Jeffrey Kluever

As I’ve shared with readers in the past, our organization’s strategic direction can be conveyed by a simple equation:  Analytics + Informed Guidance = Increased Value. Today I want to focus on the analytics portion of the equation, namely the critical importance data plays. Without access to reliable and valid data, it is impossible to measure the value of the health care employers are purchasing.

For example, data from the Wisconsin Health Information Organization (WHIO) was essential to the insightful and valuable BHCG-sponsored Wisconsin Physician Value Study conducted late last year by GNS Healthcare. That initial analysis, measuring the performance of primary care physicians and some specialists throughout the state, is available to providers to identify opportunities for quality improvement and purchasers and to promote better health care purchasing. The second iteration of that study is scheduled to be done in the first quarter of 2021 and, again, WHIO will be the primary data source.

We are also engaged in two important efforts to increase the number of self-funded employers who contribute their data to two organizations at the forefront of measuring health care value.

Self-Funded Employer Data Needed by WHIO

WHIO delivers critical insights into the health of the people of Wisconsin and evaluates the state’s health care delivery and payment systems through Wisconsin’s largest source of health-related information. It includes claims data representing approximately 4.5 million insured lives submitted by Medicaid, commercial and Medicare Advantage insurers, and some self-funded employers in all geographic areas of the state.

BHCG, working in partnership with WHIO, is focusing on one group of payers underrepresented in their database, namely self-funded employers. While some administrators provide self-funded employer data to WHIO, we are requesting that all self-funded employers direct their plan administrators to submit their claims data to WHIO. By doing so, employers play a valuable role in supporting a very innovative and important approach to increase the value of health care delivered in our state.

RAND Hospital Price Transparency Project

It is widely accepted the prices paid for hospital care by private health plans are higher and growing faster than those paid by Medicare. The increases in spending are driven by price growth, not utilization, and prices vary widely from market to market and from hospital to hospital within a market. The RAND Hospital Price Transparency Project is an ongoing employer-led initiative to measure and publicly report the prices paid by private health plans for hospital care at the hospital-and service-line level. This project is being driven by self-funded employers from across the country.

Here in Wisconsin, we partnered with The Alliance, our sister employer coalition based in Madison, and Wisconsin Manufacturers & Commerce (WMC) to ensure Wisconsin’s self-funded employers were well-represented in the most current study – RAND 3.0. With access to more robust information on prices, employers can become better purchasers of health care on behalf of their employees. While the deadline for submitting data for RAND 3.0 has passed, we are requesting that self-funded employers in the state ask their claims administrator to submit their claims data to RAND in time for the next hospital transparency report, RAND 4.0. The more self-funded employers providing their claims data to RAND, the more robust the data set will be, benefiting all health care purchasers throughout the state.

Mark your calendar for September 24 from 9:00 to 11:00 am when staff from RAND will present the results of their latest study RAND 3.0 via webinar as part of our Delivering Value Series symposiums. Watch for registration information via email in August.

If self-funded employers have any questions about providing data to these two initiatives, please do not hesitate to contact me at 262-875-3312 x1 or jkluever@BHCGWI.org. Please stay safe and well.