Center for Improving Value in Health Care
Dec 12, 2014 | 0 comments | Posted by Global Administrator
Health Reform, Price Transparency, Colorado All Payer Claims Database
The term “Big Data” is a popular phrase these days across social media and blogs, especially when it comes to health care. It’s not surprising given the challenges we’re facing with health care at the national level and the fact that data is key to managing any improvement effort. While the term “Big Data” is becoming synonymous with the golden ticket, it has the potential to become dangerous when used too broadly without a common definition. When it comes to data - “big” or “small” - not all are created equal, but the power of the right data can be instrumental to identify and inform meaningful, innovative change.
So how do you know if you have the right data? First of all, the data must be objective, credible and valid. That seems like a no brainer, but when you’re looking at disparate data sources in mass quantities, it certainly can be a challenge. For example, when it comes to administering the Colorado All Payer Claims Database, the challenge lies in combining claims from over 20 commercial payers (with 8-10 new medical and dental plans expected in 2015) plus Medicaid and Medicare, which in and of itself doesn’t sound all that difficult. However, each of the payers has multiple lines of business and different ways their systems collect and process claims information, so the data coming in to the APCD is being submitted in hundreds of different ways across millions of claims. Making sense of it all is no small task.
Data by itself, however, – even valid, credible data – isn’t useful unless it is analyzed and presented in a way that can help inform decisions and identify opportunities. In other words, the data must be actionable and relevant to the problem you’re trying to solve. In Colorado we are privileged to have multiple data sources, including the CO APCD, the Colorado Household Access Survey, state health data repositories and others across the state that are publicly available. In all of these cases, the organizations behind the scenes work hard to analyze and present the information in a format that can ideally allow users to readily identify variation and opportunities to meet their needs.
For data to be meaningful for improvement it also needs to be inclusive and evolve to meet the changing needs of those in health care. CIVHC’s mission is to identify and support opportunities to achieve the Triple Aim for Colorado and that means that we must continually improve the APCD data and evaluate the needs of those using the data to make sure it’s evolving appropriately. To that end we’ve been actively pursuing ways to collect claims from the self-insured market and fine tuning our analytic capabilities to provide information that can inform paying for high value care. We also are continually evaluating opportunities to combine the APCD with other data sources like the health information exchanges and vital statistics from the Colorado Department of Public Health and Environment to make it even more valuable to those using it.
In Colorado we are pioneering uncharted territory with our APCD. We are blazing a trail in regards to the way our APCD is run and funded, the sheer number of commercial payers we have, the number and types of reports we make publicly available on www.comedprice.org, and the types of specialized reports and analytic data sets we provide to achieve the Triple Aim of better health, better care and lower costs. That’s exciting for CIVHC and for Colorado, but unfortunately that means there is no playbook for running an APCD the magnitude of Colorado’s. Thanks to our advisory committee members, collaborative payer community, Treo Solutions and other partners, we’ve made significant strides in a short amount of time and Colorado is recognized nationally as a national leader for our APCD work.
We work hard with our data warehouse manager, Treo Solutions, and the payer community to continually improve the APCD data intake and processing system to ensure data outputs are valid and accurate. In addition, prior to launching any provider-specific price information on our public site, we also provide health care providers with an opportunity to view and verify their data. Through this process we recently identified a discrepancy in the data being submitted by one of the payers. As a result, we’ve postponed our previously scheduled December release of additional procedures on www.comedprice.org and are aiming to expand the number of procedures and facility types as soon as possible in 2015. The good news in all of this is that the provider data preview periods work as intended and we’re constantly identifying ways to make the process better and eliminate similar issues in the future.
At CIVHC, we take our role as Colorado’s APCD administrator very seriously and it’s our top priority to continue to improve upon this important resource for Colorado. I encourage you to explore all the data available from the APCD and across other sources in the state to evaluate how you and your organization can advance health care and lower costs. Please don’t hesitate to contact me (email@example.com) or our APCD team at ColoradoAPCD@civhc.org if we can be of assistance to you in advancing your work and helping you navigate your data options.
About the Author: Ana English is CIVHC's President and CEO. Contact her at firstname.lastname@example.org.
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