Public-Private Collaboration
in Health Information Policy

Milbank Memorial Fund
Reforming States Group

June 1999
 
 

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Table of Contents Foreword Acknowledgments Introduction Guiding Principles of Public-Private Collaborations Common PointsóKeys to Success Project Descriptions   Delaware   Kansas   Maine   Maryland   Massachusetts   Minnesota   Oregon   Pennsylvania   Utah   Wisconsin

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Foreword

The concern that managed care has provoked among consumers and providers is also the source of significant changes in the relationship between business and government purchasers of health care. This report distills the experience of public and private sector purchasers who are collaborating on information policy in their states in order to enhance the accountability of managed care organizations.

The report is a result of the ongoing collaboration between the Reforming States Group (RSG) and the Milbank Memorial Fund. The RSG, organized in 1992, is a voluntary association of leaders in health policy in the legislative and executive branches of government, currently from over forty states. The Fund is an endowed national foundation, established in 1905, that works with decision makers in the public and private sectors to carry out nonpartisan analysis, study, research and communication on significant issues in health policy.

The purpose of the report is to communicate to colleagues in state government and business what some of their peers have learned about acquiring and assessing useful information from health plans and providers. In 1995, the RSG and the Fund convened purchasers from business and government in six states to explore common interests. The report on this series of meetings, Information for Accountability in Health Care Purchasing, was distributed a year later. Over the next two years, the RSG discussed information policy at its annual regional meetings and provided on-site assistance to colleagues in several states.

In 1998, the RSG and the Fund, joined by the National Association of Health Data Organizations and the U.S. Health Resources and Services Administration, convened business and government colleagues from ten states to share recent experiences of collaboration on information policy. This meeting, like those that preceded it, focused on policy rather than on technology and on lessons that might be adapted elsewhere rather than on prescriptions for policy.

The RSG and the Fund then convened a small group of government and business colleagues to decide what should be said in this report. A third of the members of this group had participated in every RSG discussion on information policy since 1995. The members of the drafting group are identified in the Acknowledgments, along with the persons who attended the ten-state meeting. John Colmers, Executive Director, Maryland Health Care Access and Cost Commission, and Chair of the RSG, wrote the report.

Persons representative of the readers for whom the report is intended reviewed it in draft. After persons in the ten-state group had improved it, leaders of state government suggested other improvements during the 1998 RSG regional meetings.

John M. Colmers
Chair, Reforming States Group
Executive Director, Maryland Health Care
Access and Cost Commission

Daniel M. Fox President
Milbank Memorial Fund

Sandy Praeger
Immediate Past Chair,
Reforming States Group Chair
Public Health and Welfare Committee
Kansas Senate

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Acknowledgments

The following persons participated in meetings to plan this report and/or reviewed it in draft. They are listed in the positions they held at the time of their participation.

Alice M. Chapin, President, Maine Health Information Center; John M. Colmers, Vice Chair, Reforming States Group (RSG) Steering Committee and Executive Director, Maryland Health Care Access and Cost Commission; Kevin Concannon, Commissioner, Maine Department of Human Services; Gene Davis, Member, Appropriations Subcommittee on Health and Human Services, Utah House of Representatives; Mark Gibson, Policy Advisor for Health Care, Human Services and Labor, Office of the Governor of Oregon; Lee Greenfield, Immediate Past Chair, RSG Steering Committee and Chair, Health and Human Services Finance Division, Minnesota House of Representatives; Philip J. Griffin, Manager, Human Resources, Northwest Natural Gas Company, Portland, Ore.; Peter F. Hayes, Manager of Employment Benefits, Hannaford Brothers Company, Scarborough, Maine; Clark Hinckley, Senior Vice President, Corporate Human Resources Director, Zions Bancorporation, Salt Lake City, Utah; Daniel Hoffman, Secretary, Pennsylvania Department of Health; Mary B. Kennedy, Medicaid Director and Assistant Commissioner, Health Care, Minnesota Department of Human Services; Richard Lord, Senior Vice President, Associated Industries of Massachusetts; Denise Love, Past Chair, National Association of Health Data Officers and Director, Office of Health Data Analysis, Utah Department of Health; Brian McHale, Chair, Subcommittee on Health, Maryland House of Delegates; S. Peter Mills, Member, Taxation and Labor Committee, Maine Senate; Paul W. Nannis, Director, Office of Planning, Evaluation and Legislation, Health Resources and Services Administration, U.S. Department of Health and Human Services; Robert Politzer, Chief, Workforce Analysis and Research Branch, Office of Research and Planning, Bureau of Health Professions, Health Resources and Services Adminstration, U.S. Department of Health and Human Services; Sandy Praeger, Chair, RSG Steering Committee and Chair, Public Health and Welfare Committee, Kansas Senate; Chris Queram, Chief Executive Officer, Employer Health Care Alliance Cooperative, Madison, Wisc.; Paula Roy, Executive Director, Delaware Health Commission; Barbara Rudolph, Acting Director, Office of Health Care Information, Wisconsin Department of Health and Family Services; Elizabeth Saadi, Director, Office of Health Care Information, Kansas Department of Health and Environment; Ernest J. Sessa, Consultant, Harrisburg, Pa.; Michael Stapley, President and Chief Executive Officer, Deseret Mutual Benefit Administrators, Salt Lake City, Utah; Barbara Erban Weinstein, Commissioner, Health Care Finance and Policy Division, Massachusetts Executive Office of Health and Human Services; and Barbara Zavodny, Manager, Benefits, McCormick and Company, Sparks, Md.

