Combining Multi-Payer Claims Data to Produce Public and Private Reports
Over the last decade, the KHC has distributed over 30,000 reports to providers in Kentucky and Southern Indiana on a variety of Ambulatory Care indicators. The KHC launched the GoHealthShare.org website to display many of these previously only private reports to the Greater Louisville public on primary care and women’s health providers. A team of measurement experts from the major health plans, providers, employers, consumers, and public health sectors help select and prioritize measurement priorities.
The KHC provides multiple quality reports to individual providers and groups. Data supplied in these reports allow comparison to local and state average and benchmark scores on the quality of care patients received on select clinical areas of focus. Anthem Blue Cross Blue Shield, Humana Health Plan of Kentucky, Passport Health Plan, and WellCare Health Plan of Kentucky provide data derived from their annual National Committee for Quality Assurance (NCQA) Healthcare Effectiveness Data & Information Set (HEDIS®) submissions. Only administrative data is used; no chart or hybrid data is included. The reports are HIPAA-compliant with no patient data transferred to the aggregator in creating these reports; the KHC aggregates these data.
Annual staged reporting occurs as follows: 1) Private Individual Report, 2) Private Group Report, 3) Public Group Report, and 4) Public Community Report.
1. PRIVATE Individual Provider Reports
- Individual Provider reports are NOT made available to the general public .
- Individual Provider reports are distributed in Greater Louisville (including Southern Indiana) and throughout the Commonwealth on Kentucky.
- Providers can receive a score for up to 21 measures but must have a minimum number of patients to receive a score for that measure.
- Reports are sent to Physicians, Nurse Practitioners, and Physician Assistants.
2. PRIVATE Group Practice Reports
- Individual provider reports and group practice level data are combined to produce group practice reports.
- Only Groups in Greater Louisville receive group reports; expansion plans are underway.
- Groups receive scores on a set of measures with a minimum threshold of patients.
3. PUBLIC Group Practice Reports
- Primary care and women’s health group practices in Greater Louisville who have not opted out of sharing their data can be viewed at www.GoHealthShare.com
- A minimum of number of providers is required for a group to be eligible for public reporting.
- Groups have a review period prior to public reporting.
- Data for publicly-reported measures are examined by an expert team each year prior to publication.
4. PUBLIC Community Aggregate Scores of Greater Louisville, Kentucky, and Kentucky’s 15 Area
*Not National Quality Forum (NQF) Endorsed www.qualityforum.org/qps