Source: The Center for Improving Value in Health Care (CIVHC)
Media Contact:
Cari Frank

Claims Data Being Used for the First Time to Help Improve Population Health

DENVER – March 30, 2017 – In a four part series, the Center for Improving Value in Health Care (CIVHC) is demonstrating how multi-payer claims data in the Colorado All Payer Claims Database (CO APCD) is being used to benchmark and evaluate population health.

In 2012, the Center for Medicare and Medicaid Innovation (CMMI) launched the ambitious State Innovation Model (SIM) to improve health care and lower costs across the nation. Colorado is one of 25 states implementing a plan to improve the health of 80 percent of Coloradans by 2019.

The CO APCD is one of the sources for data and analytics for the Colorado SIM effort. In collaboration with the SIM Office, CIVHC developed innovative ways to use the CO APCD to assess how integrated behavioral and physical health influences patient health and cost of care.

Using nationally accepted specifications, methodologies were established using health insurance claims across Medicare, Medicaid and commercial payers in the CO APCD, creating claims-based quality measures. These quality measures allow benchmarking between payers and providers across the entire state, helping to identify opportunities to create targeted, meaningful interventions that improve population health, improve care, and lower costs for Colorado.

“Using the CO APCD helps us provide a multi-payer perspective on how SIM practices are doing with their quality measures compared with other practices in the state,” said Ellen Kaufman, Evaluation Program Manager for SIM. “Our goal is to help practices turn data into actionable information to improve patient care, lower costs, and help providers succeed with alternative payment models. CO APCD data provides a valuable benchmark for our work.”

“We continually look for ways to actively support local and national improvement efforts,” notes Ana English, CIVHC President and CEO. “The proxy quality measures developed demonstrate an exciting new application of CO APCD data to advance statewide population health management.”

The four part series will be released weekly over the next month, and explores four of the measures developed and their results across Colorado.

  • Hypertension
    • Nearly 65 percent of all Coloradans with hypertension may not regularly fill prescriptions as recommended.
  • Asthma
    • Most Coloradans with asthma are not filling one asthma prescription medication each year.
  • Breast Cancer
    • Colorado appears to have good breast cancer screening rates but a significant number of women still may not be receiving recommended mammograms.
  • Diabetes
    • The majority of individuals with diabetes in Colorado receive recommended blood testing; however, a significant percentage of people with diabetes may not.

There is one day left for providers to apply for the second cohort of SIM practices. Click here to apply and capitalize on valuable support to help providers integrate behavioral and physical health in primary care settings. The application closes Friday, March 31, 2017 at 11:59 p.m. MST.

Download the Hypertension Measure analysis.

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