At Center for Improving Value in Health Care (CIVHC), we often get asked how the Colorado All Payer Claims Database (CO APCD) differs from other APCDs across the nation. And the answer is that it differs quite a bit depending on which APCD you’re comparing it to. When it comes to APCDs, the phrase “Once you’ve seen one APCD…you’ve seen one APCD” comes to mind.
There are a number of ways in which the CO APCD is different than those in other states. Most of the differences break down into how it is designed and managed, how it’s used, and who can benefit from the data. Let’s break down each of the critical components that factor into the unique design and utility of the CO APCD.
- Legislatively Enacted
Colorado’s APCD is mandatory per House Bill 10-1330, meaning the state requires all payers in Colorado to submit claims to the database if they certain member thresholds per the guidelines in the Data Submission Guide (DSG). In contrast, some state APCDs receive claims on a voluntary or limited basis.
- Non-profit Managed
Many APCDs across the nation are run by state agencies, but in Colorado, CIVHC, a non-profit organization, was appointed to administer the CO APCD on behalf of the Department of Health Care Policy and Financing. This allows flexibility in how the CO APCD is funded by allowing CIVHC to receive private foundation funding to support the operating and using the database, and how the CO APCD is used by allowing CIVHC to be nimble with public and non-public reporting to quickly adjust to the changing health care landscape.
Submissions and Processing
- Timely and Robust Data
CIVHC receives monthly claims submissions from all commercial payers and Medicaid, and the entire data warehouse is updated bimonthly. In addition, we update the DSG on an annual basis to enhance the data fields and continually improve upon the ability to use the CO APCD in meaningful ways. Not all APCDs receive data as frequently or process the data as often.
Data Inclusions and Value-Adds
- Plan and Member Paid Amounts and Value-Add Processing
Payers in Colorado submit a number of important elements to the CO APCD including plan paid and patient paid amounts – not just charges – which not all APCDs collect. Other important data elements such as dental and pharmacy claims, out-of-network flags, Alternative Payment Model and Drug Rebate information are collected. In addition, CIVHC runs the claims data through value-added software tools to create additional insights into areas of improvement such as low value care and Medicare reference based prices.
- Data Quality Team
Based on the size and structure of the APCD, not all have the resource capacity to dedicate staff to quality assurance. Quality control is a number one priority for CIVHC in all steps in the process: intake, processing, data enhancement, and analytic output. This ensures that all public and non-public releases are as accurate and timely as possible.
- Transparent Data for Coloradans
On average, CIVHC releases 20-30 public analyses and data sets per year including a Shop for Care tool for patients, and Community Dashboard identifying regional and county-level health care improvement opportunities. Not all APCDs are able to produce public information, and not all provide the diversity of public reports that we have access to in Colorado.
Releasing Non-Public Data
- Supporting Change Agents
Through legislation, CIVHC is able to release data to any entity looking for information to support improving health, improving care, and lowering costs for Coloradans. Not all states are able to provide data to organizations outside the administering entity. CIVHC licenses, on average, over 100 non-public reports annually to a variety of stakeholders including state agencies, employer purchasers, providers, hospitals, and payers.
- Quick Turnaround and Financial Assistance Options
As a mission-based organization, and in keeping with the intent of the legislation creating the CO APCD, one of CIVHC’s primary goals is to get data into the hands of Change Agents who can help our state advance the Triple Aim. We continually work to reduce the cost of releasing data and have financial assistance options to help those who cannot afford licensing fees. In addition, we’ve created several standard non-public data sets and reports available that offer Change Agents low cost options to receive data with a quicker turnaround time.
For more information on how to design and utilize an APCD and comparisons across states, view the two-part Commonwealth Fund series on APCDs as a tool for improving health care value: