As of June 2020, the Colorado All Payer Claims Database (CO APCD) contained nearly 920 million claims for approximately 65 percent of insured individuals in Colorado with medical coverage, reflecting over 3.4 million lives. When those with dental and pharmacy coverage are added, the CO APCD spans 4.5 million unique lives with information from commercial health insurance plans, including Medicare Advantage as well as voluntarily submitted Employee Retirement Income Security Act (ERISA) and mandated non-ERISA self-insured employer plans, Medicaid, and Medicare Fee-for-Service (FFS) claims. The CO APCD does not contain claims for people covered by Federal health insurance programs such as the Veterans Administration, TRICARE federal employees, or Indian Health Services, and does not include information for uninsured Coloradans.

This is the middle installment of a series focusing on CO APCD data submitted by payer line of business – commercial health plans, Medicaid, and Medicare. The data in each line of business has different nuances that are helpful to be aware of when using the CO APCD.

Managing Medicaid in Colorado

The Department of Health Care Policy and Financing (HCPF) administers Health First Colorado (Colorado’s Medicaid program). Health First Colorado provides physical, dental, and mental health benefits to qualifying adults and pregnant women as well as children under 18 through the Child Health Plan Plus (CHP+). To help facilitate these benefits, HCPF divided the state into regions and designated organizations in each called Regional Accountable Entities (RAE) to help patients navigate the system and access services. Additionally, some members opt to enroll in Managed Care Organizations (MCO). HCPF and the health plans who act as MCOs or RAEs submit claims for Medicaid members to the CO APCD each month.

Graph indicating the growth in number of payers submitting Medicaid claims to the CO APCD between 2013 and 2019. 5 in 2013, 6 in 2014, 7 in 2015 and 2016, 8 in 2017, 9 in 2018 and 2019

Medicaid and COVID-19

Prior to the COVID-19 pandemic, since 2015 Colorado’s Medicaid population hovered around 1.2 million individuals. However, in the months between January 2020 and August 2021, Health First Colorado enrollment grew from 1.24 million to 1.57 million. Once the coronavirus hit and a Public Health Emergency was declared, the Families First Coronavirus Response Act provided relief funds for many sectors, including health care via Medicaid for those who may have lost coverage due to lockdowns. Incorporated in the legislation was a Maintenance of Effort requirement that ensured that once an individual was eligible and enrolled in Medicaid, they could not be disenrolled unless under specific circumstances. This requirement also meant that the Medicaid membership remains higher than in previous years. Because of this increase in membership and the incomplete nature of the 2020 data in the CO APCD Insights Dashboard in April 2021, this Query includes information through 2019 only.

Chart indicating how many unique Medicaid lives were in the CO APCD each year between 2013 and 2019. 782,800 in 2013 and 1,190,060 in 2019. The year with the highest number is 2017 at 1,251,140 unique lives.

Race and Ethnicity Data in the CO APCD

Collecting demographic and socioeconomic information, specifically race and ethnicity data, has historically been fraught, yet it is more crucial than ever to collect it accurately and safely. Without credible and reliable information, it is impossible to begin correcting the innumerable systemic disparities and inequities laid bare by the pandemic. Of all of the lines of business submitted to the CO APCD (commercial, Medicaid, and Medicare) the race and ethnicity information gathered by Medicaid is by far the most complete.

Bar graph showing a breakdown of race and ethnicity reporting in Medicaid claims data in 2019. 47.9% of claims indicated "multiple" races - Medicaid is the only payer to use the multiple race category. 1.4% of claims indicate other/unknown - in 2019, 81.70% of Commercial claims were marked Unknown/Not Specified.

Box containing the text: It is vital that providers, payers, and patients understand collecting accurate race and ethnicity information is essential if Colorado is to address inequities throughout the system and get resources to those who need them most. Concurrently, it is imperative that policy makers safeguard this information to avoid perpetuating the injustice and discrimination already endemic in the systems we are attempting to fix.Race and ethnicity data fields are frequently left blank or filled in arbitrarily when submitted to the CO APCD, especially by commercial payers who do not consistently capture this information during enrollment, leading to inaccurate or missing information. Because of the inconsistent nature of the reporting, CIVHC has no way to determine if the fields are blank because the payers are not collecting the data at enrollment or the patients do not wish to submit it. As part of the changes included in Data Submission Guide (DSG) 12, CIVHC has included a differentiator between the two as a first step in assessing the completeness of the race and ethnicity data coming into the CO APCD.