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Accessing the Power of Colorado's All Payer Claims Database

A recent Denver Post article highlighted findings from a Dartmouth Institute study that found significant variation in the percent of Medicare patients undergoing costly invasive treatments versus non-invasive lower cost procedures for similar diagnoses. Those that received costly surgical and invasive procedures for the same diagnosis didn’t necessarily have the best health outcomes. In many cases, the evidence suggests that patients can realize better outcomes from less intensive treatments including rest, physical therapy and other alternatives. This study provides a great example of the type of analysis that is possible using Colorado’s All Payer Claims Database (APCD) and highlights just a few of many possible examples.

Although surgical and invasive procedures are usually among the highest cost treatment options, in some cases they generate limited benefits for the patient and require extended recovery periods. Pursuing less intensive treatment options can improve health outcomes and patient satisfaction while reducing the overall cost of health care. Similar analysis based on the Colorado APCD can provide information on potential cost savings and facilitate comparisons across patients covered by Medicare, Medicaid and private insurance.  Results of this type of analysis will be made available through the website www.cohealthdata.org on an ongoing basis as the APCD grows and matures.

For those interested in obtaining more detailed analysis or reports that are not currently available through the APCD website, CIVHC is finalizing a formal APCD Data Release Process. According to rules promulgated by the Colorado Department of Health Care Policy and Financing (HCPF), a state or private entity may request a specialized report by submitting a written request to the APCD Administrator (CIVHC). The written request must include a description of the project and its purpose, methodologies to be employed, qualifications of the requesting entity and execution of a Data Use Agreement.

A specialized report can be similar to information already available on the APCD website, or may encompass requests for de-identified data or a limited data set as defined under the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Under HCPF rules, a request for a specialized report must: 1.) Be consistent with the statutory purpose of the APCD; 2.) Contribute to efforts to improve health care or public health outcomes for Colorado residents; and 3.) Comply with the Privacy and Security requirements of HIPAA. 

Information on the Colorado APCD Data Release Process is currently being finalized and will be made available through the CIVHC and Colorado APCD websites later this month. This information will include an overview of the Data Release Process, a list of Frequently Asked Questions as well as the Data Release Applications and Data Use Agreements.  Please contact me at jmathieu@civhc.org with any questions regarding the Colorado APCD Data Release Process.

About the Author: Jonathan Mathieu is CIVHC's Director of Data and Research. Contact him at jmathieu@civhc.org.

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