrs

of a

ge th

at

had

annu

al s

cree

ning

for

neph

ropa

thy

or e

vide

nce …

Pt(s

) 18

- 75

yrs

of a

ge w

ith

a LD

L ch

oles

tero

l in

last

12

mos

.

HTN Sinusitis, Acute Hyperlipidemia Diabetes (NS)

Wheaton Franciscan Medical Group - Rawson Medical Clinic Quality Index for top volume process measures

Quality Index Peer group average

Rawson Medical Clinic - Cost

0.00 0.20 0.40 0.60 0.80 1.00 1.20 1.40

Hyp

erte

nsio

n

Hyp

erlip

idem

ia, o

ther

Acu

te b

ronc

hitis

Acu

te s

inus

itis,

w/o

su

rger

y To

nsill

itis,

ade

noid

itis

or

phar

yngi

tis, w

/o s

urge

ry

Otit

is m

edia

, w/o

sur

gery

Dia

bete

s, w

/o s

urge

ry

Hyp

o-fu

nctio

ning

thyr

oid

glan

d, w

/o s

urge

ry

Moo

d di

sord

er,

depr

esse

d

Ast

hma

Infe

ctio

n of

low

er

geni

tour

inar

y sy

stem

, …

Oth

er m

inor

orth

oped

ic

diso

rder

s - b

ack

Nut

ritio

nal d

efic

ienc

y,

w/o

sur

gery

A

nxie

ty d

isor

der o

r ph

obia

s

Bac

teria

l inf

ectio

n of

ski

n

Wheaton Franciscan Medical Group - Rawson Medical Clinic Total Standard Cost Index by top volume ETGs

Total Std Cost Index Peer Group Avg

All Saints Spring St. - Quality

0.00

0.20

0.40

0.60

0.80

1.00

1.20 Pt

(s) t

hat h

ad a

sin

us C

T or

MR

I te

st.

Pt(s

) tha

t had

a s

inus

ra

diog

raph

ic te

st.

Pt(s

) tak

ing

an N

SAID

med

.

Pt(s

) tha

t had

an

annu

al p

hysi

cian

vi

sit.

Pt(s

) tha

t had

a s

erum

cre

atin

ine

in la

st 1

2 rp

t mos

.

Pt(s

) w/ a

dx

of U

RI t

hat d

id n

ot

have

a p

resc

for a

n ab

x on

or 3

dy

s af

ter t

he in

itiat

ing

visi

t.

Pt(s

) tha

t had

a b

lood

glu

cose

te

st in

last

12

rpt m

os.

Adul

t(s) w

/ a H

DL

chol

este

rol t

est

in la

st 1

2 rp

t mos

.

Adul

t(s) w

/ a L

DL

chol

este

rol t

est

in la

st 1

2 rp

t mos

.

Adul

t(s) w

/ a tr

igly

cerid

e te

st in

la

st 1

2 rp

t mos

.

Pt(s

) 16

- 24

yrs

of a

ge th

at h

ad a

ch

lam

ydia

scr

eeni

ng te

st in

last

12

rpt m

os.

Pt(s

) 18

- 75

yrs

of a

ge th

at h

ad

an a

nnua

l scr

eeni

ng te

st fo

r di

abet

ic re

tinop

athy

. Pt

(s) 1

8 - 7

5 yr

s of

age

that

had

an

nual

scr

eeni

ng fo

r nep

hrop

athy

or

evi

denc

e of

nep

hrop

athy

.

Pt(s

) 18

- 75

yrs

of a

ge w

ith a

LD

L ch

oles

tero

l in

last

12

mos

.

Sinusitis, Acute HTN URI (NS) Obesity and Overweight Chlamydia Scrn (NS) Diabetes (NS)

Wheaton Franciscan Healthcare - All Saints Spring Street Campus Quality Index for top volume process measures

Quality Index Peer Group Average

All Saints Spring St. - Cost

0.00

0.20

0.40

0.60

0.80

1.00

1.20

1.40 To

nsill

itis,

ade

noid

itis

or

phar

yngi

tis, w

/o s

urge

ry

Otit

is m

edia

, w/o

sur

gery

Acu

te b

ronc

hitis

Hyp

erte

nsio

n

Acu

te s

inus

itis,

w/o

su

rger

y In

fect

ion

of lo

wer

ge

nito

urin

ary

syst

em, …

Obe

sity

, w/o

sur

gery

Ast

hma

Chr

onic

sin

usiti

s, w

/o

surg

ery

Dia

bete

s, w

/o s

urge

ry

Bac

teria

l inf

ectio

n of

ski

n

Oth

er m

inor

orth

oped

ic

diso

rder

s - b

ack

Hyp

erlip

idem

ia, o

ther

Con

junc

tiviti

s

Moo

d di

sord

er,

depr

esse

d

Wheaton Franciscan Healthcare - All Saints Spring Street Campus Total Standard Cost Index for top volume ETGs

