Collecting reliable, standardized, high-quality data on race and ethnicity is a challenge most organizations working with health data across the country have grappled with for years, including administrators of All Payer Claims Databases (APCDs). However, all agree that this data is essential for to identifying health inequities across communities, gaining insights, assessing progress, and to informing solutions.

Center for Improving Value in Health Care (CIVHC), is leading the way on race and ethnicity data collection and innovation as administrator of the Colorado All Payer Claims Database (CO APCD). While CIVHC is not exempt from the significant challenges in collecting accurate and complete race and ethnicity data, continual efforts in pioneering ways to marry existing demographic information with CO APCD analyses are paving new roads in health equity reporting.

Through consistent, conscientious effort and collaboration with the State and other partners, race, ethnicity, and additional socioeconomic and demographic data in the CO APCD is continually becoming more actionable and insightful.

Race and Ethnicity Data Submitted to the CO APCD

The biggest barrier in race and ethnicity data collection is that, historically, payers have not been required to submit these fields, frequently leaving them blank or arbitrarily filled in and leading to unreliable, limited data.

CIVHC’s Insights Dashboard displays an overview of what information is currently contained in the CO APCD, including claims by type, year, payer, and region. The page also contains a downloadable report on race and ethnicity data included in the CO APCD for all payers (Commercial, Medicaid, Medicare Fee For Service (FFS) and Medicare Advantage) through 2020.

CIVHC works closely with payers to continually update the Data Submission Guide (DSG) to improve the collection

• In 2022, under DSG 13, CIVHC added a new field to capture patient’s preferred language for further insights into health equity and accessin these fields and in recent years has made significant progress, with improvements still ongoing. In late 2019, the DSG changed to require payers to report two of the race and ethnicity fields. CIVHC modeled the data requirements on the guidelines of the U.S. Office of Management and Budget (OMB), which include an indicator for Latino/Non-Latino and five race fields: American Indian or Alaska Native, Asian, Black or African American, Native Hawaiian or Other Pacific Islander, or white. CIVHC additionally collects data on races identified as “other” or “unknown.”

A sample submission field for Race and Ethnicity Information in the CO APCD. In the ethnicity fields, providers indicate whether a patient is Hispanic/Latino or Non-Hispanic/Latino. In the race fields, a provider has seven identification fields: - American Indian/Alaska Native - Native Hawaiian/Pacific Islander - Black/African American - Asian - White -Other - Unkown

However, with the addition of the new fields gaps still exist. A look at data in 2019, the last year with full data

available, shows that payers – particularly commercial payers – are still submitting a large number of members with race or ethnicity marked as “unknown.”

Overall, Medicare FFS and Medicaid provide more consistent reporting of members’ race and ethnicity, and notably Medicare has improved significantly in successfully reporting complete race and ethnicity information on its members.

CIVHC is planning an update to the race and ethnicity report in fiscal year 2024 to track progress in data submission through 2023.

Geocoding the CO APCD

Working closely with payers to improve the data submitted through the DSG is only the first step toward enhanced social demographic reporting capabilities in the CO APCD.

In 2021, CIVHC geocoded the CO APCD – one of the few to do so among APCDs –which is the process of tagging each person represented in the CO APCD with latitude and longitude coordinates. This allows analysts to link member and provider addresses to the data sources at different geography levels, including census tract level, the most recommended way of reporting on population health outcomes. It also significantly enhances CIVHC’s ability to incorporate demographic and socioeconomic information into reporting and providing a more highly detailed, precise geographic analysis.

Capabilities with Geocoded Reporting: • Demographics – Race, ethnicity, language preference • Physical Environment – Water quality, traffic volume, air pollution, commute type/length, homeownership, measurements of the food environment, access to exercise • Social & Economic – Education level, income, unemployment, income inequality, poverty, etc. • Health Behaviors – Smoking prevalence, physical activity • Access to Care – Physical distance to providers, provider-to-patient ratio, % uninsured Geocoded data opened the door for CIVHC to use external data sets, such as the U.S. Census Bureau’s American Community Survey data sets, the Area Deprivation Index, and the CDC Social Vulnerability Index to provide additional insights and opportunities to improve health care for marginalized populations.

In the last year, CIVHC has released two groundbreaking reports using these capabilities to link CO APCD data with social and economic information. The Health Equity Analysis shows the relationship between key social factors and access and use of health care services that can impact a person’s health, and the Telehealth Equity Analysis  shows the relationship between social factors in U.S. Census data and use of telehealth and in-person visits. Additional analyses integrating these powerful capabilities are planned.

A sample of the data available in the Health Equity Analysis. The data shows a breakdown of health equity measurements in Denver neighborhoods to reveal the biggest equity-based barriers to access of care. The neighborhoods shown are Elyria Swansea, Highlands, Sunnyside, and Cherry Creek neighborhoods.

CIVHC will continue to make efforts to improve race and ethnicity reporting and reduce gaps through guidance and updates to the DSG and in close collaboration with payers. Demographic reporting capabilities of the CO APCD are constantly growing in exciting, innovative ways filled with potential to be the first of its kind in accessibility, comprehensibility, and scope to address social inequities that cause harm to Coloradans.

If you have additional questions about race and ethnicity data in the CO APCD, please contact us at