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The All Payer Claims Database: Tools and Transparency to Make Informed Health Care Choices

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:

  • Patients facing higher out-of-pocket expenditures (especially those with health savings accounts and high-deductible health plans) want to know how much health care services will cost and what quality they can expect.
  • Employers want to see the cost of health coverage stabilize. And, more than ever, they want to have good information about provider cost and quality to drive their purchasing decisions.
  • Doctors and nurses want to understand the basis on which they are being paid and evaluated across all payers. They want to see how their cost and quality compare with those of their peers.
  • Health care finance and policy experts seek to understand where health dollars are spent and why, and the relationship between short-term investments and long-term health status.
  • Public health agencies want to understand patterns of disease diagnosis and treatment, and whether public education campaigns are followed by increased preventive services provided to patients.
  • Researchers want to explore the effects of investments in emerging technologies and interventions on the cost of care and the rate of hospitalizations.

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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