The following persons were part of a drafting committee for the report that met in San Francisco in June 1998: John M. Colmers, Denise Love, Sandy Praeger, Chris Queram, Paula Roy, Barbara Rudolph, Ernest J. Sessa, and Michael Stapley.

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Introduction

Significant changes in the health care delivery system over the past five years have dramatically altered the manner in which many Americans receive health care services. The growth of managed care and of integrated systems of providers has modified decades-old relationships among patients, providers, and plans. Less noticed in all this turmoil is an equally important change in the previous order, namely, the more frequent instances of cooperation between public and private purchasers in the collection, interpretation, and dissemination of health information. Indeed, the increase in collaboration can be seen as an outgrowth of the broader trends of accountability, consumerism, and performance measurement.

This report documents a range of collaborations in a number of states and identifies a series of principles that guide these efforts. The goal is to encourage further joint ventures and, ultimately, to improve the quality of care for individuals and populations. This report stems from a series of meetings organized by the Reforming States Group (RSG) in collaboration with the Milbank Memorial Fund, the National Association of Health Data Organizations (NAHDO), and the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services. Participating in these meetings were representatives from the executive and legislative branches of ten invited states and their partners in the private sector.

Listed alphabetically below are the ten states that participated in these meetings and a brief summary of a collaborative project that is ongoing in each one. In many of these states, several collaborative data activities are underway simultaneously. For purposes of this report, each state was asked to focus on only one such endeavor. Detailed descriptions of the projects follow this report.

Delaware

The Delaware Health Information Network, which operates under the direction and control of the Health Care Commission, was created by the state legislature in 1997. The legislation established a board of directors and outlined a broad framework of responsibilities for the network: promoting efficient and effective communication among health care providers, payers, and employers; eliminating redundancy in data capture and storage; and reducing administrative billing and data collection costs.

Kansas

Voluntary collaboration of public and private payers has occurred through the Accountability in Health Care Purchasing Milbank Memorial Fund Work Group, which has completed a Consumer Assessment of Health Plan Survey (CAHPS) pilot project for the Research Triangle Institute (RTI). The survey covered Medicare, Medicaid, the state employees group, the Insurance Department, and the private sector. The group is developing quality indicators for value-based purchasing.

Maine

The Maine Health Management Coalition, a nonprofit group of thirty businesses in Maine, is collaborating with providers and state agencies to establish a database of employers, health plan members, and claims. The data are being processed and analyzed in partnership with the Maine Health Information Center, a health data organization that manages a wide range of health care databases and operates the Maine Community Health Information Network.

Maryland

Maryland has developed and distributed statewide and customized purchaser-specific HMO performance report cards. Three versions of the report card are available (consumer, comprehensive, and policy), each designed for its respective audience.

Massachusetts

The Massachusetts Healthcare Purchasers Group, a coalition of both private and public employers representing over one million covered lives, was formed in 1993 to provide purchasers with more information and clout in the health care marketplace. The coalition has evaluated health plan performance against a common set of purchasing specifications, has issued consumer report cards containing both quality and consumer satisfaction data, and has analyzed the cost components of HMO premiums.

