Catalyst for Payment Reform

Unlocking the Power of the All Payer Claims Database – Use Cases from Colorado

Unlocking the Power of the All Payer Claims Database – Use Cases from Colorado

In case you missed it, the Center for Improving Value in Health Care (CIVHC), which operates Colorado’s all-payer claims database (APCD), hosted a webinar this past August demonstrating how organizations within Colorado can leverage APCD data to drive improvements in health care value.  Colorado passed legislation authorizing the creation of its APCD in 2010 and began collecting submissions in 2012.  Today, the database houses over 718 million medical, dental and pharmacy claims from 44 payers (including 35 commercial plans), representing almost 8 million insured Coloradans.  Of the 1.3M commercial lives covered within the APCD, approximately 25% come from self-insured purchasers, who voluntarily supply their claims data to the APCD.

An analytics powerhouse

What makes Colorado’s APCD so powerful, however, is its pairing with the publicly-facing reporting and analysis that CIVHC provides – in fact, Colorado is one of only six states to earn an A or B grade on CPR’s 2020 Report Card on State Price Transparency Laws.  Through partnership with the RAND Corporation’s Hospital Price Transparencyresearch, CIVHC’s reporting offers inpatient and outpatient facility prices benchmarked as a percentage of Medicare for 76 hospitals across the state.  CIVHC’s standardized reports are made available for free to any purchaser in Colorado with an adequate volume of claims [1]. In the CO APCD, and offer the following insights:

  • Medicare Reference-based Pricing Report
  • Low Value Care Report
  • Potentially Avoidable Emergency Department Visits
  • Top 5 Procedure Cost Savings Analysis
  • Chronic Condition and Avoidable Complications Report
  • Prescription Drugs and Generic Alternatives Analysis
  • Cost Driver Analysis

But the crux of CIVHC’s webinar was to demonstrate how access to these data insights can help purchasers shape their benefits and sourcing strategies.  Featured among the guest speakers were Bob Smith, CEO of the Colorado Purchasing Alliance, and Claire Brockbank, CEO of Colorado’s Peak Health Alliance.  Both organizations procure health care services on behalf of dozens of employers and thousands of plan members across the state.

Translating data into strategy

APCD data and analysis from CIVHC help these alliances identify high-performing providers, uncover opportunities for provider performance improvement, and strategically structure network and benefit design to encourage plan members to seek high-value care.  But it takes more effort than downloading a report to translate data into strategy.  For example, to understand which providers truly deliver high-value care, the Colorado Purchasing Alliance merges hospital pricing data and utilization from RAND/CIVHC with clinical quality metrics and benchmarking data from Healthcare Bluebook/CareChex.

Identifying the high-value providers is an important first step, but doesn’t automatically create higher-value care.  The Colorado Purchasing Alliance is using these data to create network and benefit design products that encourage plan members to utilize high-value providers; simultaneously, they collaborate with provider groups to identify opportunities to reduce low-value care, switch from brand to generic prescriptions, and close care gaps.

Peak Health Alliance used the Medicare Reference Pricing data to negotiate direct contracts and new fee schedules with area hospitals.  The pricing data provided a validated baseline to identify hospital pricing distortions, but the resulting contract and fee schedule (which saves Peak Health members 39-47% compared to commercial payers) was the product of elbow grease, determination, and a willingness to take the fight to the public if negotiations soured.

But where does this leave purchasers who operate out of the 34 states lacking an APCD or a public-facing price transparency website?  They still have options!  For example, Catalyst for Payment Reform’s 200-level course, Getting to Insights Faster with Benefits Data offers a comprehensive overview of the data sources for quality and pricing information, and equally important, the course offers instruction and examples that demonstrate how to convert data insights into a high-value health care strategy.  After all, as Claire explained, “The data tells you what the opportunity is; it doesn’t tell you how to take advantage of it.”

[1]. CIVHC follows CMS’s Cell Suppression Policy, and will not publish any metric comprising fewer than 10 claims.

CPR’s Director of Projects and Research, Julianne McGarry, MPP, wrote this blog post.

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