HSS unveils first integrated all‑payer claims dashboard showing plan cost drivers

HSS staff and Truven/Aon analysts showed the board the system’s first integrated all‑payer claims database (APCD) dashboard covering inpatient, outpatient and pharmacy utilization through the second quarter of 2015. Marina Coleridge (data analytics manager) described the multi‑year effort to migrate vendor reports into an APCD hosted by Truven and explained validation work and a 3% variance acceptance threshold used to confirm the numbers.

Key findings the board heard: City Plan’s small enrollment (about 876 members in the sample) makes per‑member measures volatile and gives each high‑cost case oversized influence; Blue Shield’s membership has an older 45–64 cohort that correlates with higher pharmacy use and admissions; pharmacy fills and specialty medications are a major upward trend across plans, contributing materially to per‑member cost increases. Presenters also showed average length of stay differences and argued that outpatient case mix and specialty drug utilization explain much of the premium gap.

Staff said next steps include calculating individual risk scores, incorporating additional vendor clinical categories (ICM/OMS) and adding market benchmarks; the board asked for future risk‑adjusted comparisons to isolate price vs volume drivers and suggested presenting cross‑tabulations for the 45–64 cohort. The APCD work was praised by the chair as a notable transparency and analytic advance for employer‑sponsored plan oversight.