In our last blog, you learned what an All Payer Claims Database (APCD) is and what type of information CIVHC collects. We talked about how each health care claim is a tiny, jumbled Rubik’s Cube and how each color represents a different piece of information (encrypted personal information, provider identifiers, diagnosis codes, etc.). We also discussed that CIVHC’s job, as administrator of the Colorado APCD (CO APCD), is to make sense of all these little cubes and ensure that each side of each cube is the same color.
But what, you may ask, do we do with all of the claims in the CO APCD?
As part of the legislation enabling the CO APCD, lawmakers specified that CO APCD data could only be used to improve health care, public health outcomes, and lower costs for Colorado residents. Rules established by the Colorado Department of Health Care Policy and Financing (HCPF) further specified what purposes the data could be used for and in what ways.
CIVHC takes the purpose and intent of the CO APCD very seriously. We release data in two ways: non-public, custom releases to outside entities through a detailed request process; and public releases via our website, www.comedprice.org including publishing in-house analyses highlighting opportunities to improve care or lower costs across the state. Under CO APCD statute and rule, every data requestor must demonstrate how their project will benefit Colorado, either directly or indirectly.
CIVHC also takes data privacy and security extremely seriously. We collect, store, and release CO APCD data in full compliance with all federal regulations including the Health Insurance Portability and Accountability Act (HIPAA). Patient specific protected health information (PHI) is stripped from each claim at intake, encrypted, and stored in a separate warehouse from the rest of the claim information. Access to PHI is limited to people qualified to work with sensitive information on well-defined projects allowable under HIPAA. When an independent committee of experts determines a request for this type of information is appropriate for approval (usually to support specific research projects), PHI can be re-matched to the claim information.
What type of data is available from the CO APCD?
There are four types of data sets available from the CO APCD and they are categorized by the level of detail and number of data elements included. To help illustrate what is included in each type of data set, imagine a bag of marbles – the kind that you used to play with when you were a kid.
Clearies – Identifiable Information
The transparent marbles known as “clearies” are an excellent example for identifiable data sets as these requests contain the most PHI. Light streams through these marbles with no obstruction, just as identifiable data sets provide enough detail to differentiate between patients. These data sets are difficult to obtain; the CO APCD Data Release Review Committee (DRRC) evaluates the planned use of the data to ensure that it meets not only the benefit to Colorado requirement but also all of those proscribed by HIPAA and other federal data privacy and security laws, and must recommend each request for approval. These types of requests generally require review and approval by an independent Institutional Review Board (IRB) to ensure that patient privacy will be fully protected.
One example of a project using identifiable CO APCD data is a multi-state initiative working to identify ways to improve health outcomes and lower costs in underserved populations. The requestors are combining patients’ health care claims information with their electronic health records which will ultimately provide a more complete picture of each patient’s health care history, based on both cost and clinical information.
Cat's Eye – Limited Data Set
Limited data sets still have PHI but not as much as those with identifiable information. Cat’s Eye marbles, with their swoosh of color down the center, are a lot like limited data sets; you can see through part of the glass, but the rest is obscured. In these particular data sets, the information hiding in the swoosh includes anything that might directly identify a patient, such as names or medical record numbers. The PHI that is included in a limited data set can allow requestors to perform analysis by birth date, zip code, admission, discharge dates, etc. Because some PHI is present, the DRRC must review and recommend approval of all limited data set requests.
A study by Project Angel Heart is a great demonstration of how a requestor may use a limited data set. Using claims information for chronically ill and mobility-restricted patients who received Project Angel Heart’s customized, home-delivered meals, the requestors are comparing cost, use of services and care outcomes between recipients and a control group that did not receive the meals. This information will ultimately show the return on investment for their community-based program and demonstrate the value of their services to health care payers, legislators, donors and funders.
Game Marbles – De-Identified Data Set
Game marbles are completely solid and opaque. It is impossible to see through them, just like a de-identified data set. Nothing in a de-identified data set can be used to pinpoint back to an individual. The DRRC has established criteria for the release of this type of CO APCD data and CIVHC evaluates and reports on each one to make sure that it meets the statutory requirement of benefitting Colorado.
De-identified CO APCD data allowed a graduate student to compare hospital-specific readmissions data with the results of patient surveys to see if there was a relationship between the number of readmissions and patient responses regarding the adequacy of their discharge instructions. This project helps hospitals make a business and patient satisfaction case regarding improving the patient experience and reducing future readmissions.
Rainbows – Public Data Release
Opaque and swirled with color, rainbow marbles best describe CO APCD information in public reports released by CIVHC. These releases contain no PHI and usually display information for large groups, represented by the different swirls of color, for various geographic areas and topics such as Colorado residents with asthma or diabetes by region, number of people who used emergency rooms in a given year, or the percentage of generic prescriptions filled by county. Like de-identified data sets, the DRRC has established criteria for release of non-public custom reports, but does not review public releases of reports based on CIVHC analysis of CO APCD data.
CIVHC reports facility-specific cost and quality information on www.comedprice.org as well as public health data for the entire state, including chronic disease prevalence, total cost of care, and utilization of preventive screenings. We also perform our own analyses of de-identified data, investigating drivers of health care costs like using an emergency room instead of waiting for an office visit with a physician. The purpose of providing public information is to identify opportunities for improvement statewide, inform policy decisions, and provide consumers with information on price and quality.
The CO APCD has the power to show us incredible things and bring about innovations not-yet-dreamt-of here in Colorado. CIVHC is proud to be the administrator of this amazing asset and we look forward to continuing to work with our stakeholders to lower costs, improve care, and create a healthier Colorado.