1. Pete Sheehan • VP of Business Development
Using Data to Drive Value: Supporting Payer & Practice Collaboration to Advance the Triple Aim
Pete Sheehan •
VP of Business Development

2. Our Mission
We strive to empower individuals, communities, and organizations through collaborative support services and health care information to advance the Triple Aim: Better Health, Better Care, Lower Cost
We are:
Non-profit
Independent
Objective
CIVHC is a non-profit, non-partisan, objective organization
We were formed out of a recommendation from a multi-stakeholder recommendation of the 208 Blue Ribbon Commission on Health Care
Our mission is to serve those across Colorado working to improve health and health care, and lower costs

3. Who We Serve
Change Agents Individuals, communities, or organizations working to lower costs, improve care, and make Colorado healthier.
Clinicians
Hospitals
Employers
Government
Consumers
Researchers
Non-Profits
We work with change agents across the spectrum of health care value who are dedicated to improving health and making health care better for themselves or others.
We work with each of these stakeholders who ultimately do the work they do to improve the lives of Coloradans.
Health Plans

4. Focus Areas Turning Data into Actionable Information
Public CO APCD Data
Identify opportunities for improvement in your community through interactive reports and publications
Custom CO APCD Data
License data from the most comprehensive claims database in CO to address your specific project needs
Data Literacy
Attend data academies to learn how to use available data resources across the state and country
Turning Data into Actionable Information

5. History of the CO APCD
2012
CO APCD operational; website goes live; begin providing custom data requests
2017-Present
Transition to new data vendor; enhanced capabilities; launched new website and additional public data
2008
CO APCD recommended by Blue Ribbon Commission for Health Care Reform
Enhancements to public data/infrastructure; added more payers/Medicare; increased custom data fulfillments
2010
CO APCD Legislation (HB ); CIVHC named administrator by HCPF
In 2008, the CO APCD was recommended by a multi-stakeholder commission and in 2010 legislation was passed establishing the CO APCD, and CIVHC as administrator on behalf of HCPF
In 2012, the database was operational and the first public reports were issued and shortly thereafter we started providing the first custom reports to stakeholders
From we increased access to public data, added over 25 new commercial payers, brought on Medicare and significantly increased the stakeholders we served with custom data.
In 2017 we transitioned to new data vendors, and since then we’ve been focused on increasing the quality and speed at which we are providing both public and non-public data.

6. What’s in the CO APCD Health Insurance Payers Claims Unique Lives
We receive claims from Medicaid, Medicare, Medicare Advantage, and over 37 commercial payers
Claims
The Colorado APCD has over 800+ million claims (Medical, Pharmacy, and Dental)
Unique Lives
The Colorado APCD represents over 4 million unique lives, and over 70% of insured Coloradans
There are other sources of claims out there, but they are all subsets of claims data. Plans have their own claims, and there are national aggregators, but they don’t have the depth of our database.
The CO APCD contains claims from all public and private payers, and is Colorado’s most comprehensive claims data set available:
Contains over 800 mllion medical, dental and pharmacy claims
Represents over 4 million unique lives
And represents 70+% of insured Coloradans.
Only missing –
some of the self-insured ERISA based plans (submitted voluntarily);
federal programs like Tricare/VA, and
any uninsured/self-pay patients.
Our APCD is top in nation for the breadth and depth of our data AND our public/custom reporting.

7. Claims Data Availability
Medicare Part D
Data is refreshed once every two months

8. Barriers to High Value Care
Cost Transparency
Providers and Clinicians need information to help them contain costs, negotiate with insurers, and cope with ever-changing requirements from regulatory agencies.
Price Transparency
Patients need information so they know how much they are going to have to pay for treatment.

9. Health Care Costs in Colorado Continue to Rise

10. CO Costs Higher Than Other States

11. CO Cost Drivers Total Cost Driven By:
5% higher Utilization
13% higher Prices
Only state with higher than average total cost and prices across all service categories

12. Prices are Going Up
Most Significant Increases in Inpatient and Outpatient Services
Category
2015
2016
Percentage Point Change
Total Cost
Overall
17%
19%
+2%
Inpatient
16%
21%
+5%
Outpatient
30%
34%
+4%
Professional 5% 2%
-3%
Pharmacy
24%
28%
Resource Use (Utilization)
11%
-6% 0%
-8%
25% 3%
-4%
-7%
23%
22%
-1%
Price 6%
13%
+7%
31%
+15% 4%
15%
+11% 7%

13. Significant Regional Variation in CO

14. Transparency to Inspire Meaningful Change

15. Data to Inform Practice Innovation
Data can enable Providers and Clinicians to see utilization and spending patterns outside their offices compared to their peers, giving them insights regarding the most high-value referral options.

16. Data to Inform Practice Innovation
Evaluation and Benchmarking

17. Getting to Value – Quality Measures
CO APCD can provide hundreds of NQF-endorsed quality measures
Examples of currently available measures:
Prevention
Breast Cancer Screening
Well Child Visits
Treatment
A1c testing patients with Diabetes
Medication management for Asthma
Safety
Use of Imaging Studies for Low Back Pain
All-cause Unplanned Readmissions
Potentially Avoidable Complications

18. Data to Benchmark Provider Prices (CPT4 Report)
Understand your negotiated rates compared to your market (zip code and county-level) for commercial payers, and as a percent of Medicare

19. Data to Inform Practice Innovation
Use Case – Children’s Hospital Colorado
Project: Children’s Hospital uses CO APCD data to identify children with medical complexity throughout the state and the providers serving them.
Outcome: Children’s Hospital has been able to identify care coordination partners and develop processes for children who had needs that are not being met by existing health care modes and identify cost savings opportunities.
An example of an organization using a CIVHC data set, updated annually, is Children’s Hospital Colorado
Their project is using CO APCD data to identify children with medical complexity and enhance care coordination

20. Data to Inform Practice Innovation
Use Case – Melissa Memorial Hospital
Project: Melissa Memorial used CO APCD data to understand where patients were going for care and what services they were seeking.
Outcome: Based on their findings, Melissa Memorial implemented an orthopedic program that tripled the total surgical volume and added an optometry clinic with optical retail store providing access to 1500 visits in Patients don’t have to travel which saves them money and time.
An example of an organization that has used a custom report is the American Physical Therapy Association (APTA)
APTA used CO APCD data to understand the percentage that physical rehab services make up of total health care expenditures in CO, driving legislation to minimize out of pocket costs for these services.

21. Public Data to Inform Consumers
The Shop for Care tool helps consumers locate facilities with the lowest price and best patient experience, and supports reducing health care spending.

22. Use this tool to shop for prices and quality by named providers
Prices Vary Widely
Comparing prices across Colorado providers for expensive procedures such as births, hip & knee replacements, and MRIs can help Coloradans realize significant cost savings.
The interactive Shop for Care Tool is available on our website for patients to find the lowest price, highest patient experience provider of imaging services.
Prices across named Colorado facilities are available for nearly 40 procedures including high cost procedures such as births and hip and knee replacements. Prices for a large array of imaging procedures is also available, from MRIs to common X-Rays.
Using this tool, patients and their health insurance company can save up to $35,000.
Use this tool to shop for prices and quality by named providers

23. Consumers Can Save Thousands
“Good news. The hospital settled at the reasonable level of $2,226. Using data from CO APCD, I was able to make a case for a $14,000 reduction in the $16,385 bill.
- Colorado Patient

24. Future Support for Statewide Initiatives

25. Polis-Primavera Administration Goal: Lower healthcare costs to save people money

26. Questions?
Pete Sheehan
VP of Business Development
Join our list at for updates on new data and events