The final word: The nuts and bolts of Colorado’s All Payer Claims Database

Tuesday, May 01, 2012 01:46 PM

Jonathan Mathieu, Director of Data and Research,
Center for Improving Value in Health Care

What is the APCD?
Created in statute in 2010, and administered by the non-profit organization Center for Improving Value in Health Care (CIVHC), the Colorado All Payer Claims Database (APCD) will provide an unprecedented view of health care expenditures and utilization that no other dataset can match. The APCD combines health claims data from all commercial insurers and public payers including Medicare and Medicaid. All data submitted on a claim will be available in the APCD, including amounts paid to physicians and hospitals for specific services and diagnosis; frequency of services provided; location where care is being delivered; and pharmacy information. This comprehensive dataset will offer stakeholders and providers a focused lens to evaluate patterns of care and opportunities to improve care and decrease variation in costs.

With initial reports due to release at the end of the year, the APCD will provide a variety of public reports, with more detailed HIPAA-compliant datasets available to researchers and qualifying organizations. The first set of publicly available reports will use aggregated data to provide high-level views of the health care system in Colorado, such as variation in state and regional cost patterns, utilization of services, etc. As the APCD is populated with data from additional private and public payers over the next two to three years, we’ll generate more sophisticated reports such as comparative cost and quality reports at the physician level adjusted for clinical risk and patient illness severity, analysis of the impact of payment and delivery system reforms, rates of adoption of evidence-based care standards, and more.

CIVHC is currently receiving test data from the first round of payers (top 12 commercial insurers + Medicaid) and will be onboarding three years of historical data from the same group this summer. This fall payers will submit monthly data, which will include claims that were generally adjudicated three months prior. It will require another two to three months to process the data and make it available through the APCD.

Why is the APCD important for physicians?
As payers move toward value-based payment approaches, and purchasers pursue value-based purchasing and high-deductible plans, they will have incentives to direct patients and dollars toward low-cost, high-quality providers. At the same time, primary care physicians will have incentives to direct patients to high-performing specialists. As you know, comparative data on cost and quality at the individual physician level is already available and will become more so over time and from a growing number of sources. Health plans are providing this information to their patients, and private sector entities such as Thomson Reuters make physician-specific, comparative cost and quality data available to their clients.

However, unlike currently available physician performance metrics, the APCD reports will allow you to see the underlying cost, services and diagnosis data to identify ways to improve quality and demonstrate value. The data will be risk-adjusted using a consistent set of methodologies to most effectively and fairly compare physician performance and allow you to compare your costs of treatment to those of your peers. This will allow you to identify areas where your practice already provides high-value care, as well as opportunities to improve in areas where your costs might be relatively high. The APCD will also allow you to look at within-practice treatment patterns and “leakage” of patients who receive health services in other care settings.

Many physicians and physician groups are being proactive in their response to the increased availability of comparative cost and quality information. For example, a partnership between the Society of Thoracic Surgeons and Consumer Reports provides ratings for surgeons performing coronary artery bypass graft procedures, which allows consumers to make value comparisons by surgeon. Now is the time for you to begin to think about how you can use the APCD’s expansive data to strategically position yourself in the marketplace.

This is the first in a series of articles regarding the Colorado APCD. Please e-mail jmathieu@civhc.org with any questions or comments to be addressed in future articles.