OMT - How Data Can Help

Osteoarthritis Management Toolkit

Building the Business Case: How Data Can Help

Data analytics are an opportunity to better understand and determine specifics about how conditions like knee and hip OA drive productivity and other measures. Unfortunately, choosing a strategy to assess or measure osteoarthritis in a population can be complex and challenging. Different stakeholders value different things. As a result, there is a lack of uniformity and a variety of different metrics used. Clinicians focus on disease progression and severity, patients value pain reduction and related quality of life improvements, and employers often look at impact on productivity measures and employee satisfaction. (EPIC p. 23)

To complicate things further, many people with osteoarthritis have multiple chronic conditions including heart disease, diabetes, obesity and depression. Untangling osteoarthritis from other chronic conditions can be difficult and is another challenge facing employers trying to determine the prevalence and cost impact of OA. 

Identifying Those at Risk

Basic data can be gathered using existing tools and simple observation. Although there is no specific screening for the early detection of OA, there are indicators that can help to identify employees at risk, including:

  • Biometrics from health screenings, e.g. BMI
  • Health Risk Assessment responses
  • Environmental factors, e.g. ergonomics 
  • Jobs involving repetitive motion 
  • Observation – walking through facility looking at/reviewing job functions

Other Places to Look for Data:

  • Drill down on musculoskeletal disorder (MSK) to determine prevalence of OA 
  • Connect OA to other disease states using claims data by digging deeper into common comorbidities (e.g. diabetes, heart disease)
  • Track direct costs using medical and pharmacy claims
  • Quantify indirect costs – absenteeism, presenteeism
  • Track/follow work-related injuries (e.g. back, neck, knee) and related claims and absences (e.g. disability vendor data)

Using A Data Warehouse

If a more in-depth approach is desired and resources are available, contract with a third party to warehouse all of your data. These organizations use sophisticated analytics and often provide a flexible platform where an employer can run reports using data points they chose, including those around osteoarthritis. This may include comparison reports – most employers are not currently ranking OA against other diseases or their highest cost drivers like cancer and diabetes.

Potential Issues & Solutions

Don’t be sidetracked by uncooperative inflexible vendor partners or other roadblocks you may encounter. Take these steps:

  • If your TPAs are resistant, be persistent in demanding transparency
  • Say no to generic reports from your TPA or broker – specify the data fields from the claim and EOB in raw data form
  • Find an IT partner who can securely handle and analyze raw data
  • Have a resource with knowledge about coding/billing and insurance contracting on your team


An Employer Example

An Employer’s Journey through Osteoarthritis of the Knee: Data Mapping

Mid-America Coalition on Health Care

Goals of MACHC’s member journey:

  • Provide the primary purchasers of health care with more transparency
  • Neutralize and ultimately reduce the cost of health care – eliminate waste
  • Support and partner with value-based health care organizations

 

Claims data came from two standardized forms:

  • 1,450 (hospital and ASC facility charge)
  • 1,500 (physician professional services)
  • Payment amounts (your cost) reflected on the remittance advice – 885

 

Send your TPA an excel file outlining the fields needed from each applicable form. It’s recommended that you create three tabs, one for each form (e.g. 1500, 4500, 835). The raw data will not be friendly, so you need a health care IT or consulting partner. This ensures you receive all data needed and allows for in-depth data analysis.

 

To catch all related costs, you will need to capture services both billed and paid using the following:

  • OA knee-specific diagnosis codes
  • “J” codes listed
  • Tax ID, NPI #s, place of service
  • All other CPT/HCPCS codes reported for that date of service


The focus of the data map that came out of this initiative is to provide employers with accurate directions and true cost drivers associated with osteoarthritis of the knee. Click here to view the Osteoarthritis of the Knee Data Map


 

 

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