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I’ve been in health care for over 30 years and as I think about most of the problems with healthcare… access, quality, cost, safety, etc., many of the solutions to these issues were obvious even back in those early days of my career. We knew then that fee for service reimbursement created perverse incentives and that outcome based payments aligned incentives for better care and lower costs. In general, care was siloed, inefficient and demanded vertical and horizontal coordination along with tools such as electronic health records (EHR). The problem was that there was no pressure to change unless it was self-generated. Today, many of the same problems exist, but the impetus and external pressures to improve are upon us.

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As many of you are aware, Colorado’s All Payer Claims Database went live on November 1^st at www.cohealthdata.org. The initial response has been very positive and the APCD has enjoyed extensive press coverage both locally and nationally. Along with the initial flurry of website activity and news coverage we've received some common questions which are answered below. For the complete list of APCD Frequently Asked Questions, click here.

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This time of year is sports fan’s heaven but unfortunately I seem to have been born without the “sports fan gene”. Family, friends and colleagues exchange sad, knowing glances at my pathetic mixed sports metaphors and attempts to engage in post-weekend sports banter.  Despite that, as I write this first health care blog of 2013, all I have are sports metaphors floating in my head.  I apologize ahead of time to all sports fans out there.

Having crossed into 2013, the trigger date of 2014 for implementing the biggest elements of the health care law seems imminent...

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Colorado’s bipartisan Blue Ribbon Commission for Healthcare Reform and other national health care leaders recognize the power of data to support improving health care. The Colorado All Payer Claims Database (APCD) and statewide Health Information Exchanges (HIE) were both identified by the Commission in 2008 as critical sources of data to enhance efforts towards the Triple Aim of better health, better care and lower costs. Colorado’s APCD and HIEs both serve a distinct and essential purpose for health care transformation as outlined in a new issue brief CIVHC developed in partnership with Quality Health Network (QHN) and the Colorado Regional Health Information Organization (CORHIO).

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A recent Denver Post article highlighted findings from a Dartmouth Institute study that found significant variation in the percent of Medicare patients undergoing costly invasive treatments versus non-invasive lower cost procedures for similar diagnoses. Those that received costly surgical and invasive procedures for the same diagnosis didn’t necessarily have the best health outcomes. In many cases, the evidence suggests that patients can realize better outcomes from less intensive treatments including rest, physical therapy and other alternatives. This study provides a great example of the type of analysis that is possible using Colorado’s All Payer Claims Database (APCD) and highlights just a few of many possible examples.

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The Colorado APCD website goes live November 1st, 2012, and will allow us for the first time to start evaluating the big drivers affecting health care cost and utilization in our state. To celebrate this important milestone, CIVHC is hosting a launch event at The Colorado Trust from 10-11:30am. Please join us and other health care leaders in the state as we share some of the early data and findings in the APCD and demonstrate how to use the interactive website to search the health data of interest to you.

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Developing an information resource as complex as the Colorado All Payer Claims Database is a difficult and challenging undertaking. Although sophisticated technology is available, creating a functional database from complex claims information submitted by multiple payers and spanning several years is no easy task. The reality is that even the large and well established health payers face challenges in synthesizing and making sense of their own claims data.

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by Ned Calonge, MD, originally published in Health Policy Solutions November 2, 2012

This week we saw the first presentation of the Colorado All Payer Claims Database, a project of the Center for Improving Value in Health Care (CIVHC) that is jointly funded by the Colorado Health Foundation and The Colorado Trust.

We at The Trust believe that the claims and costs data collected through the APCD, as well as specific measures of quality, will provide an essential missing part of the spectrum of data needed to inform health care decisions by business leaders, policymakers, providers, payers and, of course, health care consumers.

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Last Thursday, November 1, marked a big milestone for health care in our state with the launch of Colorado’s All Payer Claims Database. As the appointed administrator of the APCD, CIVHC is honored to serve as the steward for this unique Colorado resource. We were thrilled by the crowd of more than 200 health care leaders and stakeholders that gathered at The Colorado Trust. Enthusiasm in the room was palpable as participants saw the APCD in action for the first time. Multiple policy wonks admitted that their post-event work plans were “shot” because they planned on spending the afternoon pouring through the APCD site to see what information they could glean. This initial version of the APCD is designed to stimulate important policy discussions towards the goal of better health, better care and lower costs.

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Originally published in the Denver Business Journal, Nov. 9, 2012

by William N. Lindsay III, President of the Benefits Group-Denver for Lockton Companies

While the rate of increase in health insurance costs for Colorado employers has slowed, it continues to outpace inflation. If we want to slow this rate of growth still further, we need to understand what’s driving it. Finally, Colorado is getting a tool that will help us do just that.

