Linking Cancer Registry Data to Claims Data from BCBSM
MCC Board of Directors Sept. 21, 2005 Okemos
Why is it important to BCBSM?
Potential to improve quality of cancer care Potential to develop/improve care management programs Supports BCBSM Social Mission: ―promoting the art and science of health care‖
Project History
2001
Request T. Simmer, MD Address privacy & contracting
2002
2003
Work begins Prelim results
2004
Policies & procedures for research; training
2005
Work begins again!
HIPAA
Contract w/ MDCH
IRB
sign
Blue Cross Blue Shield of Michigan
Non-profit health insurance company 54% commercial market share within Michigan. The next largest competitor has a 6% share
Health Care Enrollment by Product
HMO 10% Traditional 24%
POS 2%
PPO 64%
Insurance Products
Traditional fee-for-service Less management Fee-forservice Large networks More management Capitation PPO POS HMO
Limited networks
BCBSM Membership Summary
Top 10 customers
General Motors Ford Motor Company Michigan Public School Retirees MESSA State of Michigan DaimlerChrysler Detroit Regional Chamber Federal Employee Program (FEP) Small Business Association of Michigan
Membership Distribution by Type of Group
8% 14%
17%
61%
Auto National Michigan Individual
Membership by Age
65 + 1% 0 - 18 27%
0 - 18 19 - 64 65 +
19 - 64 72%
Pilot Project Overview
MI Cancer Surveillance Registry Demographics Outcomes Clinical Information MI Mortality File Treatment Information BCBSM Claims & Admin Files
Economics
Pilot Link to BCBSM Process
Membership file to DCH – 1998-2002 Link to Registry Identify Cases Develop Study Cohort Select matched ―cancer free‖controls Return Study Cohort to BCBSM Pull Claims DCH Receives Claims Data Develop Linked De-Identified Study Files Forward Study File to BCBSM for Analysis
Key Steps
Pilot Proposal Contract with BCBSM/DCH DCH IRB Approval DCH Designated as IRB for BCBSM Partial CDC Funding for BCBSM
Status
All Agreements in Place Preliminary Link to BCBSM Data Set Defined BCBSM Developed Membership File DCH Developing Linkage Strategy Developing Approach to Quality Analysis
Preliminary Link
Enrollment File for 1998-1999 4.8 Million Participants Linked to Registry
Probabilistic Match
Identified 32,000 Cases
Above expectation
Potential BCBSM Plans for Data: Support Treatment and Payment Functions (1) Analyze incidence/burden of cancer with respect to demographic and social characteristics Provide and compare with benchmarks Validate uses of administrative data for cancer programs using ―gold standard‖
Potential BCBSM Plans for Data: Support Treatment and Payment Functions (2)
Support disease management programs Cost of treatment and use of services
Cost per outcome (utility analyses) Cost of survival Insurance coverage issues Delivery system: geographic variation, providers, etc.
Potential BCBSM Plans for Data: Support Treatment and Payment Functions (3)
Improve quality of care
Use of evidence-based guidelines Impact of EBG on costs and outcomes Time between dx and treatment Patient and provider factors in treatment decisions
Potential BCBSM Plans for Data: Support Treatment and Payment Functions (4)
Improve quality of care
Racial/ethnic/gender disparities Small area variation studies Quality management studies Feedback information to providers: Centers of Excellence, provider incentive programs
Potential BCBSM Plans for Data: Support Treatment and Payment Functions (5)
Correlations of cancer with other conditions/diseases: inflammatory disease, GERD, Obesity, Depression Survivorship
Potential BCBSM Plans for Data: Support for Public Policy and Social Mission
Help public health agencies evaluate the quality of treatment data in cancer registries Research to inform decisions about allocating health care resources, in MI and BCBSM Literature contributions— commercial groups Eventually an all payer database in MI
Next Steps
Complete Phase 1
Linkage Validity tests Demonstration of value***
Obtain support from MCC Board Plans for Phase 2 (next year)