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The All Payer Claims Database will Help Coloradans

Lalit BajajBy Lalit Bajaj, M.D., M.P.H., (pictured left) and Nathan Wilkes (pictured right) - APCD Advisory Committee Members

Featured in Denver Post, Guest Commentary 4/27/12

We've all heard the old adage you can't manage what you don't measure. The same is true for health care. In Colorado and across the nation, costs for health care services continue spiraling out of control, gobbling up higher percentages of our wages while taking away from resources that could improve our schools and infrastructure.

If those dollars made us all healthier they might be worth paying, but experts estimate that more than 30 percent of all our health care expenditures are wasted and do not improve care. In addition, a recent study showed massive variations in preventive medicine costs, with colonoscopies alone ranging from $786 to $1,819. So where should we start chipping away at this massive problem? We think that giving Coloradans easily comparable data on health care costs and quality is a good start.

In today's wired world, consumers have nearly instantaneous access to detailed information on the cost, quality and performance of nearly any major item they purchase. The glaring exception is health care. As a patient, would you like to know how much a medical procedure will cost and the quality ratings of the provider before you agree to have it done? As a purchaser of insurance, would you like to know how providers in one health plan's network compare on cost and quality measures with those in another? The good news is that work is happening right now to ensure that Coloradans will soon have the information they need to ensure their health care dollars are buying the highest value.

The non-profit Center for Improving Value in Health Care (CIVHC) is launching an All Payer Claims Database (APCD) containing claims information (cost, diagnosis, payer, provider, and location) that will identify variations in cost and quality across Colorado and eventually provide the comparative information Coloradans need to make informed decisions about their health care. Due to the importance of improving health care in the state, two health organizations, The Colorado Trust and the Colorado Health Foundation, have announced $4.5 million in funding to support APCD implementation.

As members of CIVHC's APCD Advisory Committee representing both the provider and patient communities, we've been hard at work to ensure that the information in the database will be private and secure and will meet all Health Insurance Portability and Accountability Act (HIPAA) regulations. We've also been determining the types of reports to be made available — reports that will prompt people, providers, and employers to ask the questions we need to think about to improve health care in Colorado.

With the first reports available this year, Coloradans will begin to see the level of variation in costs and quality within our health care system. By 2013, we will have access to vital health care information: for example, which hospitals provide the highest quality surgical procedures at the lowest cost. Health care professionals, hospitals and other health care facilities and health plans can use the information provided by the APCD to identify high-cost and often misused patient services like unnecessary emergency room visits to develop alternative care solutions that emphasize prevention and value.

With implementation of the APCD, Colorado will join nine other states in the nation with an APCD, including neighboring Utah, and we will finally have information that will help us move Colorado in a positive direction on health care. With the APCD data at our fingertips, Coloradans will be able to manage and become the primary decision makers on what they will now finally be able to measure: cost and quality.

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Because the employers are paying a HUGE chunk of the bill usually 50% to 90%. It doesn't actually cost LESS, it costs MORE. You just don't SEE it, because they're footing the tab. As to why it doesn't cost the same per person . . . because with an employer, the healthy young employees pay the same as the old sick ones, they AVERAGE the rate. So the rate for an employee might be $500 a month (and the employer pays $300 of it). When the healthy young employee shops around and buys private coverage, it might cost them $125 a month less even than their share. But when the old sick employee shops around, it might cost THEM $1200 a month. Health insurance, after all, is ONLY sharing of cost. Everyone pools their money, and the claims are paid out of the pool. The more claims that get submitted, the more the rates have to go up.
9/8/2012 9:01:16 AM

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