Colorado's All Payer Claims Database offers new data to support improving care and reducing costs.
For the first time, counties across Colorado can evaluate their health care costs compared to “expected costs” based on the overall health status of the patients from their county. Colorado’s All Payer Claims Database (APCD) now includes severity of illness adjustments that measure patient health status, an important tool to understand variations in cost and utilization. Additional reports also released this month include costs to provide care to patients with asthma and diabetes, and a breakdown of health care spending categorized by overall patient health status.
Communities can use the newly released information to gain insights into the drivers of cost of care in their area. For example, in 2011, Huerfano County, 65 miles southwest of Pueblo, Colorado, had a population with an “illness burden” of 1.15, indicating people with Medicaid and large-group and individual commercial insurance in that county are 15 percent less healthy and/or utilized more health services than Colorado residents as a whole (represented as 1.0). Analytics behind the database assign an “expected” value for certain types of health care services such as primary care and emergency room visits based on the illness burden score. Of note for Huerfano County is that patients used outpatient services 30 percent less than expected based on the health of the population but the ER visit rate was 40 percent higher than expected (see graphic pictured right).
Todd Oberheu, FACHE, CEO at Spanish Peaks Regional Health Center (SPRHC) in Walsenburg, says this data is helpful for his organization to track progress on work they’re doing to address where their community members are accessing health care services. “Patients in our community often use the ER as their primary source of care because they view it as more convenient than making an appointment at one of our primary care facilities,” said Oberheu. To encourage patients to utilize their outpatient facilities, which are more cost effective, SPRHC has expanded their clinic hours until 8pm two nights a week. “Unnecessary ER visits negatively impact our ability to manage health care costs for our community. With this data now available, we’ll be able to track our progress over time to see if the educational outreach and changes we’ve put into place to encourage patients to use our clinics are working."
Costs spent treating chronic diseases like diabetes and asthma are also now available on the APCD’s public website. “Treating patients with chronic diseases can be costly for communities, so it’s important to start evaluating where we have opportunities to better manage care, bring down costs, and learn from communities who are doing it well,” said Jonathan Mathieu, PhD, Director of Data and Research for the Center for Improving Value in Health Care (CIVHC), the organization responsible for administering the Colorado APCD.
As an example, Mathieu explained that Alamosa County’s total cost of care to treat diabetic patients was $10,515 in 2011, nearly $3,000 less than Pueblo County’s costs at $13,205 (see graphic pictured left). “This difference could be due to the fact that Pueblo has more diabetic patients (4 percent) than Alamosa (2.8 percent), and that Alamosa has a higher percentage of Medicaid claims currently in the APCD. However, when you look at where the dollars are being spent, Alamosa’s percentage of patients being admitted to the hospital is almost half (16 percent) that of Pueblo’s (32 percent),” said Mathieu. “It appears as though Alamosa is doing some things right to keep their diabetic patients from ending up in the hospital, and other communities might be able to learn from what they’re doing.”
Additional new reports on the APCD website reveal that Colorado spends roughly 78 percent of total health care dollars on only 24 percent of the population. These 24 percent of patients fall into the categories of critical illness, complex chronic disease, simple chronic disease or at risk of developing serious health conditions (see graphic pictured right). Several communities across the state are targeting these and similar high-cost groups of patients to improve overall population health and contain costs, a technique also known as “hotspotting”. These new APCD reports allow communities to evaluate their costs based on the "illness burden" score of their residents compared to Colorado and other counties across the state.
“The original legislative intent for the Colorado APCD was to provide more transparency in pricing and performance information to support realizing the Triple Aim goals of better health, better care and lower costs in Colorado,” said Phil Kalin, CIVHC’s President and CEO. “Our goal with each new release is to provide deeper analysis that will help Coloradans identify opportunities for Triple Aim improvement.”
More meaningful consumer-focused reports are currently in development for release in December that will support patients in making value-based health care purchases. “By December of this year, the APCD will become a tool for patients to use to shop for health care by provider or facility,” Kalin explained. “Giving consumers the information they need to make informed decisions will help our health care system function more like a true marketplace.”
About the Colorado All Payer Claims Database. Originally recommended in 2008 by the bipartisan Blue Ribbon Commission for Healthcare Reform and enabled by legislation in 2010, the APCD is a secure, encrypted data warehouse that provides an important window into health care spending and utilization using claims data from health insurance payers. The ACPD is Colorado’s most comprehensive health claims data resource – giving patients, purchasers, providers, payers and policymakers the tools to make informed decisions that will improve the value and efficiency of our health care system. Data in the APCD currently includes the 14 largest commercial insurers for individual, large group fully-insured and some self-insured lives, as well as Medicaid. Over two million unique individuals are represented in the APCD encompassing over 40 percent of Colorado’s insured population. By 2014 the database will expand to include remaining segments of the commercial market as well as Medicare, reflecting the majority of insured Coloradans. Visit www.cohealthdata.org for more information.
About CIVHC. The Center for Improving Value in Health Care is a nonprofit, nonpartisan organization committed to identifying and advancing initiatives across Colorado that enhance consumers’ health care experiences, contain costs and improve the health of Coloradans by creating an efficient, high quality and transparent health care system. For more information about the Center for Improving Value in Health Care, visit www.civhc.org.
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