The Colorado All Payer Claims Database (CO APCD) contains medical, pharmacy, and dental claims from the majority of insured individuals in the state and collects non-claims data on additional components that impact individual health and cost of care. However, collecting all of this data is only the beginning for those investigating how the health care system is functioning.
Once the data is in the CO APCD, Change Agents and CIVHC analysts can use it to gain valuable insights to improve health care through specialized analytics – one of the few APCDs in the country that allows such access. Two examples of these specialized analytics, that use special software tools, are reports included in the Affordability Dashboard: Low Value Care in Colorado and Medicare reference based pricing.
Medicare Reference Based Pricing
Using CO APCD data, CIVHC’s Medicare reference based pricing analysis establishes the prices paid to facilities by Medicare for combined inpatient and outpatient services as a point-of-reference and compares them to what commercial health insurance companies pay for those same services. These comparisons can identify opportunities for Change Agents to lower cost of care in Colorado.
Data presented in CIVHC’s report is based on a nationally-available analysis and public dataset released by the RAND Corporation. CIVHC submitted CO APCD commercial health insurance payment data to RAND, alongside several other APCDs and additional data sources, which RAND used to perform an analysis on what commercial payers pay for services compared to Medicare on a per-hospital basis in Colorado and across the nation.
RAND’s report simulates Medicare prices and determines how much commercial payers are paying as a percent of Medicare for those same services at the named hospital level. For additional details of RAND’s analysis, download the complete report and methodology.
CIVHC’s analysis adds additional insights to RAND’s reporting for Colorado. Using the data produced by RAND, CIVHC is able to analyze the individual hospital data by Colorado county and DOI region to provide geographic and region-based reporting. To learn more about the Medicare reference pricing analysis, read CIVHC’s full methodology and view the interactive dashboard.
Low Value Care
CIVHC’s Low Value Care analysis, which will receive an update in July, identifies use of health care services that are often costly and do not improve health or, in some cases, can even cause harm. Spending on these “low value” services accounts for millions of dollars in excess spending. Coloradans can use this identify which of these services are happening most often and where.
Low value care services have been defined in a variety of ways by a number of organizations, but a consensus has formed around the ABIM Foundation’s Choosing Wisely guidelines, which identifies more than 700 services as low value. CIVHC used these guidelines to identify and define over 50 low value services that could be measured from claims data in the CO APCD.
To perform the analysis, CIVHC engaged the health care actuarial and consulting firm Milliman to apply their MedInsight Health Waste Calculator software to the CO APCD to measure the use of these low value services.
The calculator is able to identify patients who have received one of these potentially wasteful services and determine if the service was necessary, likely wasteful, or wasteful based on patient history and the conditions around which the service was received.
The full methodology and data set for the analysis will be released in the coming months alongside the interactive dashboard, an infographic, and an issue brief on the topic of low value care.
If you have questions about either of these reports or analytics used in the CO APCD, contact us at email@example.com.