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Scholarship Funding Enabling Triple Aim Projects in Colorado

Similar to the saying, “the early bird gets the worm”, initial Colorado organizations who have applied for the APCD Scholarship awards are “the early requestors getting the data!” Three organizations have applied for and received a scholarship award for APCD data. This group of innovative organizations are focused on one or more aspect of the Triple Aim. They are using the data to improve decision-making for consumers, look at the efficacy of Accountable Care Act (ACA), and to conduct condition-based research to improve care.

One organization is a consumer advocacy group focused on achieving barrier-free access to quality and affordable health care for all Coloradans. Senate Bill 134 requires hospitals to limit charges to low income, uninsured patients to the lowest negotiated rate they have with commercial payers. This organization intends to use APCD data to provide Coloradans who meet the low income, uninsured threshold with lowest price median estimates for hospital-based health care services. While the APCD data does not contain contractual arrangements between payers and facilities, it can provide median paid amounts based on 150 million claims. This organization’s goal is to establish a baseline price for procedures at individual hospitals so that consumers can have a better understanding of prices before procedures and evaluate their options.

The second organization receiving funding is analyzing the impact of the federal ACA laws. One part of the law required insurance companies to provide their members with free preventive services. This organization wants to evaluate whether patients have started taking advantage of this new benefit and whether there has been an increase in preventive services. The APCD database is providing a baseline for the utilization of preventive services prior to the ACA going into effect and identifying whether there was an increase or decrease in these services after ACA implementation. With claims from 2009-2014, pre and post analysis is a great way to leverage the power of the APCD data.

The third scholarship awardee is studying the impact of pain medications prescribed post-surgery for acute pain. While the use of illegal drugs contributes to the number of individuals who die from overdosing, the number of individuals who die from prescription overdose is higher. The organization is evaluating prescription patterns after surgery over a multi-month period to research patient safety and the use of drugs post-surgery.

We’re thrilled to see the APCD data and the scholarship fund being used for health care improvement in Colorado.

Funding is available on a first come, first serve basis through June 30, 2015 (or until funds are depleted) and we would love to help your organization leverage the APCD to advance the Triple Aim. Here are some other questions the APCD scholarship fund and APCD claims data can be help answer:

  • Access to care and associated cost issues
    • Where are people going outside the community for care and what revenue is leaving the community? What are the costs associated with community members having to travel for care? If residents are leaving the community for care, what is the impact on employers in loss of productivity?
  • Chronic disease comparisons and cost to treat
    • What chronic diseases are prevalent in your community? What is the cost to treat those conditions compared to other regions in Colorado and are there opportunities to provide more effective care options? For example, are diabetic patients hospitalized in your area or visiting the ER more than in other regions which is driving up the cost of care?
  • Top diagnosis and utilization of health care service analysis
    • What are the top diagnosis and related costs for your community for ER visits, hospital admissions, hospital readmissions, physician office visits, etc.? Are there opportunities to address high costs of care by focusing on a particular population and where they do or do not access care?
  • Cost and utilization by provider, facility and payer type
    • What are the variations in cost by named facilities, providers, and health insurers in your area and how does that compare to the rest of the state for various procedures and services? What opportunities does your community have to bring costs down and change reimbursement structure and align payment incentives to improve quality?

State agencies, non-profits and researchers with annual budgets of less than $5 million per year are eligible for funds to help offset the cost of data and reports. We are happy to work with your organization to answer any questions you may have and help you identify how claims data can inform your work. We have a team of experienced health care specialists ready to assist you in getting access to Colorado’s most comprehensive resource of cost, utilization, and quality health care claims data.

To take advantage of the scholarship opportunity, click here to learn more or contact us directly at: ColoradoAPCD@civhc.org.
 

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