How well are our doctors providing quality and efficient care?
How much business is leaving our system?
How do our clinics benchmark against other Wisconsin clinics in quality and efficiency?
How do depression and other conditions affect the resource use of chronic diseases?
The WHIO Datamart offers WHIO's diverse members and subscribers access to reliable, actionable information to improve the quality, efficiency and transparency of health care in Wisconsin.
The WHIO Datamart gives each system, clinic and physician an Overall Quality Index based on more than one hundred quality metrics (HEDIS and others) weighted by case mix and an Overall Efficiency Index based on resource use.
These indices are relative to peer group values and allow users to see which systems, clinics or providers are offering high quality care most efficiently and to identify areas for improvement.
WHIO data are provided by participating Member organizations, consisting of health plans in Wisconsin and Wisconsin Medicaid. WHIO Members submit large sets of administrative claims and eligibility data to WHIO's data vendor twice annually. Each semiannual datamart cycle consists of data submissions, data quality-checks, consolidation and integration steps to combine the data across the (currently) 20 data sources, and application of data enhancements to enable powerful analytics. WHIO Members that contribute data are listed below:
Anthem Blue Cross and Blue Shield of WI
Dean Health Plan
GHC of Eau Claire
GHC of Southcentral WI
Gundersen Health Plan
Health Tradition Health Plan
MercyCare Insurance Company
Network Health Plan
Physicians Plus Insurance Corporation
Security Health Plan
UnitedHealthcare of Wisconsin
Unity Health Plan
WEA Trust Insurance
WI Dept. of Health Services (WIMedicaid)
WPS Health Insurance
Data Integration processes are applied to match both providers and covered members across the 20 WHIO data sources. These are complex algorithms with the goal to represent each patient and each provider uniquely and consistently across time and across WHIO datamarts. If members change health plans, the member matching process is designed to combine eligibility information from disparate sources such that the patient is represented only once. Similarly, the same provider can be found in multiple health plans' billing data. The provider matching algorithm uses demographic information to identify the same provider across all data sources, such that all care provided by him or her is appropriately attributed to the same provider identity.
An important data enhancement applied to WHIO claim data is the standardized pricing methodology. Standard pricing is the process of creating a uniform and consistent approach to classifying and pricing all services. The algorithm removes variations that may exist in allowed or paid amounts that are driven by differences in contractual arrangements, geographic regions, timeframes of data, and the health care setting or organization from which services are provided. Standard pricing normalizes the unit price of each health service, which enables apples to apples comparisons across providers, geography, and place of service. The end result is a measure of mix and intensity of services.
One of the founding principles in WHIO's data policy is that certain attributes of the administrative data are de-identified. Once the data vendor has received and integrated the fully-identified claim and eligibility data from all data sources, applied quality checks, and matching algorithms, all personal identifiers for patients, health plans, and employers are de-identified. There are still patient characteristics that remain for population-based analytics such as gender, age in years, and county of residence.
Imputed Primary Care Physician
The analytics of the WHIO Wisconsin Atlas are centered on the concept of imputed primary care physicians (PCPs). Not all health plans require their members to choose a PCP. In order to attribute patients to a PCP or a PCP system, an imputation process is applied which examines claims for primary care services and seeks to impute a PCP for each individual patient in a 12 month period.