Center for Improving Value in Health Care
Mar 5, 2012 | 0 comments | Posted by Philip B. Kalin
Delivery System Redesign, Payment Reform, Rewarding Value, Claims, Payer, All Payer Claims Database
As a patient, would you like to know how much a medical procedure will cost you before you get it? As a buyer of insurance, would you like to know how the providers in one health plan’s network compare on cost and quality measures with those in another? As a Colorado taxpayer, would you like to know how new initiatives from Medicaid, the Child Health Plan Plus and public health departments are affecting health outcomes and costs?
If you answered any of these questions “yes,” then you will welcome the creation of Colorado’s All Payer Claims Database (APCD). This statewide warehouse will securely compile de-identified claims data from private insurance carriers, Medicaid and Medicare to provide comprehensive pictures of health care costs and utilization in our state.
Colorado’s legislators created the APCD in 2010. The Center for Improving Value in Health Care (CIVHC), a nonprofit, nonpartisan organization, has responsibility for administering the database. In contrast to 10 other statewide APCDs, ours receives no public funding. Currently, it is funded entirely by grants from Colorado foundations.
It is hard to deny that our health care system is cumbersome, confusing and costly. While different people may offer different solutions to the problem, one theme emerges consistently: changing these dynamics starts with better information.
Here’s what CIVHC has heard from people across Colorado:
We have evidence from our own backyard that thoughtful use of robust data makes a difference. For more than a decade, Mesa County’s providers and payers have used claims data to identify new ways of delivering and paying for health care that have resulted in better outcomes and lower costs for Medicare patients there than in almost any other part of the country.
The APCD is not like the electronic medical record your doctor keeps. It does not capture information about individuals’ income, education or family life. It is an aggregated database of encoded information about health care services provided and paid for by Colorado insurers. Names, Social Security numbers and addresses are replaced with unique identifiers. Reports and de-identified datasets replace date of birth with an age or age range and reduce zip codes to first 3 digits (or 000 if fewer than 20,000 people live in that zip code). Reports of any data are aggregated to sufficient size to prevent someone from taking unidentified information and inferring the identity based on diagnosis or treatment type. This protection, combined with the additional de-identification strategies described above, is of particular value for Coloradans living in small communities.
The APCD represents capitalism at its best: it creates the transparency of pricing and quality that our health care system currently lacks, and that all of us need to make good decisions about our care.
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