Center for Improving Value in Health Care
Dec 12, 2014 | 0 comments | Posted by Global Administrator
Consumer Engagement, Health Reform, Price Transparency, Colorado All Payer Claims Database
Originally appeared in the November/December issue of Colorado Medicine.
In recent years, the Internet has empowered consumers to make informed choices on products and services on everything from restaurants to books to plumbing. Yet, when it comes to health care, we’ve been essentially stuck in the horse-and-buggy days.
That’s because, until recently, there’s been a dearth of reliable performance data to help patients, employers, and providers make informed decisions that help to improve quality and reduce costs. For example, how are consumers supposed to know a reasonable price to pay for a knee-replacement surgery if they can’t compare pricing among those who provide the service? On the other side of the examination table, providers focused on making their services more efficient are hamstrung given the lack of meaningful data on how much medical services cost.
Fortunately, in Colorado and elsewhere around the country, the times are changing as the floodgates for reliable data and transparency in health care begin to open up. Importantly, this is also an opportunity for providers of all types to step up to help make sure that this information is meaningful and valuable for all interested stakeholders.
Key in the state’s health-data revolution is the Colorado All Payer Claims Database (APCD) and public website, seeded through generous grants from the Colorado Health Foundation and The Colorado Trust.
In July of this year, CIVHC launched consumer-focused information on the public APCD website (comedprice.org) providing comparative price and quality data on hospitals. Equipped with transparent information, consumers can better determine if there is significant variation in what they might be asked to pay for medical services – and whether it might be worth their while to shop around.
Colorado’s APCD currently includes 2009-2013 historic claims data from commercial payers plus Medicaid. Medical services prices are currently based on 2012 claims and will be updated to reflect 2013 in 2015. Because of legal and other barriers, self-funded commercial insurance claims data and claims for patients 65 and over are not currently reflected on the website. CIVHC will add information for Medicare beneficiaries to the public website beginning in 2015.
Beginning in 2015, the website will also be updated to include data for ambulatory surgery centers and endoscopy centers. Mild and moderate complexity emergency-room visits will also be available, along with eight procedures that are performed in both hospitals and outpatient settings -- including tonsillectomies, colonoscopies, gall bladder surgeries, knee arthroscopy and hernia repair.
Future plans also include adding up to 20 imaging procedures (e.g., x-rays and MRI and CT scans), and eventually, five types of primary preventative care visits on a named physician-group basis. While not identifying individual physicians by name, the website will include comparative price and quality data at the physician practice group level. Once that occurs, consumers will have access to comparative price and quality information for about 40 common medical services, and physicians and other providers will gain the ability to compare their performance to that of their peers – albeit, at a very high level.
Though it’s unlikely that Colorado’s APCD public website will ever include all medical services and procedures – there are simply too many to ever make that possible or practical – CIVHC aims to highlight information that reflects typical experience for Coloradans for the most common medical procedures and services.
Shaping public policy and private decisions
For those seeking value in health care, the benefits of the APCD website are obvious. As the database becomes more robust in the years to come, it will evolve into an increasingly useful tool for health care consumers and employers mindful of health to manage health care costs.
The information, especially data on variation in utilization and spending, is of keen interest to policymakers who are crafting legislation that could influence the future of health care in Colorado. The governor’s office and other advocacy organizations are also carefully watching this development.
Over the next year, CIVHC will look for opportunities to provide additional information that helps employers, consumers and other stakeholders make better-informed decisions. We will also continue to conduct outreach and offer more education as we develop reports that go directly to various types of providers, to help them understand their own performance in the Colorado marketplace.
In doing this, CIVHC has forged a number of partnerships with the medical community (including the Colorado Hospital Association, Colorado Ambulatory Surgery Center Association, Colorado Medical Society and Colorado Academy of Family Physicians) to develop the kind of information members need to understand relative performance and to identify meaningful quality measures to go along with comparative price information.
Medical services providers of all types are strongly encouraged to explore the APCD site to understand what information is currently available. While some may find only limited utility now, those that want to look beyond global insights to understand their relative performance can also get a deeper dive through custom reports available under the APCD data request and release process.
If you have any questions regarding the Colorado APCD, feel free to contact us at ColoradoAPCD@civhc.org.
About the Author: Jonathan Mathieu is CIVHC's Director of Data and Research. Contact him at firstname.lastname@example.org.
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