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Colorado's HIEs and APCD: Two Important Data Sources for Triple Aim Advancement

Tracey Campbell Director of All Payer Claims DatabaseColorado’s bipartisan Blue Ribbon Commission for Healthcare Reform and other national health care leaders recognize the power of data to support improving health care. The Colorado All Payer Claims Database (APCD) and statewide Health Information Exchanges (HIE) were both identified by the Commission in 2008 as critical sources of data to enhance efforts towards the Triple Aim of better health, better care and lower costs. Colorado’s APCD and HIEs serve a distinct and essential purpose for health care transformation as outlined in a new issue brief CIVHC developed in partnership with Quality Health Network (QHN) and the Colorado Regional Health Information Organization (CORHIO).

We often get questions about why we need both an APCD and an HIE in Colorado. It’s true that both the APCD and the HIEs provide health care data, but that’s essentially where the similarities end. The type of information, availability and uses of each data source are what make them distinctly different and necessary. At the most simplistic level, HIEs provide real-time, actionable clinical information at the point of care, such as an outpatient clinic visit, a hospital inpatient stay, or a doctor’s office visit while APCDs provide retrospective data about the cost and utilization of those services.

I find it easiest to explain the difference between the two using the perspective of a patient visit to a doctor’s office. At the point of care, an HIE is helpful to the clinician and patient because medical record history is available electronically to both individuals including results of previous lab tests, medication history, allergies, etc. for the patient that is being seen that day. In this case HIEs improve efficiency and support providing a high quality visit by arming the clinician with real-time, personalized information during a patient visit.

Once the insurance company pays the claim associated with the patient’s visit to the doctor’s office, data about the facility and provider, costs associated with the visit, tests performed, and any medications that were filled are sent to Colorado’s APCD. This information on cost and utilization is valuable to demonstrate where we are spending health care dollars in Colorado. When this information is aggregated with other Coloradans expenditures in the APCD, variation in costs and quality can be seen. By the end of 2013 consumers will be able to use the APCD to find out how much they will pay for a visit to a specific facility given their insurance coverage and the quality ranking of that facility or group beforehand so they can make a value-based health care decision as to which facility they will choose to go to for that visit.

In addition to the patient and provider, other stakeholders like researchers, policy analysts, businesses and others can benefit from the HIE and APCD information. For example, researchers can look at where specific conditions are concentrated in the state to determine if there are ways to improve the health of those populations. Access our new issue brief to find out more about how these target audiences can use these important data sources to support achieving the Triple Aim in Colorado.

Personal health record privacy rules, (HIPAA and HITECH), make it difficult to combine the cost information in the APCD with the clinical data in the HIEs. However, being able to see cost and quality outcomes in tandem is a future goal and will help support meaningful change to improve health, improve quality, and lower costs to Coloradans. CIVHC, CORHIO and QHN have been investigating possible options to make this important information available while following all HIPAA privacy and security rules to ensure patient information is always protected. While we can’t say for certain when the APCD and HIE data can be combined, CIVHC does have plans to show quality metrics from other sources along with cost information in the APCD by the beginning of 2014.

For more information, view our APCD vs. HIE Issue Brief or email me at tcampbell@civhc.org.

About the Author: Tracey Campbell is CIVHC's Director of All Payer Claims Database. Contact her at tcampbell@civhc.org.

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