Center for Improving Value in Health Care
Jan 9, 2014 | 0 comments | Posted by Cari Frank
CO APCD, Triple Aim, claims, Data, database, All Payer Claims Database
As I look back on my first year with CIVHC as the Director of the Colorado All Payer Claims Database (APCD), and the first full year with an operational APCD, I think it is important to reflect on how this state resource has grown and how it’s being used across Colorado. I’m going to borrow from David Letterman’s “Top Ten List” approach to benchmark the progress of Colorado’s APCD and leave you with the APCD goals for 2014.
#10: Enhanced data. Originally 7, there are now 14 commercial health plans with 21 lines of business submitting claims data to the APCD in addition to Medicaid. This represents over 2.5 million unique Coloradans approximately 45 percent of the insured lives in the state, making the APCD the most robust claims dataset available for Colorado. Our health plan partners are critical to the success of the APCD’s Triple Aim goal of better health, better care, and lower costs, and we thank them for their continued support.
#9: New meaningful reports. The public website, www.cohealthdata.org, is continually being improved and experienced three major updates last year. New enhanced functionality allows comparisons across four years (2009-2012), compared to expected costs and services based on the health status of the population, percent generic prescription use variation across the state, chronic disease costs and prevalence, readmission rates and more.
#8: Small-group claim inclusion. During the 2012 legislative session, CIVHC and partner organizations successfully enacted HB 13-1015, which enables the collection of small group claims data in the APCD. Health plans began submitting their small group claims in September 2013, and we plan for this data to be reflected in the APCD public website in early 2014.
#7: Medicare claims data. In August of 2013, CIVHC received certification as a Centers for Medicare & Medicaid Services (CMS) Qualified Entity (QE), allowing the APCD to begin collecting Medicare claims for Colorado beginning in 2014. CIVHC is one of only twelve Qualified Entities in the US, which puts Colorado on the cutting edge of being able to provide Medicare cost and performance improvement data comparisons for providers. In partnership with counterparts from around the country and Colorado’s congressional delegation, we are also working to modify the existing restrictions on the use of Medicare data, to enable us to combine it with that from other payers in custom reports for provider performance improvement and other Triple Aim uses.
#6: Analytics to support payment innovation. APCD data has become a game-changer for CIVHC’a payment reform work, transforming it from advocacy to action. We are now able to share data with providers, purchasers and payers so they can identify areas of variation and begin to craft new payment and benefit models: bundled payment, reference-based benefit design and other pay-for-value approaches.
#5: Care coordination data. To support efforts across the state to improve the coordination and delivery of health care, including Healthy Transitions Colorado, the Colorado APCD now has a unique 30-Day all-cause readmissions by population calculation (in addition to readmissions for discharge). For the first time, Colorado communities can identify readmissions across their entire population, not solely for a particular hospital, for both Medicaid and the commercially insured. This is critical for informing community-based care transitions and health improvement activities.
#4: Data requests to improve care/lower costs. In 2013, multiple APCD data requests were filled for organizations and providers looking to achieve the Triple Aim. Examples include a research organization improving care efficacy for Medicaid patients by combining medical claims with clinical data, a non-profit organization analyzing claims to develop bundled payments, a non-profit health care association using the APCD to inform members on payment reform opportunities, and a for-profit organization analyzing APCD claims to evaluate opportunities for improve care and reduce the cost of orthopedic procedures.
#3: Sustainability. The APCD is on target to meet its long-term sustainability goal. Sustainability is critical to realize the legislative vision to create a resource for Colorado that does not use tax payer dollars, but instead, sustains itself by recouping costs to generate meaningful reports from the APCD in support of the Triple Aim.
#2: Projects to Support the Triple Aim. In 2013, CIVHC began work on several grants to expand the effective use of the APCD. A few of the intended outcomes include developing a national cost and resource use standard measure set, producing historical medical spend information to help consumers evaluate health plans on the Connect for Health Colorado marketplace, and analyzing claims data pertaining to health cost trends.
#1: National award recipient. CIVHC and its data partner, Treo Solutions, received the 2013 National Association of Health Data Organizations (NAHDO) Innovation in Health Data Dissemination award. This award reflects and reinforces our state’s commitment to using transparent data to empower patients, providers, purchasers and payers to transform our healthcare system.
CIVHC couldn’t have accomplished any of the above without the support and partnership of our board of directors, funders, the Department of Health Care Policy and Finance (HCPF), legislators, the Data Release and Review Committee and the APCD Advisory Committee, and the many organizations and individuals who continually support and promote the APCD. It is through and with this support that CIVHC will continue be a dedicated steward to this important resource for Colorado in support of making Colorado a national leader in health and in high-quality and affordable health care.
Looking ahead to 2014, we’re planning the launch of price and quality information for common procedures by named provider groups and facilities which will equip Coloradans with information to shop for services and procedures within the state. We will continue our efforts with HCPF and other Colorado stakeholders to bring self-funded employer claims into the APCD, and will work diligently to onboard Medicare data to bring the “all-payer” vision to fruition. As in 2013, we will continually evaluate and modify information on the APCD public website and enhance our ability to provide organizations and providers with information to guide innovation and improve care and costs for Colorado. All of these efforts will bring tangible value to the all stakeholders in Colorado in the use of this important resource and utility for the state.
If you have any questions about this information or would like more information on the Colorado APCD, please contact me at firstname.lastname@example.org. Here’s to 2014 being a promising year in health care for Colorado!
About the Author: Tracey Campbell is CIVHC's Director of All Payer Claims Database. Contact her at email@example.com.
Share on: Digg, Facebook, Reddit, Delicious, Twitter
© Copyright. Center for Improving Value in Health Care. All rights reserved.
950 S. Cherry Street, Suite 208, Denver, Colorado 80246 | 720-583-2095 (main phone) | 720-549-9189 (fax) | contact us