Center for Improving Value in Health Care
Jul 11, 2014 | 1 comments | Posted by Edie Sonn
CO APCD, Health Reform, claims, Data, database, Health, Information, All Payer Claims Database
On July 31, the Colorado All Payer Claims Database website will launch the first phase of comparative price and quality information for hospitals in Colorado. While this phase will be modest—a baby step—it is nonetheless significant, marking the first time Coloradans will be able to see real pricing information across all commercial payers and Medicaid for hospital-based services.
To understand this better, let’s explore what our baby looks like now, and our plans for helping it grow.
The site, featuring the new name CO Medical Price Compare (accessible through www.comedprice.org and www.cohealthdata.org), will present information about four inpatient hospital services—total knee replacement, total hip replacement, uncomplicated vaginal birth, uncomplicated cesarean birth.
Here’s what’s important about the site:
We’re excited about our baby’s strengths, but there are important limitations to bear in mind. Currently the APCD does not contain claims from self-insured employers—a significant chunk of the commercially-insured market. As a result, hospitals with a large volume of self-insured business may appear on our site to perform fewer procedures than they actually do. Accordingly, we’ve worked with CHA to set up a link to hospitals’ self-reported volumes information, so consumers can get an accurate sense of how many procedures a given hospital performs. We’re confident, though, that the absence of self-insured claims does not significantly affect the pricing information on the website. This is because insurers negotiate with hospitals on behalf of all their customers at once; in most cases, they don’t negotiate one price for fully-insured customers and another for self-insured. In fact, as we have validated data with key hospitals, we’ve found that our pricing information matches their internal records to the dollar.
In addition, Medicare data is just beginning to be collected in the APCD and will not be included in the initial release. We plan to include Medicare information in future releases to provide an even more expansive view of prices in the state.
It’s also important to recognize that we are starting small—showing a limited number of services, and only for hospitals. But the site will grow in the coming months with additional services (including many diagnostic tests) and facilities (ambulatory surgery centers, free-standing diagnostic facilities). This is complex work and it’s important to get it right.
In fact, we want to thank CHA for helping us to get it right. We have worked closely with them for 18 months to plan this release, but once we shared preview information with hospitals in May we all identified some important issues that needed to be addressed (e.g., the volume issue described above) to ensure that we clearly explain what the data do, and don’t, show.
We also worked directly with consumers over the past year, asking them what information they wanted and how we should present it. We plan to conduct additional focus groups after the first phase goes live, so we can fine-tune the site before we add more procedures and facilities. We’re also waiting until later this year when additional procedures become available to conduct major consumer outreach for the site.
We look forward to continuing to work with facilities to ensure the accuracy of the content, and with consumers to ensure ease of use.
We’re having a baby. We look forward to your help in raising it.
About the Author: Edie Sonn is CIVHC's Interim CEO and Vice President of Strategic Initiatives. Contact her at email@example.com.
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