The CO APCD is a state-legislated, secure health care claims database compliant with all federal privacy and antitrust laws. It is the only claims repository in the state that represents the vast majority of insured lives in Colorado, with more than ten years of data from commercial health insurance payers, Medicaid, and Medicare.
Contents of the CO APCD
The CO APCD currently contains over 870 million claims for nearly 70% of Coloradans with medical coverage (over 5 million unique individuals across all coverage types), with information from commercial health insurance plans, voluntarily-submitted Employee Retirement Income Security Act (ERISA) self-insured and mandated non-ERISA self-insured employer plans, Medicare Advantage, Medicare Fee-for-Service (FFS), and Medicaid. The CO APCD does not contain claims for people covered by Federal health insurance programs such as the Veterans Administration, TRICARE, Federal Employees Health Benefits, or Indian Health Services, and does not include information for uninsured Coloradans. For more information regarding the number of lives, payers, and more that are in the CO APCD, and how it has changed over time, visit the CO APCD Insights Dashboard.
Due to a 2016 ruling by the United States Supreme Court, states cannot mandate submission of claims data from self-insured Employee Retirement Income Security Act (ERISA) employer plans to APCDs. Self-insured claims are estimated to represent half of the total commercially insured lives in Colorado and CIVHC estimates that the CO APCD currently contains approximately 50% of all self-insured plans, including 25% of ERISA self-insured plans.
When a Coloradan with health insurance receives a health care service, the provider typically submits a claim for reimbursement to the patient’s health insurance company. Once the claim has been paid, the health insurance company submits the information for collection in the CO APCD.
How the CO APCD is Used
CIVHC releases CO APCD data in two ways:
- Non-public releases, licensed by Change Agents working on specific projects to improve care for Coloradans, and
- Public information on civhc.org designed to foster decision-making at all levels of the health care system, from consumers to state agencies.
Non-Public Data Releases
CIVHC provides non-public data sets and reports to organizations and researchers seeking to advance the Triple Aim. Every release of data must benefit Colorado, as mandated by CO APCD regulations, as well as adhere to federal privacy and anti-trust laws. Learn about projects powered by CO APCD data on the Change Agent Index.
There are several ways non-public CO APCD data is provided, depending on the question the requestor is hoping to answer and their experience using claims data. For Change Agents who do not have time or the expertise to analyze data on their own, CIVHC can provide a Custom or Standard report in a business intelligence or data visualization tool like Tableau or Excel. When partners have a strong analytic background and are interested in performing their own analyses using tools of their choosing, CIVHC provides them with a Custom or Standard Data Set. Depending on the level of personal health information (PHI) required, data sets are De-Identified, Limited, or Fully Identifiable. Every request containing any element of PHI is reviewed in detail by the Data Release and Review Committee to ensure they meet all state and federal privacy regulations prior to approval and production.
Increasing access to transparent health care data for all Change Agents is foundational to the legislative vision of the CO APCD, CIVHC’s mission, and Colorado’s ability to make informed decisions that will have lasting benefit for Coloradans. Making public analyses and interactive tools available on civhc.org is one of the methods CIVHC employs to bring transparency to the health care marketplace. The Shop for Care tool is available to help patients identify where they can go to receive the best care at the lowest price for procedures and services.
Public releases of CO APCD data are used widely in Colorado and across the nation and, in some cases, are provided as in-kind donations to help Change Agents who do not have the resources for a full non-public release access information. Visit civhc.org to access all publicly available reports, and contact us at email@example.com to see if your project qualifies for an in-kind public release.