The Green Mountain Care Board got a crash course in health care claims data Tuesday.
Dian Kahn, director of analysis and data management for the Department of Banking, Insurance, Securities and Health Care Administration, outlined the available data that health insurers provide through the Vermont Healthcare Claims Uniform Reporting & Evaluation System (VHCURES).
By statute, the agency must compile eligibility and claims data from insurers as a means of measuring and improving the health care system’s performance. The board will utilize this information to help it develop a benefits package for Vermont’s new universal health care system.
Kahn explained that the data includes information from insurers, third-party administrators and pharmacy benefits managers. The agency is also working to use additional data from the Centers for Medicare and Medicaid Services. The data tracks Vermont resident visits in the state and to hospitals in New Hampshire, Maine and New York. It is used to develop what will be covered in the Vermont Blueprint for Health, the state system that provides care for people with chronic conditions. It also provides data on payments per month, per member of insured people for different areas, as well as the amount of potentially avoidable trips to the emergency room people make.
Anya Rader Wallack, chair of the Green Mountain Care Board, said the VHCURES data will be one of the board’s primary tools moving forward with its plan to develop a benefits package and a method of providing health care to all Vermonters.
“This is an important building block,” Wallack said.
She said the board needs to analyze the data itself and determine what it can and cannot do with it.
Kahn echoed that while the information will be helpful to determine the needs of Vermonters, sometimes the numbers alone will not paint the whole picture.
“Certain things only a clinician can understand,” Kahn said.
To learn more about VHCURES data visit the BISHCA website.