Total Std Cost Index Peer Group Average

All Saints Spring St - Providers

0.6

0.7

0.8

0.9

1

1.1

1.2

1.3

1.4

0.60 0.70 0.80 0.90 1.00 1.10 1.20 1.30 1.40

Ove

rall

Qua

lity

Inde

x

Overall Std Cost Index

Wheaton Franciscan Healthcare - All Saints Spring Street Campus Family Practice Peer Group

Individual Provider Cost and Quality Indices

Above Avg Std Cost, Statistically significant Std Cost Index, no statistical significance Below Avg Std Cost, Statistically significant

WHIO ETF Analysis

ETF Member Comparisons to WHIO Commercial and WI Medicaid

Population Demographics


11.1% 11.6% 10.2% 9.5% 10.4% 9.5%

17.3% 15.5%

1.7% 2.0% 0.7% 0.6%

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

F M F M F M F M F M F M

00-17 18-30 31-44 45-64 65-74 75+

WHIO COMMERCIAL POPULATION: ETF vs NON-ETF

ETF not ETF

Episode-based analysis using Episode Treatment Groups (ETGs)

ETGs are a basic illness classification methodology that combine medical and pharmacy services into mutually exclusive and exhaustive categories — they provide a medically meaningful statistical unit representing a complete episode of care.


ETF Members Total Billed and Episode Volume

by Major Practice Category


$448,657,443

$261,687,461

$198,681,549

0

20,000

40,000

60,000

80,000

100,000

120,000

140,000

160,000

180,000

200,000

$ M

$50 M

$100 M

$150 M

$200 M

$250 M

$300 M

$350 M

$400 M

$450 M

$500 M

# of

Epi

sode

s

Tota

l Bill

ed

Total Billed # of Episodes

There are over 800 Episode Treatment Groups (ETGs); they are grouped into clinical Major Practice Categories

Proportion of Total Billed Charges ETF vs. Non-ETF Comparison

by Major Practice Category


21.7

%

9.9%

9.5%

5.9%

5.8%

5.7%

5.2%

3.8%

4.8%

4.1%

4.1%

3.6%

3.7%

2.2%

2.7%

1.8%

1.4%

1.2%

1.1%

0.7%

0.5%

0.4%

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

30.00%

Orth

oped

ics

and

Rhe

umat

olog

y

Car

diol

ogy

Gas

troen

tero

logy

Endo

crin

olog

y

Gyn

ecol

ogy

Neu

rolo

gy

Oto

lary

ngol

ogy

Pulm

onol

ogy

Psyc

hiat

ry

Prev

enta

tive

and

Adm

inis

trativ

e

Der

mat

olog

y

Uro

logy

Obs

tetri

cs

Hem

atol

ogy

Oph

thal

mol

ogy

Hep

atol

ogy

Neo

nato

logy

Nep

hrol

ogy

Infe

ctio

us D

isea

ses

Che

mic

al D

epen

denc

y

Late

Effe

cts,

Env

ironm

enta

l Tra

uma

and

Pois

onin

gs

Isol

ated

Sig

ns a

nd S

ympt

oms

ETF non ETF Commercial

Ranking and relative proportion of total charges is consistent between ETF and non-ETF Commercial populations

ETF Members Top 20 Episode Families - # of Episodes


$0

$40,000,000

$80,000,000

$120,000,000

$160,000,000

$200,000,000

$240,000,000

0

20,000

40,000

60,000

80,000

100,000

120,000

Episodes Total Billed

Episode Families are intermediate categories between Major Practice Category and ETG

“Visual disturbances” are eye exams, refraction, eyeglass fitting, etc.

