There is something special about learning a new piece of technology, a feeling of unlocking potential and an excitement at mastering interfaces. Last year I bought myself an Apple watch and found myself at the start of a new learning curve with capabilities and screens and notifications to figure out. Apple is known for developing great products and even though they work to make it as intuitive as possible, I learn something new each week and know that I am not taking advantage of all its potential benefits.  I have also found that there are some quirky things with my watch that I don’t necessarily like and therefore don’t use.  As I became more familiar with my new gadget, I began to mull over how the process of learning my watch was similar to how CIVHC is working to understand the Colorado All Payer Claims Database (CO APCD) and using it to its full potential.

While exciting, understanding new things isn’t easy and with something as multi-faceted as the CO APCD, it isn’t so much a learning curve as a learning mountain. Very nearly everything we do at CIVHC has never been done before and we are constantly learning how best to create meaningful and credible analyses. Along with the 17 other states with APCDs, we are developing best practices as we implement them – then stepping back and adjusting those that didn’t turn out as planned.

New things also come with expectations which, when not met, cause disillusionment and frustration. At the launch of the CO APCD in 2012, we anticipated that by the end of 2013, facility cost and quality information for multiple procedures would be available for consumers to use when shopping for care. It turned out a bit different once we got the data and began to put it into the reports. It wasn’t as straightforward as we expected and it was more difficult to narrow down the measures and analyses into information that was consumer friendly and easily understood. We kept at it though, releasing iterations and refining based on feedback, and the most recent iteration released in February included facility cost and quality information for episodes of care for common procedures.   The implementation of episode-based analytics against an entire APCD with commercial, Medicaid, and Medicare had never been done before and we learned a significant amount.  As we reviewed with our facility partners, we made adjustments with each round of processing.  It was a significant investment in resources but the value of this enhanced set of information is immense!

We see similar experiences with Change Agents who come to us to use the CO APCD to improve care for Coloradans. Many have expectations about what the data is and can do, others have expectations about what CIVHC understands and can do, and most have expectations about what data they need to answer their questions. More often than not, these expectations eventually become roots of frustration and misunderstanding.

With every project, CIVHC learns new things about the CO APCD and new ways to discuss projects with those requesting data. We’ve learned to explain that claims data is retrospective, administrative, and financial; it will show a picture of a point in time and will not contain detailed clinical information.  We discuss with requestors how comparing claims data to other sources like hospital discharge information or patient survey data is like comparing apples to oranges – it can be done but it will require establishing methodology accounting for the differences between the datasets. Finally, we’ve learned to work with requestors to determine what it is they really want to know and help them craft a data request to meet their needs.  All of this is done while ensuring we are meeting federal and state statutory and regulatory guidelines such as HIPAA privacy, security and anti-trust guidelines.

However, even after five years of working with the CO APCD and though considered a leader in APCD data release, CIVHC is nowhere near being an expert on what it can do. Every day, Change Agents come to us with projects that require us to figure out yet new ways to use the data; and, as with any learning process, there are setbacks and re-dos as we work toward unlocking the information requested. When possible, we’re taking what we learn from these projects and applying them to standard offerings that can help others answer similar questions.

Learning is a process, whether its a curve or a mountain. I love my Apple watch and can honestly say that I’m not sure how I ever got along without it. Similarly, Colorado is coming to love and understand the CO APCD while recognizing the value it provides to our health system. CIVHC is grateful to the General Assembly and the Department of Health Care Policy and Financing for the allocation of funding for the CO APCD in the coming fiscal year. We look forward to further cultivating a partnership designed to create meaningful transparency while broadening access to this valuable resource.

By: Ana English, MBA, CIVHC’s CEO and President