June 30th marks the end of my first full fiscal year at CIVHC. I started in March of 2018, just as the year-end activities were ramping up. At that time, I was struck by how many ways CIVHC and the Colorado All Payer Claims Database (CO APCD) support different stakeholders. A year later, having watched projects evolve from ideas into reality, it’s exciting to see the diversity of stakeholders using CO APCD data and the innovative work being done by our partners. Colorado has a broad and diverse set of Change Agents utilizing claims data to make health care better for all of us in the community.
While I could describe hundreds of ways individuals, organizations and communities are using the CO APCD to inform positive change, below are just a few examples of ways CIVHC has supported Change Agents in the past year:
- The CO APCD was consistently referred to as a necessary resource for effective policy-making throughout the 2019 legislative session. It is listed as one of the sources of data for out-of-network payments in the out-of-network health care services patient bill (HB 19-1174) and the supporting primary care bill (HB 19-1233) and is included in the Governor’s Roadmap to Lowering Health Care Costs. CIVHC provided data related to these bills to stakeholders and legislators on both sides of the aisle to inform the conversations, and we look forward to supporting the Division of Insurance with implementation.
- At the beginning of 2019, CIVHC released new facility cost and quality information for common procedures on civhc.org. This information allows Coloradans to shop for health care services that they can schedule, like births or hip replacements. Patients can save significantly by shopping around – from $3,520 for cataract surgery up to $35,220 for a knee replacement. We’re hearing this information has already helped many Coloradans save money on their health care costs and helps providers benchmark their prices with their peers.
- Over the past year, CIVHC worked with rural health care providers to develop patient migration reports to show where patients are going for care and what services they are seeking when they leave the community. Equipped with this information, rural providers are identifying gaps in the local community’s network of care and which is helping them identify additional services that might be needed locally.
- We’ve been collaborating with physician partners for several years to provide data to help them focus on what is really important, their patients. The information we provide helps physicians ensure they are providing the highest quality care possible at a reasonable cost by showing them data not only for their practice but benchmarked to their peers and across the state and country.
- Beginning in the summer of 2018, employer groups and coalitions started using CO APCD data to determine how much they are paying for services compared to Medicare as a new benchmark to establish insurance payments.
- Concurrent with Medicare reference-based pricing initiatives led by these coalitions, CIVHC began working with partners to encourage bringing more self-insured employer data into the CO APCD. Submission of data to the CO APCD is voluntary for many self-insured employers and we are working with employers to show the value of inclusion by demonstrating the cost savings possible with cross-payer and provider analyses.
The CO APCD was envisioned as a tool to facilitate transparent “reporting of safety, quality, cost, and efficiency information at all levels of health care.” CIVHC is working with the State to broaden access to CO APCD data with many projects slated for the coming year. We are also actively working with researchers, advocacy organizations, payers, health systems, and many other Change Agents to determine how CO APCD data can best support their cost, quality, and utilization initiatives, and we look forward to what this next fiscal year will bring in terms of helping drive innovation and value into the system by providing data as a decision-making tool.
By Pete Sheehan, VP of Business Development