Minnesota

Minnesota expanded its data collection during the period of health care reform that took place in the early 1990s, and it also created a public-private partnership, known as Minnesota Health Data Institute (MHDI). The data are available to purchasers, consumers, and researchers, with purchasers acting as the strongest supporters of data collection. Minnesota also contributes to the preparation of health plan report cards for public and private plans.

Oregon

Health plan data collection and collaborative purchasing are emerging as a result of periodic meetings of large public and private health purchasers. The Oregon Health Care Purchasers Coalition agreed to sponsor a joint effort with health plans, purchasers, providers, and state agencies to survey members of eleven area health plans (six HMOs and five PPOs). The Research Triangle Institute was a consultant for the survey, which was part of the (CAHPS) demonstration and evaluation project.

Pennsylvania

Members of the Pennsylvania Health Care Cost Containment Council consist of purchasers, providers, state government, and insurers. Its database includes hospital discharge information, payment data from payers, admission severity and morbidity data (using a proprietary system), small area analysis data, select outpatient data, and hospital financial and utilization information.

Utah

The Utah Health Information Network (UHIN) is owned by competing health plans, health care providers, employers, and state government. UHIN performs three major functions: standardizing electronic formats; transacting a broad range of electronic operations; and providing administrative data to the state health statistical database.

Wisconsin

The Bureau of Health Care Information is a state agency with a board of directors from the private sector that shares the responsibility for rule making with the Secretary of the Health Department. The board is composed of representatives from the medical society, the hospital association, and business. The Bureau is expanding the pool of data collected from hospitals and ambulatory surgery facilities to include physicians.

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Guiding Principles of Public-Private Collaborations

Leaders of the public and private sectors in the ten states identified the principles that guided their collaborative projects. These principles have been applied either to the collaborative process generally or to the data collection and reporting activities that were the object of the collaboration. There was considerable overlap among the states in their selection of principles. Each consortium shared examples of how its members have translated these principles into action.

The members of the group also recognized an overarching premise that deserved special attention. These health care leaders in the public and private sectors agreed that data collection cannot be divorced from policy or politics. More simply stated, Data collection for its own sake is not sustainable in the long run. The leaders identified the following principles:

Value purchasing

A broader marketplace objective is slowly replacing strict cost containment: that of obtaining value. Although broadly conceived to be a combination of price and quality, value can be categorized according to measures of productivity, employee retention, long-term costs, and improvement of individual and community health status. Moreover, the definition of value and its measurement are not immutable: both change over time. Public and private purchasers recognize that the definition of value depends on the persons to whom they are accountable (voters and shareholders, among others). Consequently, each participant in a collaborative enterprise may subscribe to a different definition of value. Finally, the participants noted that quality, as a component of value, could be defined along a number of dimensions:

• Service quality
• Technical quality
• Choice
• Access

Accountability

Accurate and timely information that is widely available in the health care market is essential to maintaining the accountability of all participants. For too long, information on the health care industry has been either closely guarded or, if publicly available, inaccessible, and oftentimes it is retained in the files of multiple organizations. Public and private purchasers recognize the value of placing this information in the public domain in a format that allows for easy interpretation by a variety of audiences. Further, the purchasers' focus on accountability pushes provider organizations to improve systems, processes, and outcomes of care.

Transparency

The methods for arraying and distributing relevant information to the various audiences should be transparent, a word borrowed from the financial services industry and its regulators. Transparent information is readily accessible, concise, and free of unnecessary complexity or jargon. This requires that the data presented be targeted to the information needs of the intended audience. The graphic presentation and content should support clear and simple decision making. Simplicity is essential, and knowledge, rather than data, should be emphasized. Understanding the information needs of the users and tailoring the material to those needs appropriately places the burden on the compilers of the information rather than on the users. Transparency often requires the various collectors of health information within a collaboration to work to eliminate redundancy so that information is collected only once within a community and then displayed logically and informatively for the appropriate audiences.

Confidentiality

All successful collaboration projects have taken the initiative in addressing the issue of privacy and confidentiality. An absolute commitment to the confidentiality of personally identifiable patient information does not conflict with holding the health care system accountable. Technical solutions, like encryption and advanced security protocols, can lessen the risk of exposure and should be coupled with severe penalties for unauthorized release. The objective of the system is to answer questions of what happened, why, and at what cost over time. It is important to identify the populations that experience the events being examined while fiercely protecting the names of the individuals involved as a matter of policy.

