Big data is revolutionizing healthcare. The ability to collect reams of detailed information about how care is provided, how much it costs, and then to link that back to effectiveness and outcomes is powerful.
New data tools offer the potential to improve individual and collective decision-making that targets just the right resources to the right people at the right time. Smart use of data can minimize both costly overtreatment and dangerous underservice.
Connecticut policymakers need to do much better at using data. Non-governmental health thoughtleaders have consistently given Connecticut a C- or D+ grade for data-based policymaking over the last five years. As healthcare costs continue to rise and the state budget remains tight, Connecticut really doesn’t have a choice but to use data to make policies and avoid wasting money.
It’s not that we don’t have data. Connecticut made a huge data leap when Medicaid fired private insurers in 2012 and shifted to a care management-based plan. In addition to saving hundreds of millions of tax dollars, improving access to care and quality, we also created a single data source for all claims in the program that serves 800,000 state residents. The Comptroller’s Office has been a leader in opening up state spending and revenue data, with Open Connecticut. DPH is extraordinary in putting their statistics online and easily accessible.
Unfortunately, unlike other agencies and other states, DSS has not been open with even the most basic information. Medicaid enrollment data, just the number of people in the program, has been very difficult to access. No information was made public from July 2016 until this May. We still don’t have information on enrollment during 2017 despite multiple requests from multiple sources.
Getting the data is only the first step; analysis is key. Openly sharing data allows the state to benefit from fresh eyes and unique perspectives to get the most from this precious resource. I’ve been in dozens of meetings where someone sees something important in the data that policymakers missed. DSS is very selective in sharing data, providing only a few PowerPoint bullets instead of data.
In May advocates had to file a Freedom of Information request to get accurate information on DSS Call Center wait times when a hard-to-believe statistic was reported at the Medicaid Council meeting. It turned out that DSS combined their call center’s response time, which was over 100 minutes, with Access Health CT’s call center, which has always answered calls quickly, misrepresenting their own performance. It’s critical to release all the data, not just the parts that make programs look good and support what policymakers have already decided to do.
But even analysis is not enough. The most important step is using data and analysis to guide decisions. This is where Connecticut most often fails. Following through requires strength of will to overcome entrenched interests, internal biases, and the latest shiny new toy from policy wonks. Despite failures in more sophisticated states and programs, Connecticut is rushing to expand an experimental payment model for Medicaid, despite acknowledged risks to people’s health and significant liability for taxpayers. In 2016, Connecticut closed the legislative Program Review and Investigations Committee which had been delivering thoughtful, nonpartisan policy analyses and recommendations since 1972. Over the years, Connecticut has instituted a variety of planning groups designed to analyze data and hold government accountable for results, with little to show for the effort. Eventually politics trumps everything.
Connecticut’s latest hope for data-driven health policymaking is the much-anticipated All-Payer Claims Database (APCD). Development of the APCD in Connecticut has been frustratingly slow. In at least eighteen states, APCDs collate healthcare claims data across payers and programs allowing smart, evidence-based policy decisions, identification of gaps, evaluation of policies and programs, and information for consumers to make the best choices for their care. APCD enabling legislation passed in 2012 and Connecticut has received significant federal funds to develop this resource. Since then the APCD has moved between agencies and advisory/oversight groups and management has changed, but we are told that useable information will be available soon.
It is sorely needed. Connecticut’s policy environment has traditionally been very slow to adopt best practices and overly influenced by political winds. Our only hope to solve the twin problems of rising costs and declining value in healthcare is to honestly look at all the data, make the hard decisions, and follow through. I hope our next governor is listening.
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