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All Payer Claims Database Debut Supports Colorado’s Health Care Journey

Last Thursday, November 1, marked a big milestone for health care in our state with the launch of Colorado’s All Payer Claims Database. As the appointed administrator of the APCD, CIVHC is honored to serve as the steward for this unique Colorado resource. We were thrilled by the crowd of more than 200 health care leaders and stakeholders that gathered at The Colorado Trust. Enthusiasm in the room was palpable as participants saw the APCD in action for the first time. Multiple policy wonks admitted that their post-event work plans were “shot” because they planned on spending the afternoon pouring through the APCD site to see what information they could glean. This initial version of the APCD is designed to stimulate important policy discussions towards the goal of better health, better care and lower costs.

Local and national media coverage was extensive and commended Colorado for taking this important step. The APCD was identified as another reason why our state stands out as a national leader in health care reform. Further validation of Colorado’s wisdom in pursuing this transparency strategy was an announcement on the same day by a national consortium of major companies and labor unions, including GE, Wal-Mart, Boeing and the AFL-CIO, demanding price transparency from both health care providers and insurance companies. The consortium stated that consumers “have the right to know the price and quality of their health care choices,”— especially as health care costs continue to rise and high-deductible health care plans become more common.

Currently the APCD contains claims data from the eight largest commercial health plans for individual, large group fully-insured and some self-insured lives, as well as Medicaid, making it the most comprehensive health care cost and utilization source available. Initial reports available on the website, www.cohealthdata.org, support health policy decisions by identifying variation in cost and utilization of services by geography. Over the next year, more payers and data will be added and the information will be vetted with providers and facilities. By the end of 2013, the APCD will identify facility service costs and a corresponding quality score providing consumers and purchasers with an important value-based decision-making tool.

The 2008 Blue Ribbon Commission for Health Care Reform recommended the APCD as an essential “first step” to support controlling health care costs and improving the health and quality of care for Coloradans. The bipartisan Commission identified cost and quality data as essential ingredients to support a functional health care marketplace. It further emphasized that when consumers and purchasers are equipped with consumer report equivalent information for health care services, they can drive the market towards exceptional, affordable care.

Following that report and with bipartisan support, legislation was passed creating the APCD and giving Colorado’s Department of Health Care Policy and Financing the authority to appoint an administrator. CIVHC is proud to take on this role of helping shepherd this critical Colorado resource. The APCD is intended for consumers trying to figure out what a procedure will cost, for businesses struggling with health premium increases, for providers wanting to know how they compare to their peers on cost and quality, for health plans wanting to contract with high quality, low cost providers, and for health policy experts making sure our health care taxpayer dollars are maximized.

If you haven’t had a chance to look at the website, it’s full of interactive report capabilities allowing users to look at things like total cost of care, ED utilization, hospital admissions and readmissions, and provider density across Colorado. More detailed analytics show variation in cost for specific procedures like high cost imaging. Snapshot reports show data for the 20 highest volume facilities in the state, and our imaging cost graphic identifies wide variation – up to 5 times for payments to facilities for similar services.

Why costs vary across facilities is the first in a long chain of questions that an APCD will help answer. We know that variation could be due to patient severity, demographics, payer mix or a host of other reasons. The APCD encourages us to start asking the right questions, and provides a tool that facilitates drilling down to determine what’s driving variation in cost, utilization and certain quality measures. Data in the APCD will eventually be risk and severity adjusted so that consumers, providers, businesses and policy analysts will be able to discern a detailed and accurate picture of these metrics to further our movement towards the Triple Aim of better care, better health and lower costs.

The APCD is an excellent testament to Colorado’s determination and follow-through on an idea and recommendation that has now become a reality. As Anne Warhover, CEO at the Colorado Health Foundation stated at the launch, development of the APCD is an example of what can happen when stakeholders rally together around a common goal of using transparency to achieve the Triple Aim. Shared goals and ways to measure their achievement is what collective impact is all about and at CIVHC we’re excited to join stakeholders across Colorado in achieving those aims.

About the Author: Phil Kalin is CIVHC's President and CEO. Contact him at pkalin@civhc.org.


 

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