Colorado’s All-Payor Claims Database Highlights Payment Discrepancies for Common Services

A new tool for measuring healthcare costs and utilization across payors throughout Colorado, and designed to improve care and reduce costs, is now available.

Colorado’s All-Payor Claims Database (APCD) is a comprehensive health claims data resource — giving patients, purchasers, providers, payors and policymakers the tools to make informed decisions, officials say. Data in the APCD currently includes the eight largest commercial insurers for individual, large group fully-insured and some self-insured lives, as well as Medicaid. Over 2 million unique individuals are represented in the APCD encompassing over 40 percent of Colorado’s total covered lives. By 2014 the database will expand to include remaining segments of the commercial market as well as Medicare, reflecting approximately 90 percent of insured Coloradans.

Geographical discrepancies are evident fromt the tool’s initial data: while certain counties match statewide averages for Medicaid, they have higher than average costs for commercially insured patients. Officials hope this first glimpse into total cost of care will encourage health policy experts, health plans and providers to start asking why discrepancies exist and provide a basis for communities to further evaluate their own cost and health disparities.

Other discrepancies brought to light with the APCD include the wide range of costs for common healthcare services like diagnostic imaging. A current APCD imaging payment report shows variation in payments for MRIs of the knee, ranging from $297 to $1,261. Payments for high cost imaging services (including both MRIs and CT scans) ranged from as low as $385 to high as $2,049. These differences are important for Coloradans paying for these services out of pocket or under a high-deductible insurance plan, and for facilities trying to determine where they stack up against the competition.

The APCD can also enable hospitals and other providers to identify where their care patterns are out of the norm for their peers, and begin to understand how they might achieve better patient outcomes more effectively and efficiently, officials say.

The planning phase for the APCD was supported through a grant from The Colorado Trust. An additional $4.5 million in funding from the Colorado Health Foundation ($2.5 million) and The Colorado Trust ($2 million) supports ongoing development, implementation and management of the APCD.

With the launch of the APCD, Colorado joins 11 other states across the United States with similar databases that provide an unprecedented ability to identify variations in cost and utilization. The first round of reports from the APCD can be found at www.cohealthdata.org.

Source: Center for Improving Value in Health Care (CIVHC), November 7, 2012

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