Standardization

The multiplicity of information systems increases the likelihood that data elements are not similarly defined or measured. Although standardization in measurement is critical for comparison, it should not be allowed to paralyze all efforts to move forward. Early identification of dissimilarities, combined with incremental steps toward their elimination, should be encouraged. The process of developing standards is collaborative: the needs of data users must be considered as well as the impact of external forces, such as changes in health care interventions and information technology.

Feedback to users

Successful programs have developed ways of reporting the information back to decision makers in a timely and usable fashion. Transmitting the information to those with the ability to implement change enhances the likelihood of success. Sophisticated information systems have been used to identify practice variations and to report the information to physicians in an educational and nonconfrontational manner.

Realism

Although creating a vision of an ideal health information system is important to defining goals and creating direction, successful collaborations do not blindly adhere to their original vision. Instead, they are committed to finding practical interim solutions to the very complicated problems of data collection, analysis, synthesis, and distribution. The "good" is not the enemy of the "perfect."

Evolution

The long-term commitment that is required of the parties to a successful collaboration means that the details of the project will evolve over time as users respond to its output. By paying attention to the feedback on the usefulness of their reports, the collaborators are continually changing what they measure, how they go about doing it, and the means they use to communicate the results. By agreeing to long-term goals and keeping them firmly in mind, leaders of the projects from both the public and private sectors can work to ensure that such changes do not threaten the collaboration.

Open-mindedness

Stereotypes are anathema to successful collaboration. These public- and the private- sector purchasers have discarded the stereotypes of inviolate ERISA (Employee Retirement and Income Security Act) preemption and rigid government regulations. The ability of organizations (for example, of payers) that are otherwise competitors in the marketplace to cooperate in establishing data standards has been essential to collaborative efforts. Similarly, payers' and providers' willingness to overcome preconceived notions of their colleagues' positions has allowed them to achieve considerable success.

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Common Points
Keys to Success

Although each example of successful public-private collaboration on health care data is unique, certain characteristics are common to all.

Credibility

Credibility is the single most important quality of an information initiative. The most successful programs have produced results or information that are compelling, relevant, reliable, accurate, and sufficient. Thus, persons who use the information can focus on the conclusions without being distracted by doubts about their believability.

Shared vision

Establishing a shared vision among the participants is a critical element of successful collaborations, and, once established, it becomes the driving force of the project. Such a vision is sparked by a compelling, common, practical interest, like, perhaps, the recognition of the state as a purchaser.

Critical mass

Collaboration, by definition, requires that multiple organizations work cooperatively on a project. Although the precise number of participants necessary to achieve success differs in each state, a certain critical mass is necessary to get the project off the ground. In certain instances, a small number of representatives of a significant number of covered lives achieves the critical mass. All affected parties may be invited to participate; however, all need not join the endeavor. There should be at least some representation of the various categories of interests: public and private purchasers, payers, providers, and community residents, to name a few. A sufficiently broad representation can help balance the natural resistance to change and increase understanding of the roadblocks to collaboration.

Demonstrated commitment

Sustaining a successful collaboration is not easy, and early efforts may fail. Participants in successful ventures are committed to working out their problems; evidence of their resolve may be the willingness to participate in lengthy planning meetings or to commit financial resources. Even when the financial contribution required of each participant is negligible in relation to the overall data-processing budgets, a minimal commitment of money from each participant helps to move the process along. Stable funding allows the group to focus on data collection and analysis rather than on fund raising.

Leadership

The most difficult step in collaboration is often the first one. Because the process requires disparate parties to be brought together, the stature of the organization or individual initiating the contact is critical. The individual convener takes on multiple roles by keeping the group focused on the task at hand and acting as a broker between different interests, alternatively serving as interpreter, mediator, deal maker, and enforcer. This individual's personal relationships and expertise are important, especially when disagreements occur.

Managing hidden agendas

If this were easy to do, all the projects would have reached a much more advanced stage. In successful collaborative projects, although institutional interests and agendas have not been eliminated, the participants have learned to manage them.

Incremental approach

Leaders of successful projects emphasize that they have not attempted to change the world overnight. Even projects that involve considerable changes to the status quo have established modest intermediate goals in order to gain acceptance and encourage momentum.

