Date: 03/01/2012
Final
Update on the All-Payer Claims Database
COMMITTEE ON JOINT HEALTH AND HUMAN SERVICES
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02:28 PM -- Update on the All-Payer Claims Database
Phil Kalin, Chief Executive Officer, Center for Improving Value in Health Care (CIVHC) introduced himself and Dr. Lalit Bajaj, Children's Hospital, and Paul Rulison, Treo Solutions, to the committee. A copy of their presentation was distributed to the committee (Attachment C). Mr. Kalin described the goal of the All-Payer Claims Database (APCD) which is to provide data on health care costs in an aggregated form to allow consumers and businesses to determine quality and cost-effectiveness in health care. He said the health care marketplace cannot function without data and the goal of the database is to determine where there is value in the health care system.
02:33 PM
Mr. Kalin discussed the reasons for the creation of APCD, stating that consumers were clamoring for actual information about how much health care services cost. He stated that businesses are in need of information about where to best spend their health care dollars, and that health policymakers are interested in knowing how new initiatives from Medicaid and other public health programs are affecting health outcomes and costs. He noted that an APCD is a tool for empowering informed decision making by consumers and business purchasers, a gateway to transparency that is necessary for bending the cost curve, and a tool for creating transparency of pricing and quality in the health care system. He stated that an APCD is not a centralized electronic medical record, a tool to see individual health records, or a means of controlling or denying care for individuals.
02:38 PM
Mr. Kalin described the history of CIVHC and the APCD. He described the 2011 milestones for the APCD including the completion of rulemaking to guide data submissions, the receipt of funding from the Colorado Health Foundation and the Colorado Trust, and the entry into a contract with database manager Treo Solutions after a competitive procurement process. He described the 2012 plan of work, which includes the creation of a database to accept test data in February of 2012; the submittal of test data by March 31, 2012; the submittal of historic data by June 30, 2012; the submittal of the first six months of 2012 claims data by August of 2012, and then monthly thereafter; and the generation of the first reports from the APCD by late 2012. He discussed the requirements for health payers to submit data to the APCD, stating that in 2012, Medicaid and commercially fully insured large groups and individual insurers are required to submit data, and in 2013, Medicare, small group insurers, and large group self-insured payers must submit data. He noted that by 2014, CIVHC expects that the APCD will have collected claims data for 90 percent of Colorado's 4.2 million insured individuals.
02:44 PM
Mr. Kalin responded to questions from Representative Acree regarding how the APCD interacts with anti-trust laws and from Representative McCann regarding whether payers are required to participate in the APCD. Senator Roberts asked if the database will be able to parse out trends regarding individual patient acuity.
02:55 PM
Representative Kerr asked how data will be secured within the APCD and Mr. Kalin provided an overview of the encryption measures that will be used to protect the information in the database.
03:02 PM
Dr. Lalit Bajaj, Children's Hospital, described the samples of reports that may be generated by the APCD which are contained in Attachment C. He highlighted how the reports will provide consumers data relevant to the costs and quality of care they may need. He also noted how the data will provide information for employers on the cost and quality of health plans. He noted that the database will generate reports regarding the utilization of health care services and the outcomes of care.
03:07 PM
Dr. Bajaj responded to questions from Representative Young regarding the reports that will be generated by the APCD and the analysis of the data from the APCD. He further responded to questions from Senator Roberts regarding comparisons of data from the APCD to other states' data. Dr. Bajaj responded to questions from Representative Kefalas regarding how physicians will use the data in the APCD to improve the quality of care. Dr. Bajaj continued to respond to questions from the committee regarding potential applications of the data obtained from the APCD.
03:22 PM
Mr. Rulison described the privacy and security protections in the APCD. He described how data is transmitted to the APCD and stated that data can only be submitted from an Internet address that is unique to each payer using a unique encryption key. Once data is submitted, only a combo of keys held by the submitter and Treo can make the data intelligible. After submission, the data are moved to another server and re-encrypted using a different encryption key. He described the password protections for the data and stated that attempted connections from unauthorized systems will automatically be blocked and logged. Mr. Rulison described the security measures in place at the APCD's physical location and the APCD's electronic access controls.
03:40 PM
Mr. Kalin responded to questions from Representative Gerou regarding whether the APCD will contain data on individual patients. He further responded to questions from Representative Gerou regarding appropriate uses of the data within the APCD.
03:47 PM
Senator Boyd thanked the panel for the presentation. The joint committee adjourned.