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New Claims Data Provides Colorado with Expansive Health Care Insights

Hospital readmission rates for Medicaid and commercially insured individuals are now available on the Colorado All Payer Claims Database (APCD) website demonstrating, for the first time, quality of care provided to Coloradans under 65. Generic prescription medication use and claims from 2012 are also now available on the public site, providing Colorado communities with a more expansive view of cost and health care services being used by their population.

“As a state, we have limited access to Medicare information, but that doesn’t tell us what’s happening to the broader population,” explained Center for Improving Value in Health Care’s (CIVHC) interim CEO, Edie Sonn. “With this latest APCD update, we now have the ability to view readmissions and other important health care metrics across the Medicaid and commercially insured populations, providing a much sought after window into health care in Colorado.”

The Colorado APCD now includes readmission rates, regardless of the cause, within 30 days of discharge from any hospital. Medicaid and commercial health insurance readmissions are broken out to allow for more specific population comparisons at the county and ZIP Code 3 (first three digits) level. In addition, two different ways of looking at readmission rates are available – the more traditional readmission rate as a proportion of hospital discharges (similar to the way Medicare rates are currently reported), and a readmissions per 1000 population-based rate.

“Calculating readmission rates compared to the number of people insured in a particular county is important because it provides a way to measure and track progress on readmissions regardless of fluctuation in the number of admissions,” explained Alicia Goroski, MPH, CIVHC’s Director of Performance Measurement and co-author of a seminal Medicare readmissions JAMA article. “Many efforts to improve care transitions result in reductions in both 30-day readmissions and in overall admissions. When both admissions and readmissions decrease, the resulting proportion of readmissions to hospital discharges can misrepresent actual decreases.” 

CO Medicaid Readmissions per populationThe population-based readmission rates in the CO APCD allow communities to track reductions in both overall hospital utilization as well as declines in 30-day readmissions.

Goroski, having spent the last seven years assisting communities locally and nationally with reducing readmissions, noted that one of the greatest challenges was only being able to track and monitor readmission rates for the Medicare fee-for-service population. 

“The availability of publicly reported readmission rates for Medicaid and commercial payers is ground-breaking. Colorado is leading the way.”

Tables 1 and 2 (click to picture to CO Commercial Readmissions per population 2012enlarge) show Medicaid and commercial payer all cause 30-day readmission rates per 1,000 insured people in the APCD for the 10 most populous counties in Colorado. Not surprisingly, given that its patient population is generally less healthy than commercially insured patients, Medicaid has higher rates of readmission statewide (6.2 per 1,000 people insured in the APCD) and across the largest 10 Colorado counties than commercially insured (1.4 per 1,000).

In addition to Medicaid and commercial payer breakouts in readmissions, the latest Colorado APCD update allows users to compare the two payer types across all available metrics. Examples of other available comparisons include total cost of care by geography, emergency room visit utilization and associated costs, and prevalence and cost to treat for diabetes and asthma patients.

The latest release also features a new “Percent Generic Prescriptions” metric to identify variation in the percentage of generic medication prescriptions being filled across the state. The map below (click to map to enlarge) identifies the variation in generic prescription use across Colorado’s counties for those commercially Percent Generic Scripts Map Commercially Insuredinsured. As highlighted, El Paso County has the lowest generic prescription use in the state (77 percent), five percent below what would be expected for their population based on their health status and utilization of health care services. This could have implications on the cost of care in El Paso since traditionally generic prescriptions are less costly than name brand medications.

The CO APCD’s purpose is to provide a broad picture of health care spending and utilization across Colorado to identify opportunities to improve care, reduce costs and track improvements. Future releases of the APCD will provide consumers with comparative price and quality data for common health care procedures and services at facilities across the state. Planned for 2014, this information will assist consumers with identifying high value health care services.

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