ACA – Testing a Model of Data Aggregation under the Comprehensive Primary Care initiative

Objectives: The Comprehensive Primary Care (CPC) initiative is a multi-payer initiative fostering collaboration between public and private health insurance companies (“payers”) to strengthen primary care. Recognizing that the impact of any one payer alone is limited, the payers in CPC have committed to establishing an approach that is coordinated with that of the Innovation Center to transform the way in which primary care is practiced and financially supported. In May-July 2012, the Innovation Center executed a Memorandum of Understanding (MOU) with each participating payer. One of the stated goals in the MOU is improving the flow of cost and utilization data to CPC primary care practices to support practices in their efforts to improve outcomes through care coordination and quality improvement. The MOU described a collaboration by which each regional group of payers – with CMS’ input – would produce a written plan “that outlines how participating payers will transition to a common approach for sharing data with participating primary care practices.” The MOU defined this endeavor in the following way: . . . If an appropriately structured and protected multi-payer claims data system exists or can be created in [Market] to support a common approach for sharing data with participating primary care practices, the Innovation Center and [payer] will submit its data to the system. In order to improve care coordination and support practices to provide better patient care, payers have agreed to work together to improve data-sharing to practices. The goal of data aggregation is to combine patient-level cost and utilization data from all payers in a uniform and actionable format so that physicians can better coordinate care across their entire population. This data will help CPC primary care practices deliver better care to their patients by providing information to support their efforts to improve care outcomes through care coordination and quality improvement. CPC practices have been asking for this data to be aggregated for their practice rather than to receive it individually from each payer, which has been cumbersome and less useful for them in managing the health of their patients. Payers in four CPC regions have been delivering data in this format, but Medicare data has not to date been included. The purpose of this program is to support vendors in four CPC regions to combine Medicare claims data with claims data from other commercial payers in each respective region and create actionable feedback reports for practices to improve care coordination and population health, and decrease costs. The end-users of this aggregated data are the CPC practices; including Medicare data in this demonstration is central to the stated goal of improving care coordination by providing actionable data to primary care practices. We are proposing to add Medicare data in CPC regions with existing multi-payer databases to test a model of data aggregation within the CPC initiative to better understand how Medicare data may be incorporated and used by practices to improve care coordination and quality improvement. The activities funded by these cooperative agreements are projected to run for the duration of the CPC initiative, currently scheduled to end December 31, 2016. Specifically, these cooperative agreements are intended for vendors in four CPC regions: • Taconic Health Information Network Community (THINC) in the Capital-District Hudson Valley region of New York; • The Health Collaborative in the Cincinnati-Dayton region of southwestern Ohio and northern Kentucky; • MyHealth in the greater Tulsa region of Oklahoma; and • Rise Health in Colorado The CPC payers in each region have selected the vendors listed above as their data aggregation vendors and have asked CMS to provide Medicare data to these vendors to be included in these existing multi-payer databases. Each group of regional payers is structuring their data a