Wyoming Multi-payer Claims database
What is on this site?
First, please note that this site is still under development. Please give us feedback on any other areas you'd like to explore.
This site illustrates aggregated and summarized trends on healthcare cost and utilization for self-insured plans that are members of the Montana Association of Health Care Purchasers (MAHCP) and the Wyoming Business Coalition on Health, including the State of Wyoming's Employees' and Official's Group Insurance (EGI) plan.
Currently, these trends include:
- Per-member per-month (PMPM) costs, which drive health insurance premiums;
- Enrollment, by age and sex;
- PMPM costs by health care provider types, which show how much of total costs goes to hospitals, drugs, physicians, etc.;
- Emergency department (ED) and inpatient (IP) utilization, which are some of the most expensive components of healthcare;
- Outpatient (OP) visit rates and primary care (PC) visit rates;
- Prices paid by EGI vs national averages;
- Enrollment and costs by plan cost sharing;
- Disease burden rates by diagnosis; and
- Pharmacy spending by brand name and Veterans Administration (VA) National Formulary classification groups.
All of these graphs are interactive -- you can mouse over datapoints to bring up specific values, for example.
Why show this data?
The purpose of this site is to answer some basic questions:
- Are healthcare costs for the State of Wyoming higher than for other self-insured payers?
- If so, why? Is higher cost due primarily to unit prices, or utilization?
Additionally, the Wyoming Department of Health was mandated to make healthcare information public through Footnotes 4(a) and 4(b) to Section 048 of the 2016 Budget Bill, shown below:
4. (a) From these general fund appropriations and any reversions in section 303(n) of this act, the director of the department of health may expend up to four hundred forty thousand dollars ($440,000.00) from any general fund savings identified by the department and certified by the governor for purposes of establishing or joining a multi-payer claims database pursuant to subsection (b) of this footnote. Funds shall only be expended if the department makes the information in the claims database established or joined pursuant to this footnote available to the public. The information made publicly available shall not disclose personally identifiable information but shall include statistical information related to healthcare costs in the state. The department may provide in-kind services for data collection and analysis in lieu of monetary contributions to a multi-payer claims database provider.
(b) In consultation with the department of insurance and the administrator of the employees' and officials' group insurance plan within the department of administration and information, the department of health shall study and, if determined appropriate, join or develop a volunteer multi-payer claims database. The study shall consider only the inclusion of information from the employees' and officials' group insurance plan, Medicaid, and any other health insurance program that receives contributions from state funding sources. The department of health shall report its findings to the joint appropriations committee not later than October 1, 2016.
How will the multi-payer claims database lower healthcare costs?
It won't, by itself.
The data here can provide situational awareness of how costs are trending, how they compare to other payers, and even why they are trending in certain ways.
In order to lower healthcare costs, plan administrators must enact policies informed by this kind of information. These policies could include:
- Incentives for members to improve their health;
- Incentives for members to "shop around" for the most value (price vs. quality) in health care that is "shoppable" (i.e., not emergent);
- Restricting benefits / increasing oversight (e.g. prior authorizations).
- Developing more restrictive networks of lower cost / higher quality providers; and
- Working with providers to develop value-based alternatives to fee-for-service.
How much does this project cost?
The total project cost is approximately $430,000, including contractor work, cloud computing resources, and national price comparisons to be provided by the Health Care Cost Institute (HCCI).
This site itself runs on the State of Wyoming's Google infrastructure; additional cloud computing resources to process the claims data into the graphs shown on this site is expected to cost an additional $5 - $10 per month.