One Billion Claims Can Tell You a Lot CMS designates MPA a Virtual Research Data Center (VRDC) Innovator

November 2016

MPA Healthcare Solutions (MPA) is pleased to share the good news that we were recently designated as a Virtual Research Data Center (VRDC) Innovator by CMS, greatly expanding our ability to perform meaningful analyses and develop tools that inform and guide leaders in the healthcare marketplace.

CMS covers 100 million patients through Medicare, Medicaid, and the Children’s Health Insurance Program; and the Medicare program alone handles more than one billion claims per year.[i] As a VRDC Innovator for CMS, MPA is one of a select group of companies that has access to this extensive data warehouse of Medicare and Medicaid claims.

MPA has 30 years of experience building predictive models, performing analyses, and conducting research using CMS LDS and RIF datasets. MPA’s new designation as an Innovator means that we can now access more data in expanded ways to perform analyses and create tools and other products that directly support the business needs of payers, hospitals, physician groups and other stakeholders who are interested in measuring and improving health care quality and reducing costs.

CMS dataHigh-quality Medicare and Medicaid claims data provides a unique opportunity to study utilization and outcomes across time, settings, facilities, and patient populations. These analyses may provide useful insights into care in commercial populations as well as for Medicare and Medicaid populations. MPA has consistently found that predictive models for drivers of care outcomes and cost translate well from Medicare to commercial populations.

With the added flexibility of the Innovator program, and the speed of data delivery through the VRDC, MPA can offer immense benefits to our partners. The following represent just a few of the many areas where the combination of our analytic capabilities and the VRDC data can create market advantages:

Bundled Payments – Detailed data across the full continuum of care permits a deeper exploration and understanding of opportunities under Alternative Payment Models (including with commercial payers), building on more powerful predictive models for both outcomes and costs. Sustainable, robust care redesign and gainshare programs can be developed that may be uniformly adopted across service lines and recognize and reward the performance of individual clinicians.

Outpatient Care – The quality of outpatient procedures can be benchmarked against potential competitors. In addition, analyses can guide site-of-service decisions (inpatient vs. outpatient) to minimize costly adverse events.

Post-Acute Care – The more detailed ability to track patients throughout the post-acute period permits analyses that can inform payers and providers about the effect on quality and cost of important post-acute care decisions and interventions. Providers, for example, can identify whether SNF, IRF, or HHA is the most appropriate discharge disposition for specific patients.

Emergency Department Visits – Emergency Department visits may represent an adverse outcome of care or may provide an opportunity for early intervention, thus avoiding serious and costly adverse events (e.g. readmissions) in the future. Analyses can expand an understanding of the quality of care and can guide care redesign and interfacing with Emergency Departments to further improve outcomes and reduce overall costs in Alternative Payment Models.

Population Health – Analyses can identify failures of prevention (where traditionally low cost patients shift into higher cost groups) and failures of treatment (where patients remain in high cost groups that would be expected to return to lower cost groups). Provider ability to avoid these failures can be evaluated and insights into the most effective deployment of resources for specific subpopulations (not just the highest risk groups) can be gained.

These are just some of the possibilities available. Have some ideas? Please contact us.


Gregory Pine

Gregory Pine is the CEO of MPA Healthcare Solutions. He oversees strategic and financial planning and establishes priorities for developmental and marketing initiatives. Since assuming this role in January 2004, Mr. Pine has been instrumental in shifting the firm’s focus from individualized developmental and consulting engagements to the creation of innovative products and service packages that meet the needs of a broad spectrum of healthcare organizations.

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