Proportion of Total Episodes Comparison for Top 20 High Volume Episode Families


9.8%

4.1%

3.9%

3.1%

2.9%

2.9%

2.3%

2.1%

2.0%

2.0%

1.9%

1.6%

1.6%

1.6%

1.5%

1.4%

1.4%

1.4%

1.2%

1.2%

0.00%

2.00%

4.00%

6.00%

8.00%

10.00%

12.00%

14.00%

non ETF Commercial non ETF Medicaid ETF

Top Episode Families • Routine Exam plus the other top 5 episode families account for

24-25% of total billed in both ETF and non ETF Commercial populations


Total Billed % of Total Billed Episode Family ETF not ETF ETF not ETFtop 20 families Joint degeneration, localized $171.9 M $1.0 B 10.12% 10.25%

Ischemic heart disease $59.4 M $418.9 M 3.50% 4.13%Pregnancy, with delivery $54.0 M $300.0 M 3.18% 2.96%Joint derangement $47.1 M $275.3 M 2.78% 2.72%Routine exam $41.3 M $252.1 M 2.43% 2.49%Hypertension $34.3 M $245.5 M 2.02% 2.42%Malignant neoplasm of breast $32.5 M $225.7 M 1.91% 2.23%Diabetes $32.7 M $223.5 M 1.92% 2.21%Mood disorder, depressed $37.1 M $174.0 M 2.19% 1.72%Closed fracture or dislocation $29.0 M $176.1 M 1.71% 1.74%Non-malignant neoplasm of female genital tract $23.2 M $140.5 M 1.37% 1.39%Non-malignant neoplasm of intestines & abdomen $24.0 M $129.6 M 1.41% 1.28%Inflammation of esophagus $20.7 M $129.4 M 1.22% 1.28%Chronic sinusitis $24.5 M $122.0 M 1.44% 1.20%Minor orthopedic trauma $23.2 M $118.2 M 1.37% 1.17%Hyperlipidemia, other $15.5 M $119.4 M 0.91% 1.18%Other minor orthopedic disorders $21.7 M $104.7 M 1.28% 1.03%Cerebral vascular accident $16.0 M $101.9 M 0.94% 1.01%Chronic renal failure $15.4 M $100.2 M 0.90% 0.99%Cataract $13.9 M $69.4 M 0.82% 0.69%

all other $960.5 M $5669.3 M 56.57% 55.94%Grand Total $1.7 B $10.1 B 100.00% 100.00%

ETF Members Top 5 Total Billed Episode Families – ETG Detail


0

10000000

20000000

30000000

40000000

50000000

60000000

70000000

Back

Knee

& lo

wer

leg

Nec

k

Thig

h, h

ip &

pel

vis

Shou

lder

Foot

& a

nkle

Han

d, w

rist &

fore

arm

unsp

ecifi

ed

Elbo

w &

upp

er a

rm

Isch

emic

hea

rt di

s

Preg

nanc

y, d

eliv

ered

Knee

& lo

wer

leg

Shou

lder

Han

d, w

rist &

fore

arm

Thig

h, h

ip &

pel

vis

Foot

& a

nkle

Elbo

w &

upp

er a

rm

unsp

ecifi

ed

Hyp

erte

nsio

n

Joint degeneration, localized IHD OB Joint derangement Hypertension

c-section vaginal delivery w/o surgery with surgery HTN

Non ETF Commercial Members Top 5 Total Billed Episode Families – ETG Detail


0

50000000

100000000

150000000

200000000

250000000

300000000

350000000

400000000

450000000

Back

Knee

& lo

wer

leg

Nec

k

Thig

h, h

ip &

pel

vis

Shou

lder

Foot

& a

nkle

Han

d, w

rist &

fore

arm

unsp

ecifi

ed

Elbo

w &

upp

er a

rm

Isch

emic

hea

rt di

s

Preg

nanc

y, d

eliv

ered

Knee

& lo

wer

leg

Shou

lder

Han

d, w

rist &

fore

arm

Thig

h, h

ip &

pel

vis

Foot

& a

nkle

Elbo

w &

upp

er a

rm

unsp

ecifi

ed

Hyp

erte

nsio

n

Joint degeneration, localized IHD OB Joint derangement Hypertension

c-section vaginal delivery w/o surgery with surgery HTN

REGIONAL VARIATION IN PER-EPISODE RESOURCE USE

Examples


Hypertension Episodes Regional Variation in Average Billed


$0

$1,000

$2,000

$3,000

$4,000

$5,000

$6,000

ETF not ETF ETF not ETF ETF not ETF ETF not ETF

1 2 3 4

by Episode Severity Level


Hypertension Episodes Regional variation in Average Resource Use


0

500

1000

1500

2000

2500

3000

3500


1 2 3 4



Ischemic Heart Disease w/o Surgery Episodes Regional Variation in Average Billed


$0

$10,000

$20,000

$30,000

$40,000

$50,000

$60,000


1 2 3 4



Ischemic Heart Disease w/o Surgery Episodes Regional variation in Average Resource Use


