Colorado Medical Society

http://www.cms.org/articles/all-payer-claims-database/

All Payer Claims Database

Saturday, November 01, 2014 12:23 PM

In recent years, the Internet has empowered consumers to make informed choices on products and services for everything from restaurants to books to plumbing. Yet, when it comes to health care, we’ve been essentially stuck in the horse-and-buggy days.

That’s because, until recently, there’s been a dearth of reliable performance data to help patients, employers, physicians and medical practices make informed decisions to improve quality and reduce costs. For example, how are consumers supposed to know a reasonable price to pay for a knee-replacement surgery if they can’t compare pricing among those who provide the service? On the other side of the examination table, physicians focused on making their practices more efficient are hamstrung given the lack of meaningful data on how much medical services cost.

Fortunately, in Colorado and elsewhere around the country, the times are changing as the floodgates begin to open up for reliable data and transparency in health care begin to open up. Importantly, this is also an opportunity for physicians to step up to help make sure that this information is meaningful and valuable for patients and physicians.

Key in the state’s health-data revolution is the All Payer Claims Database (APCD) and public website developed by the Center for Improving Value in Health Care (CIVHC) and seeded through generous grants from the Colorado Health Foundation and The Colorado Trust.

Comparative data
Colorado’s APCD currently includes 2009-2013 historic claims data from commercial payers plus Medicaid. Medical services prices are currently based on 2012 claims and will be updated to reflect 2013 data in December of this year. Because of legal and other barriers, self-funded commercial insurance claims data and claims for patients 65 and over are not currently reflected on the website. CIVHC will add information for Medicare beneficiaries to the public website beginning in December 2014.

In July of this year, CIVHC launched consumer-focused information on the public APCD website (comedprice.org) to provide comparative price and quality data on medical facilities and providers. Equipped with transparent information, consumers can better determine if there is significant variation in what they might be asked to pay for medical services – and whether it might be worth their while to shop around.

Beginning in December, the website will include data for ambulatory surgery centers and endoscopy centers. CIVHC will also add mild- and moderate-complexity emergency room visits, along with eight procedures that are performed in both hospitals and outpatient settings including tonsillectomies, colonoscopies, gall bladder surgeries and hernia repair.

In 2015, the website will include up to 20 imaging procedures and, eventually, five types of primary preventative care-type visits on a named physician-group basis. While not identifying individual group physicians by name, the website will include comparative price and quality data at the physician-group level. Once that occurs, consumers will have price and quality information for primary care services, and physicians will gain the ability to compare their performance to that of their peers – albeit, at a very high level.

Physicians driving change
While private sector companies, like Castlight Health and Healthcare Bluebook, are collecting, analyzing data and publicly reporting comparative performance data without any interaction with physicians on whom they’re reporting, the Colorado APCD and CIVHC present an opportunity for physicians to really understand and shape how they’re being evaluated. Rather than using black box methodologies and choosing poorly understood performance measures, CIVHC has intentionally and consistently sought physician feedback and participation to help:

Though it’s unlikely that Colorado’s APCD public website will ever be completely comprehensive – there are simply too many different procedures to ever make that possible or practical – CIVHC aims to highlight information that reflects typical experience for Coloradans for the most common medical procedures and services.

Shaping public policy and private decisions
For those seeking value in health care, the benefits of the APCD website are obvious. As the database becomes more robust in the years to come, it will evolve into an increasingly useful tool for health care consumers and employers mindful of health to manage their health care costs.

The information, especially the data on variation in utilization and spending, is of keen interest to policymakers who are crafting legislation that could influence the future of health care. The governor’s office and other advocacy organizations are also carefully watching this development.

Over the next year, CIVHC will look for opportunities to provide additional information that helps people make better-informed medical decisions. The organization will also do a lot more outreach and education as it develops reports that go back to physician practice groups to help them understand their own performance in the Colorado marketplace.

In doing this, CIVHC has forged a number of partnerships with the medical community (including the Colorado Medical Society) to develop the kind of information that physicians need to understand their performance and identify quality measures that are meaningful to go along with comparative price information.

Physicians and their practice teams are strongly encouraged to explore the APCD site to understand what information is currently available. While some may find only limited utility now, those that want to look beyond global insights to understand their population and costs can also get a deeper dive through custom reports using the APCD data request process.

If you would like to help shape this process, please contact Chet Seward in the CMS offices or Jonathan Mathieu at CIVHC.


APCD Facts

Colorado is only one of 12 states to have an APCD, and we are only one of three that have consumer price information available.

The Colorado APCD received the national 2013 Innovation in Data Dissemination Award from the National Association of Health Data Organizations (NAHDO).

Colorado is one of the few states that offer custom reports and analytic data sets based on the APCD data to providers to support Triple Aim related projects.

Visit www.civhc.org for more information about Colorado’s APCD.