Claims data across payers now available to support
improving care and reducing costs in Colorado
The first round of reports from Colorado’s All Payer Claims Database (APCD) - a groundbreaking tool for measuring health care costs and utilization throughout Colorado - are now available at www.cohealthdata.org.
Originally recommended in 2008 by the bipartisan Blue Ribbon Commission for Health Care Reform and enabled by legislation in 2010, the APCD is a secure, encrypted data warehouse that provides an important window into health care spending and utilization. The ACPD is Colorado’s most comprehensive health claims data resource – giving patients, purchasers, providers, payers and policymakers the tools to make informed decisions that will improve the value and efficiency of our health care system. Data in the APCD currently includes the eight largest commercial insurers for individual, large group fully-insured and some self-insured lives, as well as Medicaid. Over two million unique individuals are represented in the APCD encompassing over 40 percent of Colorado’s total covered lives. By 2014 the database will expand to include remaining segments of the commercial market as well as Medicare, reflecting approximately 90 percent of insured Coloradans.
Initial data analysis for Medicaid and commercially insured populations reveals wide variation in the total cost of care by county. For example, counties like Mesa, Delta and Montrose match the statewide average for Medicaid, but have higher than average costs for commercially insured patients. This first glimpse into total cost of care will encourage health policy experts, health plans and providers to start asking why discrepancies exist and provides a basis for communities to further evaluate their own cost and health disparities.
The Center for Improving Value in Health Care (CIVHC), a non-profit, nonpartisan organization, administers the APCD. “The relentless rise in health care costs directly impacts the wages of Coloradans and makes our businesses less competitive. Numerous studies estimate that between 25-30 percent of the money spent is wasteful and doesn’t add any real value to the patient,” said CIVHC CEO Phil Kalin. “The APCD offers transparent pricing and performance information that our health care system currently lacks and that all of us need to make value-based decisions that will lower costs and promote quality improvement. With comprehensive data at our fingertips we are more fully equipped to improve the system.”
One of many uses of the APCD is to illustrate differences in payment for common health care services, such as diagnostic imaging. For example, a current APCD imaging payment report shows variation in payments for MRIs of the knee. In 2011, the costs paid for a knee MRI to the 20 highest-volume facilities in Colorado varied by a factor of four ranging from $297 to $1,261 for this procedure. Payments for high cost imaging services (including both MRIs and CT scans) varied by a factor of five ranging from as low as $385 to high as $2,049 amongst the 20 highest volume facilities. These differences are important for Coloradans paying for these services out of pocket or under a high-deductible insurance plan, and for facilities trying to determine where they stack up against the competition.
“The APCD can enable hospitals and other providers to identify where their care patterns are out of the norm for their peers, and begin to understand how they might achieve better patient outcomes more effectively and efficiently,” said Jay Want, MD, CIVHC’s Chief Medical Officer. “Physicians and other clinicians can begin to compare cost and quality performance across the market with their own and drive value into the system.”
In this age of technology when consumers can evaluate cost and ratings of just about any product on the market, health care is the stark exception. As other segments of the health insurance market are added to the APCD, the database will give consumers and employer purchasers comparative data to make informed choices about purchasing health care and accessing services.
“For any market to function properly, consumers must be in the driver’s seat, equipped with cost and value comparisons,” explains Kalin. “The APCD launch lays the foundation for consumers and purchasers to have access to important pricing and quality information. By 2014, if you need hip surgery, you will be able to use www.cohealthdata.org as a tool to see how much that surgery would cost at various locations in your area and compare that with quality information, such as infection rates.”
“Americans are accustomed to being consumers, and having the tools to evaluate what they are getting for what they spend. The APCD is a first step to unlocking the power of markets to drive value and affordability in health care,” notes Want.
The planning phase for the APCD was supported through a grant from The Colorado Trust. An additional $4.5 million in funding from the Colorado Health Foundation ($2.5 million) and The Colorado Trust ($2 million) supports ongoing development, implementation and management of the APCD.
All information in the APCD is encrypted to maintain security, and all APCD data releases must comply with the privacy and security requirements of the Health Insurance Portability and Accountability Act (HIPAA). The database is powered by Treo Solutions, an organization with a 10-year unblemished record of protecting the privacy and security of health data.
With the launch of the APCD, Colorado joins 11 other states across the U.S. with similar databases that provide an unprecedented ability to identify variations in cost and utilization. For more information about Colorado’s APCD, visit www.cohealthdata.org.
The Center for Improving Value in Health Care is a nonprofit, nonpartisan organization committed to identifying and advancing initiatives across Colorado that enhance consumers’ health care experiences, contain costs and improve the health of Coloradans by creating an efficient, high quality and transparent health care system. For more information about the Center for Improving Value in Health Care, visit www.civhc.org.