WHIO: Improving Health Care in Wisconsin with Award-Worthy Work

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The WHIO  received a Health Transformation Award from The Alliance on October 1, 2020  for significantly improving transparency and high-value health care in Wisconsin. The Alliance created a case study that captures WHIO’s award-worthy work. This blog article is a condensed version of the case study.

The Wisconsin Health Information Organization, or WHIO, as it’s known, is a non-profit data and information resource established in 2008 that helps employers, providers, health insurers, and the state government to improve the quality and control the cost of health care using claims information. It includes health care claims data on 4.9 million citizens – roughly 72% of Wisconsin’s population.

Where Does WHIO’s Data Come From?

Health plans have been using claims information for many years to evaluate the performance of their network providers and the experiences of their members.

WHIO, an All-Payer Claims Database (APCD), is essentially a super-sized claims data system. They obtain and aggregate claims data from multiple health plans and other payors on commercial, Medicare Advantage, Wisconsin Medicaid, and self-funded employer plans – including The Alliance. The WHIO cleans, integrates, and enhances the claims data to enable sophisticated measurement and tracking of quality and resource use over time.

Using WHIO’s vast data resource, we’re all able to access the same objective source of information, which produces transparency and paves the way for collaboration.

The All-Payer Claims Database: A Single Source of Information

Organizations participate in the WHIO so that trends and patterns in health care can be identified that would otherwise go undetected and to benchmarks results.

“Wisconsin was an early adopter of the all-payers claims database concept,” said Dana, “Many states limit the use and access of information but in Wisconsin, we encourage it’s used by all stakeholders: health plans, employers, providers, researchers, state agencies, and more. We’ve taken an approach where all are encouraged to use the information because it improves the health care delivery system overall.”

Another advantage of having a single source of claims information is that multiple organizations can access that information, reducing the administrative costs of obtaining and providing the data to multiple, separate organizations.

Providing Important Information for Payers and Purchasers Alike

Health plans and purchasers (like The Alliance) use WHIO data to identify high-value providers when designing benefit plans and making network expansion decisions. Employers also use the information to create high-value networks of providers and to design benefit plans that encourage employees to use high-quality, lower-cost provider organizations, or clinicians.

In addition, doctors and hospitals can use WHIO data to identify opportunities to improve care and lower their costs, too. Providers use the information to benchmark themselves against other organizations that provide care – or to statewide or regional benchmarks.

“Benchmarking is important because it provides organizations with the ability to put context around various results, providing them with an opportunity to create improvement strategies,” Dana explained, “So let’s say, for example, you received a result or score of 80. You wouldn’t know if you’re actually performing well or not by looking at that number alone. By using benchmarks, you can prioritize where you are going to put your improvement resources.”

Using Claims Information to Combat COVID-19

Under Dana’s leadership, and through an extraordinary public health crisis, WHIO – using their resource of vast information – has developed an analysis to help identify citizens who are most at-risk for severe complications of the coronavirus (COVID-19).

“We’ve used the information to identify individuals who are high-risk for serious diseases if they were to contract the coronavirus infection,” she said. “We provide that information to the Department of Health, Medicaid division, and other health plans, so they can individually identify these people and work with them to provide the resources necessary to make proper health care choices.”

Wisconsin Collaborative for Healthcare Quality Partnership

WHIO is planning to add additional types of data to their information system to augment their claims information.

“Beyond using claims information on its own, the WHIO is thinking towards a future where we can use our new technical platform to integrate other types of data in tandem with claims information,” Dana said.

For example, WHIO has forged a collaborative partnership (called 360 ValuCounts) with the Wisconsin Collaborative for Healthcare Quality to integrate their clinical data with WHIO claims data. That information will be used to create more comprehensive reports – starting with patients diagnosed with diabetes or behavioral health issues – to create a more complete picture of the care provided for those patients.

“With this, we’ll be able to include process quality measures, outcomes, as well as the cost of care that was used to provide those outcomes,” Dana said.

An Exciting Future for WHIO and Wisconsin

WHIO is looking to expand the use of its information system by adding information on social risk (or social determinants) of health.

“In general, we can use publicly available surveys that allows us to see the environment that an individual is living in. So, for example, approximate income level, or education level, or the density of housing that they’re living in, can help us identify social disparities in health care.” After being asked what she hopes the future brings for her organization, Dana responded with an aspiration for collaboration between all employers and providers.

My hope for WHIO and the State of Wisconsin is that our work is woven into the very fabric of health care in the state; where all organizations can take advantage of this information and contribute to improving the health of Wisconsinites and the healthcare delivery system through information driven decision-making.”

Read the case study.