Center for Improving Value in Health Care
Mar 11, 2015 | 0 comments | Posted by Global Administrator
Consumer Engagement, Price Transparency, Triple Aim, Colorado All Payer Claims Database
After joining CIVHC last year, I made a point of pouring through all of our past grants and reports to gain as much historical knowledge as possible. I wanted to understand our roots, our challenges, our successes and the progress we’ve made in the few short years since our inception as an organization. The Colorado All Payer Claims Database (CO APCD) annual legislative report was one in particular that I found intriguing given the astounding progress made between the time the APCD was signed into law in 2010 through last year’s 2013 recap. The 2014 annual legislative report just released is yet another reminder of how far we’ve come in such a short amount of time. While it’s important to celebrate the accomplishments made over the past year, we continue to set our sights on where we need to take this important statewide resource to ensure it is providing the highest value possible to Colorado.
Before I dive into where we’re headed with the CO APCD, I do want to pause and reflect on last year’s accomplishments. A number of significant achievements were made in 2014 including releasing unprecedented consumer focused price and quality information on www.comedprice.org, developing a custom data scholarship fund for organizations with financial constraints, and adding Medicare claims in the database. These are all incredibly important milestones along our journey towards making the CO APCD an invaluable resource for Colorado.
The unique design and capabilities of Colorado’s APCD also received more national attention in 2014. The CO APCD is considered a model for APCDs nationally according to a recently released APCD Development Manual developed by the APCD Council. In addition, national leaders in health care innovation such as Dr. Len Nichols, Director of the Center for Health Care Policy Research and Ethics at George Mason University, applauded Colorado’s efforts to provide consumer transparency and encouraged other states to follow our lead.
What’s equally exciting to CIVHC and our team is how the APCD is being used more broadly by health care organizations, researchers, providers, state agencies and others to do boots on the ground projects aimed at improving health, health care, and costs. We’ve worked hard over the last few years to improve our data release request process and make APCD custom data sets more affordable and timely for organizations. As a result, we’ve been able to fulfill 33 custom data requests since early 2013 with a significant portion of those fulfilled in the last year. Many different types of organizations have received custom data from the APCD for their innovation projects and a number of state agencies like the Division of Insurance and Medicaid are also putting the APCD into action for the benefit of the public good. We’re also excited to be able to support important statewide initiatives such as the State Innovation Model and the State Health Care Cost Commission with data and analytics from the APCD. I encourage you to visit www.comedpriceshowcase.org to see a summary of data requests fulfilled to date and descriptions of their innovative projects.
Successes aside, we remain laser focused on where we’re taking the CO APCD into the future. When first launched in 2012 we knew we had to start small and build the APCD slowly with intention of purpose – to inform opportunities for improvement through transparency. One of our most important upcoming milestones in 2015 and beyond includes continuing to provide consumers with expanded price and quality information to make informed health care decisions. As the table below demonstrates, we are working towards enhancing the public website to make price and quality information available for additional health care services across ambulatory surgery centers, imaging centers and eventually physician office groups. We will also be making enhancements to the utilization and cost of care data and reports on the public website to make it more valuable to policy makers and communities looking for opportunities to improve and monitor performance.
With the inclusion of Medicare data in 2014, we’ve made significant strides towards achieving the “all payer” vision of the APCD (see graph below). Self-funded claims from large employer groups account for approximately 27 percent of health insurance claims in the state and represent the largest significant segment of the market not yet represented in the APCD. In partnership with the Department of Health Care Policy and Financing (HCPF), a rule change is being proposed early this year to include claims in the APCD from self-funded employers. If enacted, we anticipate receiving self-funded claims in the database at the end of 2015.
Based on feedback from stakeholders and national and local health care trends, CIVHC also believes that claims data on its own, though critically important, should ultimately be supplemented with other health and health care data sources in order to achieve the level of analytics necessary to continue to advance health care. As a result, we plan to continue to work with key Colorado and national stakeholder organizations to evaluate supplementing the APCD with information such as capitation, settlement, and incentive payments; vital-statistics; socio-economic determinants of health; clinical outcomes information; and enhanced patient experience and quality metrics.
We are proud to demonstrate that the Colorado APCD is providing the transparency essential to identify opportunities for health care innovation and effectively drive the market. Going forward, we believe the APCD will continue to become an even more valuable resource as it continues to equip patients, employers, providers, payers and others with the tools and information they need to make smart decisions and implement changes that benefit Colorado.
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About the Author: Ana English is CIVHC's President and CEO. Contact her at firstname.lastname@example.org.
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