Center for Improving Value in Health Care
May 8, 2013 | 0 comments | Posted by Sara Schmitt
Cost Transparency, Triple Aim, All Payer Claims Database
At the forefront of efforts to achieve the “holy grail” of health care cost and quality transparency, CIVHC continues to add data to and enhance public reporting based on the Colorado All Payer Claims Database (APCD). The latest APCD release added an additional 400,000 covered lives. New interactive reports give users more analysis opportunities, including “Professional Claims” and “Percent Covered Population,” as well as a new static report on facility costs and utilization rates for knee replacements. These reports provide new views into variation across Colorado’s health care landscape. What continues to strike me, as someone who loves to dig into data and find interesting “nuggets,” is the fact that regardless of the metric you choose to analyze with the APCD, there seems to be significant variation everywhere.
Using the map view option on the website and selecting “Professional Claims” as pictured above, we can now see the striking variability in number of claims for provider services (per thousand members per year) by county and throughout the state. Categories in “Outpatient Visits” in the table below show that Diagnostic Testing, Radiology, and Lab Services account for 16 percent of outpatient utilization in Denver County, but only 11 percent and as high as 26 percent in El Paso and Archuleta counties, respectively. Home Health Services represent almost 16 percent of outpatient utilization in Denver County, 32 percent in El Paso County, and 7 percent in Yuma County. In rural counties like Archuleta, one might anticipate variation in costs for services due to access to care issues, but a 16 percent difference between El Paso and Denver counties can’t be accounted for as easily. What’s most important at this stage of the CO APCD development is identifying where variation exists to help Colorado to start asking the right questions to develop appropriate solutions to improve care, improve health and lower costs.
The Colorado APCD website also provides detailed “Static” reports on certain procedures commonly known to have high cost variation. Knee Replacement was added in last month’s update and can be found on the Reports tab under Static Reports. As the graph below displays, there is high variation in the average prices being paid to facilities for knee replacements, ranging in 2011 from a low of $15,359 to a high of $60,051, for those 20 facilities with the highest volumes in Colorado. Though specific facilities and counties are not currently named, they will be in future reports, allowing consumers to “shop” for high value providers. Currently costs only reflect plan paid amounts to facilities, but in future releases, costs will be more comprehensive and break out categories like providers and plans, facility and professional paid amounts.
The CO APCD website now contains claims from the eight largest commercial payers’ individual and large-group fully-insured lines of business, plus Medicaid, representing approximately 2.5 million Coloradans. The completeness score in most counties is now “C2”, up from “C1”, indicating the APCD currently has about 50 percent of insured lives as expected. In July, the incidence and costs of treating certain chronic disease conditions (e.g., asthma and diabetes) will be available. By the end of this year, data will become available online that will allow consumers to view comparative pricing information on different types of office visits and numerous common medical procedures. Data is continually being added, and it's planned that by 2014 the APCD will represent over 90% of insured Coloradans.
Using the Colorado APCD, CIVHC is moving rapidly toward providing greater price transparency, helping Colorado to achieve the Triple Aim of better health, better care, and lower costs. As you take a look at the new reports and metrics available on www.cohealthdata.org, please let us know if you have any questions or feedback at ColoradoAPCD@civhc.org, or feel free to email me at email@example.com.
About the Author: Beth Newsom is CIVHC's Data Analyst. Contact her at firstname.lastname@example.org.
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