An effort launched four years ago to get a better handle on how to slow the growth of healthcare spending may begin to yield results later this year. And while results seem likely to come too late for the current legislative session, leaders in Salem appear eager to learn from the research being done by John McConnell’s team.
OHSU’s Center for Health Systems Effectiveness was founded in 2011, and charged with using data and an economic perspective to seek insights into healthcare spending and delivery – in other words, to apply the promise of “big data” in a way that might yield health policy insights. In an interview with The Lund Report, founding director John McConnell shared updates on the progress made by the center, and his thoughts on what’s yet to come.
Easier said than done.
To start, the program had only three people on staff, charged with finding evidence on how to slow the growth in healthcare spending – what in industry jargon is sometimes called the “sustainable growth rate of heatlh care.”
Early efforts involved gaining access to databases that could ultimately lead to insight about the reasons for healthcare pricing, particularly what’s known as the “all payer, all claims database,” which in Oregon collects information about every medical and pharmacy claim filed with most commercial insurance companies in the state, as well as claims filed with Medicaid-funded Coordinated Care Organizations and Medicare Advantage claims.
This data first became available in March 2011 in Oregon, the result of legislation passed two years earlier. Before the Center for Health Systems Effectiveness staff began evaluating and assessing the data, they had to get it in shape.
“We spent a long time with data management, getting claims into the shape we wanted,” McConnell said. “We finally feel confident in the way we have set up our analytic databases. We are in the process of running results right now, as we speak.”
Asked white it might take several years to get to this point, McConnell said: “There’s a balance between timeliness and correctness, so we don’t want perfect to be the enemy of getting things done, but we do put a high premium on getting things right. We do spend a lot of time looking at the numbers we have and trying to make sure they make sense.”
Today, the Center for Health Systems Effectiveness has about 13 people on staff, most engaged in data analysis, including three doctorate-holding economists, working with datasets from multiple states. And researchers are beginning to publish their results –so far primarily with descriptive papers explaining how CCOs work, with other more data-driven work under review or expected to come out soon.
Until the work is published, McConnell declined to discuss specifics.
“It’s really about trying to provide the evidence-base on how to slow healthcare spending, hopefully in an optimal way that provides high-value care,” he said.
Up-close look at CCOS
Much of the work being done at the center looks at coordinated care organizations, the centerpiece of Oregon’s Medicaid transformation.
“We see this CCO change as the largest attempt ever to hold the healthcare system accountable for the growth in spending,” McConnell said.
“So, for example, we have claims data, and we are trying to understand how the CCO changes affected care,” he continued. “We are trying to develop a causal estimate of the CCO change. … How can Oregon’s experiment be used to inform other policy?”
Though McConnell said he believes the center’s work will have potential policy implications, he added that he would only comment on policy issues if invited.
“I would not try to insert myself into whether or not we deserve a place at the table. There are a lot of people trying to figure out what the right things are to do. There may be questions we can’t help with. But do we think we’ll have data that can help influence policy by next year? The answer is yes.”
If asked to present results to the state’s Health Policy Board, “We’d be more than happy to present them,” McConnell said. “I hope that the data and the findings will be useful to policy makers.”
Still, he said, while policymakers may be eager for quick results, they’ll have to wait a little bit longer.
“I wish people gave as much credit or acclaim to the research process as they do to the results,” he said. “I don’t have anything astounding for you yet.”
It's important to use the APAC to analyze how CCOs manage money. ~1 in 5 Oregonians are served by CCOs. But how will OHSU leverage the data?
Moreover, how will this make a difference for the remaining Oregonians who purchase insurance in this so-called marketplace, where negotiated prices are a trade secret?
The APAC has failed Oregonians.
Kris Alman