Demonstrated practical value

The sooner a collaborative project can demonstrate some immediate practical value to the various participants, the greater is the likelihood that the collaboration can be sustained. Most collaborative information projects require a commitment of some resources by the interested parties, who expect a return on that investment. When intermediate goals with important practical application are reached, the commitment to the long-term goals of the project is reinforced.

Local focus

The successful projects demonstrate the adage that "all politics are local." No one-size-fits-all approach will work. Even projects with similar goals and outcomes have tackled the issues with an attitude of respect for the local culture, politics, and health system environment. The lessons that states can learn from one another must be tailored to their own local conditions.

Responsible public reporting

Successful collaborations have used the public reporting of information about the performance of health plans as an inducement to change. These projects have bridged the gap between the public good, on the one hand, and proprietary concerns or competitive tensions, on the other. Releasing good information is a more effective route to change than chastising providers or payers who fall below the mark. If a defensive response by embarrassed payers or providers results in a narrow debate about the accuracy of the numbers, the opportunity to address the real issues of improved health outcome, efficiency, and access may be lost or diminished. Similarly, coordinators of successful projects recognize that, in a competitive market, acknowledging and, to the extent practicable, controlling for legitimate differences in risk, case mix, or severity assures buy-in by plans and providers and demonstrates a commitment to quality improvement. Early agreement on how the information will be used is essential, although the participants recognize that this consensus will change along with the participants' changing information needs.

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Project Descriptions

STATE Delaware DESCRIPTION Delaware Health Information Network PARTICIPANTS Public- and private-sector stakeholders: Public Private Budget Director State Chamber of Commerce Secretary of Health and Social Services Health Care Coalition (Purchasers) Insurance Commissioner Delaware Medical Society Health Care Commission Hospital industry PROJECT OBJECTIVE Purpose: Promote the design, implementation, operation, and maintenance of public and private facilities to provide health care information in the state. Short-term goals: Promote electronic data interchange to enable providers and payers to exchange information that is currently moved through payer transactions. Long-term goals: Collect information that allows researchers and policy makers to understand health care problems. BRIEF HISTORY Legislation creating the Delaware Health Information Network (DHIN) was enacted in July 1997. The action followed discussion among all interested partiesóboth public and privateófor approximately one year. It represented the joining of two important desires: For a mechanism to standardize the transmission of information in order to communicate more efficiently among payers and providers, thereby reducing both the cost and the "hassle factors" that are often associated with the administration of health care in a managed care environment. For a mechanism to promote the voluntary acceptance of standardization while also facilitating the capture of information, which will help policy makers, government officials, and researchers to clarify their understanding of Delaware's health care problems and thus to come up with effective solutions. The board of directors of the DHIN represents the collaboration between the public and private sectors and among purchasers, payers, and providers. It operates under the direction and control of the Delaware Health Care Commission. DATA ELEMENTS N/A CONTACT/FURTHER INFORMATION Paula Roy, Executive Director, Delaware Health Care Commission Tatnall Building, Ground Floor, 150 William Penn Street, Dover, DE 19901 (302) 739-6906, fax: (302) 739-6927.

 

STATE Kansas DESCRIPTION A dialogue among public-private purchasers of health care to develop common goals for accountability in the health care market. PARTICIPANTS State employees' health plan; Medicaid; several large business purchasers; state health data agency; state PRO; medical directors of several health plans. PROJECT OBJECTIVE To build a consensus around common objectives in "value-based" health care purchasing by creating common quality indicators in order to simplify data reporting for providers and health plans. BRIEF HISTORY The dialogue grew out of a Kansas-Iowa meeting arranged by the RSG and funded by the Milbank Memorial Fund. At that meeting, public and private purchasers began to explore the areas of common interest and practice in "value-based" purchasing of health care for their beneficiaries. The Kansas group has continued to meet on a regular basis, most recently for the purpose of identifying a set of quality indicators that both sectors could use as guidelines for collecting data from providers and health plans. DATA ELEMENTS N/A CONTACT/FURTHER INFORMATION Sandy Praeger, Chair, Public Health and Welfare Committee, Kansas Senate State Capitol Building, Room 128-S, Topeka, KS 66612-1504 (785) 296-7364, fax: (785) 296-6718. William McKee, Executive Director, Human Resources and Benefits, Western Resources, Inc., 818 Kansas Avenue, Topeka, KS 66612 (913) 575-6592, fax: (913) 575-6523.

