HD26 - Report of the Virginia Health Information's Strategic Plan

Executive Summary:
Virginia Health Information (VHI) is a nonprofit public/private partnership organized under authority of the Virginia General Assembly for the purpose of collecting, maintaining, and processing health care data in order to create and disseminate information that will assist in informed health care decisions by Virginia consumers, purchasers, providers, and policy makers.

VHI is evolving from a "gatherer/care taker" role with regard to health care data to that of a catalyst for the development of health care information. An extremely important aspect of this evolution is the refinement of our perspective of who is our customer.

Who is our customer?

The VHI Board views its primary customers as the patients (i.e., consumers of health care services as well as the purchasers (payers) of these services). Next, all health care practitioners, providers, and associated stakeholders are considered secondary customers.

What is our role?

This change in perspective as to whom VHI is organized to serve is a change in the role we have been directed to perform. Previously, the Patient Level Data Base has focused VHI's attention primarily on the hospitals within the state. Now we are chartered to produce an efficiency and productivity report which expands our focus to nursing homes. Further, we are directed to develop quality measures; collect, compile, and publish Health Employer Data and Information Set (HEDIS); and collect, review, and recommend applications for outpatient data (currently state data only). Additionally, VHI is to recommend appropriate fees or funding for the accomplishment of these tasks. Clearly, VHI is operating in a new and expanded environment.

How are we doing?

Where is VHI in this evolution regarding focus and responsibilities? In clear and unambiguous language--we are not there yet. Given the statement above, it is appropriate to examine the environment that exists as well as the problems and probability for success.

The VHI Board is in full agreement that health care consumers and purchasers are our primary customers. This understanding provides a solid foundation for resolving all the other issues. Add to this focus the fact that the VHI Board is composed of competent and professional individuals committed to our mission of providing valid and useful health care information, and the probability for success increases markedly.

What are the issues?

The stakeholders to this process--business, consumers, health plans, hospitals, nursing homes, physicians, and the state- are in varied positions reflective of their current involvement in terms of data, cost, and expectations.

Hospitals have expressed continued concern that they are the focal point of the majority of data collection and health care reporting efforts. Hospitals also note that they are unfairly burdened with a disproportionate cost burden.

Nursing homes, while similarly concerned about an unequal cost burden, support efforts to utilize federally mandated data collection efforts to develop quality indicators for nursing home profiling.

Both stakeholder groups have expressed commitment to the goal of providing meaningful health care information which reports across the full provider spectrum: health plans, hospitals, nursing homes, and physicians.

Physicians, as a stakeholder group, tend to be disparate in their views which may be a function of their dispersion within the health care matrix and distance from current health care reporting efforts. Generally, the fact that physicians represent such a large segment of the health care provider equation and the no-homogenous nature of their involvement will pose continuing problems achieving committed consensus to health care information reporting. There are some basic standards which all physicians, as do all stakeholders, expect as a requirement for reporting: data accuracy and proper attribution to reported treatment and procedures.

Health plans are similar to physicians in the context of lack of homogeneity between indemnity and managed care plans. The managed care plans are significantly ahead of other insurance plans in terms of standardized reporting. Finding and establishing a rational comparison tool for health plans poses a major challenge.

Another issue that is shared by physicians and health plans is that of funding participation. To date, these two stakeholders have not been called upon to participate, as have hospitals and nursing homes.

The State as a stakeholder in the health care matrix is both a consumer, in its need for health care information to support its policy and legislative functions, as well as a purchaser, in terms of its employees and for the recipients of Medicaid. As such the state is both a primary and secondary customer. While the potential for role conflict exists with regard to the state's multi-layered involvement with VHI, none has occurred nor is expected and, therefore, is not an issue.

Consumers and businesses (primarily small businesses) represent the final stakeholder groups to be addressed. As recipients and purchasers of the products and services of the health care industry, these two groups hold the preeminent position. Their needs are for valid and timely information of sufficient quality to provide the basis for choice making. Their participation in the cost matrix needs to be evaluated.

It is therefore understood and agreed that due diligence is required by VHI to ensure that there is value from the information process and regular validation of the outputs.

In summary of the stakeholders' critical issues, we find:

• all stakeholders are dissatisfied with the pace and progress of health care information delivery,

• some stakeholders are dissatisfied with the unequal data reporting and funding requirements,

• all stakeholders are committed to voluntary efforts prior to mandating data and funding requirements, and

• all stakeholders agree on the primary customers--consumers and purchasers.

Moving to other critical issues, the technology required to accomplish VHI's objectives does not fully exist. Certain data elements need to be developed. Examples of these data are:

• quality indicators for both inpatient and outpatient data bases,

• valid and accurate physician identifiers, and

• health plan identification numbers for various coverage types.

Software needed to produce information and reports does exist; however, the methodology must be tested and validated for the specific application. VHI is committed to using existing software and does not plan to invent software applications. Additionally, VHI will seek to link existing databases prior to expanding data requested. The technology issues, while critical in terms of time required to develop and test, are not insurmountable.

One remaining critical issue is of sufficient magnitude that could block VHI from accomplishing its primary mission--funding.

Adequate funding is basic to VHI's mission. It is the plan of VHI to seek Participative Funding for projects on an equitable basis that is representative of the public/private partnership that was the foundation of VHI. As noted previously, stakeholder involvement in the development of fee structure and collection protocols will be sought on a voluntary basis prior to requests for mandates.

Given the issues stated above, where does VHI propose taking health care information initiatives in the Commonwealth? The following matrix provides a summary of the proposed major actions over the next three years. These projects are presented in priority order after recognition of mandated efforts.

This is an Executive Summary and as such is not an exhaustive examination of the issues facing VHI. The VHI Board wishes to convey the complexities involved in bringing viable and understandable health care information to the consumers and purchasers within the Commonwealth.