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As a patient, would you like to know how much a medical procedure will cost you before you get it? As a buyer of insurance, would you like to know how the providers in one health plan’s network compare on cost and quality measures with those in another? As a Colorado taxpayer, would you like to know how new initiatives from Medicaid, the Child Health Plan Plus and public health departments are affecting health outcomes and costs?

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As an economist, I understand all too well that there can be no meaningful and well-functioning market without accessible and actionable information to inform consumer choices. Health care is no exception, yet we currently have very few places to turn for data that helps us make educated purchasing decisions that drive value into the system. Fortunately this situation is beginning to be addressed nationally through Health Care Cost Institute’s (HCCI) national claims database and CIVHC’s more robust Colorado All Payer Claims Database (APCD).

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Rarely does a day go by that I don’t run into another article arguing the efficacy of health care reform tactics such as medical homes, Medicare payment reform, and Electronic Health Records (EHR). A recent example is “Do Electronic Medical Records Save Money?” by the New York Times. The piece reveals the results of a 2008 federal survey showing that physicians using electronic records actually ordered more high cost tests than their peers who were still using paper medical records. This is contrary to the belief that EHR systems have the potential to save costs by reducing the number of tests being ordered.

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By Lalit Bajaj, M.D., M.P.H., and Nathan Wilkes - APCD Advisory Committee Members

Featured in Denver Post, Guest Commentary 4/27/12

We've all heard the old adage you can't manage what you don't measure. The same is true for health care. In Colorado and across the nation, costs for health care services continue spiraling out of control, gobbling up higher percentages of our wages while taking away from resources that could improve our schools and infrastructure.

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February 13th marked five years since Governor Ritter signed the Executive Order to develop the Center for Improving Value in Health Care. In those five years since CIVHC was merely an idea born out of the 208 Blue Ribbon Commission on Health Care Reform, much has changed for our organization and our state as a whole. The future of health care in Colorado looks bright, and I’d like to take this opportunity to introduce several new staff and highlight some new resources we made available this month in support of Colorado efforts.

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An email with the subject line “Patients Prefer High Cost Care” came through my inbox a few weeks ago. It was spurred by a recent study in Health Affairs revealing that patients would typically select a higher cost service like an MRI over a lower cost CT scan even after being educated on the marginal difference between the results.

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Only a self-admitted data wonk has a favorite health care economist. Mine is Dr. Uwe Reinhardt of Princeton. Over the years he’s amazed me with his witty and succinct analyses of the health care marketplace and why it is so profoundly broken. He just came out with his latest blog, “U.S. Health Care Prices Are the Elephant in the Room”. I highly recommend this article for the nuggets of insight it provides as well as a range of other resources and articles that he points to.

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I read with great interest the Health Affairs Article, “Focus Groups Highlight That Many Patients Object to Clinicians’ Focusing on Costs.” This study found that patients will opt for a more expensive treatment or diagnostic option even if the more expensive choice offers only a slightly improved chance for a better outcome. I am paraphrasing and simplifying the scope of the study but the general sense is that when it comes to a patient’s decision on what medical intervention they want, cost is not important. My professional experience as a physical therapist and orthopedic practice administrator has shown me that costs can play a major role in a patient’s decision to seek elective care. I would like to contrast the Health Affairs study using focus groups’ responses to a hypothetical situation with the real world experience of actual patient dollars being part of the patient’s decision.

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Also posted on Project Health Colorado blog

Last month, Project Health Colorado, an initiative of The Colorado Trust, asked me to address a common theme raised in posts on their website about the lack of cost information given to patients before receiving health care services. John from Colorado Springs wrote, "It's completely unacceptable that we're letting our healthcare providers get away with NOT providing us with good faith estimates of what our portion of the charges will be!" And a post by Taneil from Boulder summed it up best. "For each procedure there should be sane ways to assess benefits and costs. People are totally uninformed in both areas."

So what changes need to be made so that consumers understand the cost of their health care before they buy it?

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At the forefront of efforts to achieve the “holy grail” of health care cost and quality transparency, CIVHC continues to add data to and enhance public reporting based on the Colorado All Payer Claims Database (APCD). The latest APCD release added an additional 400,000 covered lives. New interactive reports give users more analysis opportunities, including “Professional Claims” and “Percent Covered Population,” as well as a new static report on facility costs and utilization rates for knee replacements. These reports provide new views into variation across Colorado’s health care landscape. What continues to strike me, as someone who loves to dig into data and find interesting “nuggets,” is the fact that regardless of the metric you choose to analyze with the APCD, there seems to be significant variation everywhere.

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