January is the month when people often take note of how much they spent during the holidays. Many look at their bank accounts wondering how they spent so much money and where it all went. Maybe you had a few individual big ticket items that were expensive, or maybe you just purchased a lot of little things that added up.

Similarly, when we try to understand why health care in the U.S. costs so much, we look at two important factors: 1. how much health care was used (how many things were purchased), and 2. how much those visits cost (how much each purchase cost). Data in the Colorado All Payer Claims Database (CO APCD) allows us to explore both of these factors. A recently released utilization report from the CO APCD helps Change Agents (people working on improving the health care system) identify patterns of care and ways we might be able to help Coloradans access lower cost, more efficient sources of care.

The new interactive report includes a number of high cost services that can be evaluated at the state and individual county level:

  • Unplanned Hospitalizations
  • Emergency Room Visits
  • 30-day Readmissions
  • Observation Stays
  • Outpatient Services
  • Prescription Fills (All)
  • Prescription Fills (Generic Only)

Why are the health care services above important to track? Many of these services – hospitalization, ER visits, readmissions and prescriptions have high price tags and sometimes visits can be avoided. For example, since being hospitalized is very expensive, providers can focus on keeping people healthy and possibly avoid having patients go to the hospital when it’s not planned for things like having a baby or taking care of a bum knee. Understanding where we have a high number of unplanned hospitalizations in the state can help us locate where we might be able to proactively address hospitalizations and keep people from going in the first place.

Similarly, visits to the emergency room are also very costly and roughly three out of ten visits are for non-emergencies that would be better suited (and a lot less expensive) to treat in a doctor’s office or urgent care. If we know where in the state ER visits are higher than in other areas, we can pinpoint areas to start making improvements.

On the flip side, we also need to understand what trends exist in lower cost options like observation stays, outpatient services, and generic prescriptions. These services are also included in the new reports.

So what have we learned so far from the utilization data available from the CO APCD? Our initial insights document shows a number of interesting opportunities:

  • Emergency Room visits have gone up 6.3% from 2012 across all health insurance payers (Medicaid, Commercial and Medicare Advantage combined). However, for patients with Medicaid, ER visits have gone down 0.7% while visits for commercially insured patients has gone up 2.0% and Medicare Advantage has gone up 12.7%.
  • 30-day Readmissions have gone down across all payers (-7%) since 2012, yet readmissions for commercially insured patients is up 7.3%.
  • Unplanned hospitalizations are up 1.7% across all payers since 2012, with the highest increase in the commercially insured population (2.3%), and lowest in Medicare Advantage (-1.3%) patients.
  • On average, Coloradans fill about 10.8 prescriptions per person, and roughly 2 of those medications are not generic.
  • Number of prescriptions filled per person has gone up across all payer types by 3.7% since 2012, with the highest rise in commercially insured (5%), second highest for Medicaid (4.7%), and Medicare Advantage going down 2.3%.
  • In general, rural counties have higher rates of outpatient service utilization than most urban counties.

These initial insights only provide a sliver of what can be learned from the CO APCD Utilization report. Click here to play around with our interactive report and learn more about variation in how Coloradans use health care services.

Curious about something? Have an idea about a future Plaintalk Blog? Let us know at info@civhc.org or by commenting below.