0

10,000

20,000

30,000

40,000

50,000

60,000


1 2 3 4



Joint Degeneration, Knee & Lower Leg w/ Surgery Episodes Regional Variation in Average Billed


$0

$10,000

$20,000

$30,000

$40,000

$50,000

$60,000

$70,000

$80,000

$90,000

ETF not ETF ETF not ETF ETF not ETF

1 2 3



Joint Degeneration, Knee & Lower Leg w/ Surgery Episodes Regional Variation in Average Resource Use


0

5,000

10,000

15,000

20,000

25,000

30,000

35,000

40,000

ETF not ETF ETF not ETF ETF not ETF

1 2 3



ETF Members Joint Degeneration, Knee & Lower Leg w/ Surgery

Average Billed per Episode by Health Plan


$0

$10,000

$20,000

$30,000

$40,000

$50,000

$60,000

$70,000

$80,000

$90,000

Plan A (n=236)

Plan B (n=63)

Plan C (n=77)

Plan D (n=90)

Plan E (n=94)

Plan F (n=155)

Plan G (n=38)

Plan H (n=108)

Average Billed per Episode

Severity 1 Severity 2 Severity 3

Top 10 Health Systems


$434 M

$159 M $119 M $115 M

$45 M $34 M $32 M $31 M $29 M $29 M

$0 M $50 M

$100 M $150 M $200 M $250 M $300 M $350 M $400 M $450 M $500 M

UW

HEA

LTH

DEA

N/S

T M

ARYS

JO

INT

VEN

TUR

E (S

MD

V)

MER

ITER

HO

SPIT

AL

AMG

AU

RO

RA

MED

ICAL

GR

OU

P C

OR

POR

ATE

OFF

ICE

FRO

EDTE

RT

HEA

LTH

WH

EATO

N F

RAN

CIS

CAN

H

EALT

HC

ARE

- SO

UTH

EAST

W

ISC

ON

SIN

INC

CO

LUM

BIA

ST M

ARYS

INC

- C

OLU

MBI

A C

AMPU

S

MER

CY

HEA

LTH

SYS

TEM

C

OR

POR

ATIO

N

BELL

IN H

EALT

H &

TH

EDAC

ARE

PHYS

ICIA

N P

ARTN

ERS

LTD

MAY

O C

LIN

IC H

EALT

H S

YSTE

M

ETF Member Total Billed Charges

ETF has smaller % of members with $0 claims; and with $1 - $5,000


11.57%

70.26%

22.10%

$1 - 5,000 79.56%

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

90.00%

100.00%

Range of annual Billed Amount per member

DISTRIBUTION OF MEMBERS BY BILLED CLAIMS RANGE

ETF % Members Non-ETF COM % Members

ETF Members have more episodes


4.49 4.76

4.22 4.44

3.49 3.69

3.91 3.75 3.69

3.21

0.00

1.00

2.00

3.00

4.00

5.00

6.00

WI: NORTHEASTERN

WI: NORTHERN WI: SOUTHEASTERN

WI: SOUTHERN WI: WESTERN

ANNUAL EPISODES PER MEMBER

ETF Non ETF COM

More members with multiple episodes


16.3% 16.5% 15.2%

52.0%

23.6% 19.8%

15.9%

40.8%

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

1 2 3 4 or more episodes annually

% o

f Mem

bers

# of Episodes in 1 year

ETF Non ETF COM


1.30

1.48

1.29 1.37

1.15

1.03

1.12 1.12

0.97

0.78

1.34

1.03

0.00

0.20

0.40

0.60

0.80

1.00

1.20

1.40

1.60


ETF HAS HIGHER RETROSPECTIVE "RISK"

ETF Non ETF COM ETF Statewide Non ETF COM Statewide


0.00

0.20

0.40

0.60

0.80

1.00

1.20

1.40

1.60

1.80

PLAN A PLAN B PLAN C PLAN D PLAN E PLAN F PLAN G

SOUTHERN REGION HEALTH PLANS ETF HAS HIGHER RETROSPECTIVE "RISK"

Plan ETF Southern Overall Non ETF Southern Overall


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with confidence

Discussion

Thank you!

Jo Musser, CEO [email protected]

(608) 442-3877

wisconsin health information organization...

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