 

STATE Maine DESCRIPTION The Maine Health Management Coalition (MHMC) unites the purchaser and provider communities in a partnership to measure and improve the value of health care services. PARTICIPANTS Thirty-one Maine employers, including 8 hospitals, 2 physician practices, 4 health plans, and 1 workers' compensation carrier. PROJECT OBJECTIVE MHMC is the employer organization in Maine that wields the most influence over health policy. It collaborates with other stakeholders to encourage systemic change in order to produce a health care system that informs and educates health care decision makers. BRIEF HISTORY Incorporates a comprehensive claims-driven database that produces comparative data on quality, health status, utilization, and costs for 165,000 lives. Teams up with a physician organization to review and disseminate data in order to modify and standardize practice patterns. Builds on collaborative efforts for value improvement partnerships, health improvement initiatives, and physician practice excellence awards. DATA ELEMENTS Membership and claims data for 165,000 lives in all settings, based on UB92 and HCFA 1500 formats. CONTACT/FURTHER INFORMATION Doug Libby, Executive Director, MHMC, P.O. Box 3231, Portland, ME 04104 (207) 883-8141, fax: (207) 885-5489, dlibby@maine.rr.com.

 

STATE Maryland DESCRIPTION Development and distribution of statewide and customized, purchaser-specific HMO performance report cards. Three versions of the report card are available (consumer, comprehensive, and policy), each designed for a different audience. PARTICIPANTS State of Maryland Health Care Access and Cost Commission; State of Maryland Employee Benefits Division; several Maryland-based private-sector purchasers; commercial HMOs operating in the state. PROJECT OBJECTIVE To encourage better health plan performance and higher quality by stimulating market competition at the retail and wholesale levels. The consumer version of the report card is designed to encourage individual consumers to select among the plans available to them. The comprehensive version of the report card is designed to assist purchasers with decisions about which plans to offer their employees. The policy version of the report is designed to inform policy makers about the state of managed care in Maryland. BRIEF HISTORY Statutory authority was granted to the Health Care Access and Cost Commission (HCACC) in 1993. A pilot project with five volunteer plans was completed in January 1995. Regulations adopted in September 1995 by the commission required submission of HEDIS (Health Plan and Employer Data Information Set). All 15 commercial plans were notified in December 1995, on which measures to report. During the first year, HCACC provided technical support to assist the plans with the collection of information in order to assure consistency and accuracy. HCACC engaged an independent auditor to verify the data. A single outside vendor administered a survey to 28,000 enrollees. The first consumer and comprehensive reports were released in October 1997. The policy report was released in February 1998. The second consumer and comprehensive reports were released in September 1998. A customized report was distributed to state employees with their open-enrollment material in September 1998. The commission plans to develop employer-specific reports in 1999. DATA ELEMENTS HEDIS 3.0 performance measures and results from enrollee satisfaction survey for commercial HMOs operating in Maryland. CONTACT/FURTHER INFORMATION John Colmers, Executive Director, HCACC, 4201 Patterson Avenue, 5th Floor, Baltimore, MD 21215 (410) 764-3563, fax (410) 358-1236. All reports are available to view or download at HCACC web site: www.hcacc.state.md.us.

 

STATE Massachusetts DESCRIPTION Massachusetts Healthcare Purchasers Group (MHPG): A nonprofit organization of private and public purchasers of health care. Fifty members, large and small, represent more than two million covered lives throughout New England. The MHPG conducts several data-gathering initiatives: Guide to Health Plan Performance: An annual report card, designed for employees, uses six quality-of-care measures plus member satisfaction data drawn from the NCQA Quality Compass. Comprehensive Plan Evaluation: Local plans are evaluated biannually for their performance in critical areas that affect the cost and quality of care. Rate Analysis Report: This annual analysis of how managed care organizations allocate premium dollars examines utilization and expense rates and highlights differences among plans. Cost Challenge: An exercise is conducted each year to determine (and challenge plans to minimize) the rate of the premium increase experienced by members. The 1999 cost challenge looked at copayment policies for office visits, emergency room visits, and prescription drugs. PARTICIPANTS Members of the MHPG; health plans; Division of Healthcare Finance and Policy PROJECT OBJECTIVE To maintain a health care market in which high-quality health care is available at a reasonable price. To help our members become better, more informed purchasers of health care. BRIEF HISTORY Large employers created MHPG in 1993 to gain clout and improve accountability. Its activities, products, and services were designed to address quality, cost, and education, to support members, and to lobby for public policy. DATA ELEMENTS Projects can require a range of data, including quality-of-care measures, cost, utilization rates, and actual premiums, among others. CONTACT/FURTHER INFORMATION Paula Breslin, Executive Director, Massachusetts Healthcare Purchasers Group, 705 Centre Street, 3rd Floor, Jamaica Plain, MA 02130 (617) 522-0255, fax (617) 522-0285, info@mhpg.org

