Collecting reliable, standardized, high-quality data on race and ethnicity is a challenge administrators of All Payer Claims Databases across the country have grappled with for years. However, all agree that incorporating data on race and ethnicity is essential to identifying health inequities across communities, providing insights for solutions and interventions, and most importantly to assess progress.

Center for Improving Value in Healthcare (CIVHC), is working hard to help lead the way on race and ethnicity data collection in the Colorado All Payer Claims Database (CO APCD). Through steady, conscientious work and collaboration with the state and other partners, data on race, ethnicity, and other socioeconomic and demographic data in the CO APCD is more actionable and insightful than ever before. Continuing to improve this data collection is a focus priority for CIVHC, with several projects underway to improve visibility and understanding of the impact of racism and social inequities on disparities in health and the health care system.

What Race and Ethnicity Data Does the CO ACPD Have Now?

On the Insights Dashboard page, you can download a report on race and ethnicity data included in the CO APCD for all payers (Commercial, Medicaid, Medicare and Medicare Advantage) through 2020. However, when looking at the data, it’s important to remember it does not yet represent a comprehensive landscape of race and ethnicity data in the CO APCD.

Data currently in the CO APCD represents just the beginning of improved race and ethnicity data collection to come. Since the establishment of the CO APCD in 2012, payers were not required to include race and ethnicity fields in claims, and often left them blank or filled them in arbitrarily leading to limited and unreliable data.

In late 2019, the Data Submission Guide (DSG) changed to require payers to report two of the race and ethnicity fields. CIVHC modeled the data requirements on the guidelines of the U.S. Office of Management and Budget (OMB), which include an indicator for Latino/Non-Latino and five race fields: American Indian or Alaska Native, Asian, Black or African American, Native Hawaiian or Other Pacific Islander, or White.  CIVHC additionally collects data on races identified as “other” or “unknown.”

However, the addition of the required fields does not mean there aren’t still significant challenges in collecting reliable, comprehensive data. A look at the data in 2019 shows that payers, particularly Commercial payers, are still submitting large number of members with race or ethnicity information marked as “unknown.” Overall, Medicare FFS and Medicaid provide more consistent reporting of members’ race and ethnicity, and notably Medicaid has improved significantly successfully reporting complete race and ethnicity information on its members.

Through updates and changes in the DSG and other efforts, CIVHC is collaborating with payers to remedy the gaps in race and ethnicity reporting and collect more complete data.

CIVHC is already turning attention to DSG 13, which will go into use in 2022, to provide more guidance to submitters on race and ethnicity fields and will be recommending an indicator for what languages patients speak. Additionally, CIVHC is working closely with the Department of Health Care Policy and Finance (HCPF) as they update their race and ethnicity data submission standards. After the current adjustments to HCPF data submission standards are finalized, CIVHC will adjust submission standards to match.

Taking Steps Forward

Working on improving data submissions with payers and through the DSG is only the first step towards enhancing the social demographic reporting capabilities in the CO APCD.

This year CIVHC geocoded the CO APCD — one of few to do so among APCDs — which allows analysts to link member and provider addresses to data sources at different geography levels, including census tract level, the most recommended way in current literature of reporting on population health outcomes. While data is currently available in all CIVHC reporting at the DOI, county and zip code levels, census tract level data significantly enhances CIVHC’s ability to incorporate demographic and socioeconomic information from the census data and other sources in reporting and providing more precise geographic analysis.

Through geocoding, analysts are able to significantly enhance accuracy and specificity of reporting capabilities on the landscape of health in Colorado.

Additionally, geocoded data opens the door for CIVHC to include external data sets at the census tract level, or other levels of aggregation, such as the U.S. Census Bureau’s American Community Survey datasets, the Area Deprivation Index, and the CDC Social Vulnerability Index to provide additional insights and opportunities to improve health care for marginalized populations.

The CO ACPD geocoding will be updated each year and eventually incorporated into public reporting and non-public analyses as appropriate according to data release guidelines and privacy and security laws.

Further, while working with the state to update submission guidelines, CIVHC is moving forward on a project in collaboration with Contexture to create a Master Patient Index for Medicaid patients that will allow member-level demographic data on race, ethnicity, education, occupation, income, and more to create a close-level, pinpointed analysis of the current picture of the Colorado health landscape across communities, demographics, and social groups.

The demographic reporting capabilities of the CO APCD are growing in exciting, innovative ways filled with potential to be the first of its kind in accessibility, comprehensibility, and scope to address social inequities that cause harm to Coloradans. To learn more and see further information about the data included in the CO APCD please visit the CO APCD Insights Dashboard and view the resources list.