News
As a patient, would you like to know how much a medical procedure will cost you before you get it?
As a buyer of insurance, would you like to know how the physicians in one health plan's network compare on cost and quality measures with those in another?
As a Colorado taxpayer, would you like to know how new initiatives from Medicaid, the Child Health Plan Plus and public health initiatives are affecting health outcomes and costs?
If you answered any of these questions “yes,” then you will welcome the creation of Colorado's All Payer Claims Database (APCD). This statewide warehouse will aggregate de-identified claims data from all private insurance providers in Colorado, as well as Medicaid and Medicare, to provide comprehensive pictures of health care costs and utilization in our state.
Colorado's legislators created the APCD in 2010. The Center for Improving Value in Health Care (CIVHC), a nonprofit, nonpartisan organization, has responsibility for administering the database. In contrast to 10 other statewide APCDs, ours receives no public funding. Currently, it is funded entirely by grants from Colorado foundations.
It seems everyone agrees that our health care system is cumbersome, confusing and costly. While the solutions to those problems may vary, all share a common theme: Changing these dynamics starts with better information. Here's what CIVHC has heard from people across Colorado:
> Patients facing higher out-of-pocket expenditures (especially those with health savings accounts and high-deductible health plans) want better and more accessible information about the cost and quality of the care available to them.
> Employers want to see the cost of health coverage stabilize and get value for their, and their employees' premium dollar. And, more than ever, they want to have good information about provider cost and quality to drive their purchasing decisions.
> Doctors and nurses want to understand the basis on which they are being paid and evaluated across all payers. They want to see how their cost and quality compare with those of their peers.
> Health care policy experts look for trends in cost and utilization, and meaningful ways to measure quality, in order to develop targeted policy interventions.
> Health care finance experts seek to understand where health dollars are spent and why, and the relationship between short-term investments and long-term health status.
> Public health agencies want to understand patterns of disease diagnosis and treatment, and whether public education campaigns are followed by increased preventive services provided to patients.
> Researchers want to explore the effects of investments in emerging technologies and interventions on the cost of care and the rate of hospitalizations.
We have evidence from our own backyard that thoughtful use of robust data makes a difference. For more than a decade, Mesa County's providers and payers have used claims data to identify opportunities for new ways of delivery and paying for health care that have resulted in better outcomes and lower costs for Medicare patients there than in almost any other part of the country.
Some people fear the APCD will be a way to justify denials of care, or learn details about individual patients' health care usage. These fears are baseless. The APCD is not designed to be used in such ways — and it cannot be.
The data that carriers will submit to the APCD will always be encrypted, access-controlled and aggregated. The APCD is not like the electronic medical record your doctor keeps — no one will ever be able to search for or display information on an individual identified patient. No identified data will be available in the datasets or reports we provide. Social Security numbers and personal health information will be stripped, a unique identifier assigned, birth date replaced with age category, zip code reduced to first 3 digits (or 000 if fewer than 20,000 people live in that zip code).
The APCD represents capitalism at its best: it creates the transparency of pricing and quality that our health care system currently lacks, and that all of us need to make good decisions about our care.
For more information on CIVHC and the All Payer Claims Database, please visit: www.civhc.org/APCD
Phil Kalin is CEO of the Center for Improving Value in Health Care
As a buyer of insurance, would you like to know how the physicians in one health plan's network compare on cost and quality measures with those in another?
As a Colorado taxpayer, would you like to know how new initiatives from Medicaid, the Child Health Plan Plus and public health initiatives are affecting health outcomes and costs?
If you answered any of these questions “yes,” then you will welcome the creation of Colorado's All Payer Claims Database (APCD). This statewide warehouse will aggregate de-identified claims data from all private insurance providers in Colorado, as well as Medicaid and Medicare, to provide comprehensive pictures of health care costs and utilization in our state.
Colorado's legislators created the APCD in 2010. The Center for Improving Value in Health Care (CIVHC), a nonprofit, nonpartisan organization, has responsibility for administering the database. In contrast to 10 other statewide APCDs, ours receives no public funding. Currently, it is funded entirely by grants from Colorado foundations.
It seems everyone agrees that our health care system is cumbersome, confusing and costly. While the solutions to those problems may vary, all share a common theme: Changing these dynamics starts with better information. Here's what CIVHC has heard from people across Colorado:
> Patients facing higher out-of-pocket expenditures (especially those with health savings accounts and high-deductible health plans) want better and more accessible information about the cost and quality of the care available to them.
> Employers want to see the cost of health coverage stabilize and get value for their, and their employees' premium dollar. And, more than ever, they want to have good information about provider cost and quality to drive their purchasing decisions.
> Doctors and nurses want to understand the basis on which they are being paid and evaluated across all payers. They want to see how their cost and quality compare with those of their peers.
> Health care policy experts look for trends in cost and utilization, and meaningful ways to measure quality, in order to develop targeted policy interventions.
> Health care finance experts seek to understand where health dollars are spent and why, and the relationship between short-term investments and long-term health status.
> Public health agencies want to understand patterns of disease diagnosis and treatment, and whether public education campaigns are followed by increased preventive services provided to patients.
> Researchers want to explore the effects of investments in emerging technologies and interventions on the cost of care and the rate of hospitalizations.
We have evidence from our own backyard that thoughtful use of robust data makes a difference. For more than a decade, Mesa County's providers and payers have used claims data to identify opportunities for new ways of delivery and paying for health care that have resulted in better outcomes and lower costs for Medicare patients there than in almost any other part of the country.
Some people fear the APCD will be a way to justify denials of care, or learn details about individual patients' health care usage. These fears are baseless. The APCD is not designed to be used in such ways — and it cannot be.
The data that carriers will submit to the APCD will always be encrypted, access-controlled and aggregated. The APCD is not like the electronic medical record your doctor keeps — no one will ever be able to search for or display information on an individual identified patient. No identified data will be available in the datasets or reports we provide. Social Security numbers and personal health information will be stripped, a unique identifier assigned, birth date replaced with age category, zip code reduced to first 3 digits (or 000 if fewer than 20,000 people live in that zip code).
The APCD represents capitalism at its best: it creates the transparency of pricing and quality that our health care system currently lacks, and that all of us need to make good decisions about our care.
For more information on CIVHC and the All Payer Claims Database, please visit: www.civhc.org/APCD
Phil Kalin is CEO of the Center for Improving Value in Health Care