 

STATE Minnesota DESCRIPTION The Minnesota Health Data Institute (MHDI) is a public-private partnership created to gain access to health data that measure quality and access to care and then to publish reports on the findings. PARTICIPANTS Health Department; Department of Human Services (Medicaid); Department of Administration; HMOs; hospitals; buyers (self-insured businesses); consumers; and other health care entities. PROJECT OBJECTIVE To gain access to health data in a cost-effective way, to introduce measures of quality and patient satisfaction, and to prepare report cards on health care entities. BRIEF HISTORY The Minnesota Care health reform bill, which was approved by the legislature in 1993, gave the Minnesota Department of Health the authority to collect data on cost, on specific conditions, and on any other topic deemed essential by the Commissioner of Health. In 1994, at the request of some large buyers and health providers, the Minnesota Health Data Institute (MHDI) was created to carry out the efficient, cost-effective collection of data in order to measure quality and satisfaction. DATA ELEMENTS Basic description information of health care providers, consumer assessment, and standard quality indicators, such as NCQA's HEDIS measures. CONTACT/FURTHER INFORMATION James Golden, Assistant Director, Health Policy & Systems Compliance, Minnesota Department of Health, 121 E. 7th Place, Suite 400, St. Paul, MN 55101 (651) 282-5640

 

STATE Oregon DESCRIPTION The Oregon Shared Health Information Network (OSHIN) is envisioned as a voluntary, multipartner, public-private data-sharing enterprise for collecting and reporting on issues of quality and access in health care. PARTICIPANTS Medicaid, State Department of Public Health, private health plans, ambulatory surgery centers, consumers, and other health care entities. PROJECT OBJECTIVE The goal of the Oregon Shared Health Information Network (OSHIN) project is to bring together the various participants in the health system and create an information base that will provide better, more complete answers to questions about the state's health environment than are currently available. Additionally, this project attempts to direct the policy debate away from the current focus on producing health care and toward the more relevant goal of producing health, while recognizing that health care is a major component in the process. BRIEF HISTORY The Oregon Health Council, the state's primary health policy advisory body, was directed by the state legislature to oversee the creation of a statewide health data system. The Office for Oregon Health Plan Policy and Research, which staffs the council, is taking the lead on this project as the principal health data collection office in the state. DATA ELEMENTS As yet undetermined. Potentially, data elements are demographics, utilization, financial, health status, provider and community characteristics. CONTACT/FURTHER INFORMATION Michael Kennedy, Health System Analyst, Oregon Health Plan Policy and Research, 255 Capitol NE, 5th Floor, Salem, OR 97310 (503) 378-2422 Ext. 414., Michael.a.kennedy@state.or.us.

 

STATE Pennsylvania DESCRIPTION The Pennsylvania Health Care Cost Containment Council (PHCCCC) is an independent state agency that is responsible for collecting and reporting objective information that reduces cost, improves quality, and increases access to health care services for all citizens of the Commonwealth. PARTICIPANTS The Council consists of 21 members: Pennsylvania Secretary of Health; Pennsylvania Secretary of Public Welfare; Pennsylvania Insurance Commissioner; 6 representatives of the business community; 6 representatives of organized labor; and 1 representative of each of the following groups: consumers, hospitals, physicians, Blue Cross and Blue Shield plans in Pennsylvania, commercial insurance carriers, and HMOs. PROJECT OBJECTIVE The Council strives to provide the information that the public needs to make more informed medical decisions, and, in so doing, to improve the quality and restrain the cost of health care in Pennsylvania. BRIEF HISTORY The Council was formed under Pennsylvania statute (Act 89 of 1986) in order to address rapidly growing health care costs. The Council's strategy is to stimulate competition in the health care market by (1) giving comparative information about health care providers to individual consumers and group purchasers of health services; and (2) giving information to health care providers that they can use to identify opportunities to contain costs and improve the quality of care. DATA ELEMENTS Information is collected on several topics: UB 92 hospital discharge information; admission severity data (using a proprietary system); select outpatient procedure data; hospital financial and utilization information; payment data from payers. CONTACT/FURTHER INFORMATION Marc P. Volavka, Executive Director, Pennsylvania Health Care Cost Containment Council, 225 Market Street, Suite 400, Harrisburg, PA 17101 (717) 232-6787, fax: (717) 232-3821.

 

STATE Utah DESCRIPTION The Utah Health Information Network (UHIN) performs three major functions: standardizes electronic health formats; acts as a value-added network; and provides administrative data to the State Health Statistical Database. PARTICIPANTS Public- and private-sector stakeholders: Health care insurers Providers Other interested parties, including state government PROJECT OBJECTIVE To reduce the cost and improve the quality and accessibility of health care and to facilitate research by taking the following steps: Creating and managing an electronic, value-added network so that members of the health care community can exchange financial and clinical information. Standardizing health care transactions, reporting, electronic interface development, and communications services. Gathering and providing information for a statewide data repository. Conducting educational programs that are consistent with the Network's organizational goals. Providing data free of charge to state agencies so they can fulfill their legislatively mandated responsibilities. These objectives are to be achieved while remaining in compliance with national data standards. The focus of the initiative is to streamline the system and reduce administrative costs for the benefit of the Utah health care community, including consumers. BRIEF HISTORY Utah health care payers, health care providers, and members of the government formed a coalition to reduce the cost of administrative health care in the state, resulting in the incorporation of UHIN on November 12, 1993. DATA ELEMENTS UHIN supplies a copy of all claims, encounters, and remittances to the Utah State Health Data Authority. As requirements change, it will supply additional data to the state. CONTACT/FURTHER INFORMATION Bart Killian, Executive Director, Utah Health Information Network, 1939 South 300 West, Suite 186-11, Salt Lake City, UT, 84115 (801) 466-7705, fax: (801) 466-7169, bkillian@uhin.com.

 

STATE Wisconsin DESCRIPTION ACT 231 was the culmination of a collaboration that was designed to expand the data collected by the state on inpatient discharge and ambulatory surgery to include physician office claims as well. PARTICIPANTS Supporters of ACT 231 included: Wisconsin Department of Health and Family Services; Wisconsin Manufacturers and Commerce; AFL-CIO; American Association of Retired Persons; Wisconsin HMOs; Wisconsin Hospital Association; Employer Health Care Alliance CO-OP; Wisconsin Business Coalition on Health; Rural Wisconsin Health CO-OP; WEAC; Coalition ofWisconsin Aging Groups; Center for Public Representation; Wisconsin Nurses Association; State Representative Gregg Underheim; State Senators Carol Roessler and Rod Moen. PROJECT OBJECTIVE To extend the availability of health data across the continuum of care in order to supply information to the health care market and update consumers about the options that are available to them. BRIEF HISTORY The Wisconsin Office of Health Care Information (now called the Bureau of Health Information) has collected hospital discharge and ambulatory surgery data since 1988. During its strategic planning process, the Board on Health Care Information determined that additional data were needed because of the continuing shift of care to outpatient office settings. Shortly thereafter, a Legislative Study Council was created to examine whether additional data were needed for consumers and purchasers. They agreed with the Board that there was a need. Bill 315 was introduced in the state senate, and, as a result of public and private collaboration, it was passed as Act 231, allowing the state to collect physician office data. Act 231 also provided for an assessment on physicians to cover the costs of the new data collection. DATA ELEMENTS Under the new system, data elements that are consistent with the HCFA 1500 form will be collected. However, name, street address, and social security number cannot be required by the state. CONTACT/FURTHER INFORMATION Barbara Rudolph, PhD, Director, Bureau of Health Information, 1 West Wilson Street, Suite 372, P.O. Box 7984, Madison, WI 53707-7984 (608) 267-0236, rudolba@dhfs.state.wi.us.

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