Community Partner: CIVHC Pioneers Claims Data in Colorado

Organization Marks 10-Year Anniversary of Colorado All Payer Claims Database

Over the years, CORHIO (a Contexture organization) and the Center for Improving Value in Health Care (CIVHC) have demonstrated resilience, versatility and success in the still-growing field of healthcare data. Both CORHIO and CIVHC recently marked significant milestones, with CORHIO celebrating a decade of data exchange and CIVHC celebrating the 10^th anniversary of administrating the Colorado All Payer Claims Database (CO APCD).

As one of the country’s largest and most successful health information exchange (HIE) networks, CORHIO collects and delivers electronic health data, notifications and services that help healthcare professionals effectively use technology to improve care delivery.

By contrast, CIVHC’s focus is collecting and analyzing claims data provided by all major healthcare insurers throughout Colorado (as mandated by state law). That data identifies costs for medical procedures and services and can help stakeholders address issues related to cost, access, utilization and quality of care.

“We collect what the provider charged, the amount actually paid by the insurance company as well as any patient responsibility,” says Kristin Paulson, JD, MPH, Chief Operating Officer for CIVHC. “We have the ability to figure out exactly what folks are paying for each (medical) procedure and how that varies by provider and payer. That’s the advantage of an APCD.”

Making health data history
CORHIO and CIVHC experienced their genesis early in the 2010s, when Colorado was highly regarded for its pioneering efforts in healthcare reform and technology. Starting in 2007, Colorado convened an influential panel of experts – then known as the Blue Ribbon Commission on Health Care Reform -- to study reinventing the healthcare system. In retrospect, much of the commission’s report looked like a blueprint of what would become the Affordable Care Act (ACA) of 2010.

As recommended by the report, Colorado became one of the first states to support the transfer of HIE, an APCD and other IT advances that have since proliferated nationwide in healthcare.

Fast forwarding to 2022, the life-saving potential of health data has been evident throughout the pandemic, but health systems still have a long way to reach the vision of interoperability where pertinent information can be seamlessly and securely shared. Locally, CORHIO and CIVHC are thriving and growing. CIVHC, which started with just two people sharing an office in Glendale, CO, expects to employ 50 people by the end of this year. CORHIO has now merged with Health Current, the Arizona HIE under the umbrella organization Contexture, which employs nearly 200.

An unexpected path
Paulson, who joined CIVHC in 2014, says that the CO APCD’s trajectory didn’t play out exactly as many anticipated. The CO APCD is a repository for pharmacy, provider, claims and insurance-enrollment files for all major payers, and because it was a new resource in Colorado and many other states didn’t have one or fully utilize theirs at the time, it was unclear exactly how it could support changing healthcare.

“In the beginning, statewide goals established across multiple organizations were very aspirational,” she says. “We thought we could immediately use the data to convert Colorado to 100% alternative payment models (as opposed to non-fee-for-service) in only five years. But the data can’t make these types of things happen that require in-depth provider and payer system-level changes. However, it can bring to light what’s going on and show opportunities to reduce variation and improve the healthcare landscape.”

With the foundation of the CO APCD, CIVHC thought payers and health systems would be among CIVHC’s primary clients. Instead, the data has found a market across the entire healthcare stakeholder spectrum, including state agencies, researchers in Colorado and nationwide (including University of Colorado, Stanford, Brown and Duke), employer-purchasing alliances and advocacy organizations.

How the data is used
Cari Frank, CIVHC’s Vice President of Marketing & Communication, estimates that their analysts produce about 120 non-public releases a year. For example, Stanford is using CIVHC’s data to examine the prevalence and impact of long-term effects of COVID. Among myriad uses, one state agency used CO APCD data to evaluate the impact of living close to a fracking site.

Frank says that the public reports CIVHC posts on its website have helped Colorado consumers become their own advocates.  

“We have one (uninsured) consumer who received a $16,000 bill from a hospital for a simple x-ray,” she says. “He was able to go into our website and found that the average reimbursement for his procedure was $2,000. He negotiated with the facility for a substantial reduction.”

What’s next for CIVHC?
While the COVID-19 pandemic initially led to significant state budget cuts that affected CIVHC’s bottom line, the organization managed to cut expenses and avoid layoffs. Indeed, demand for CIVHC’s data and analysis has increased exponentially throughout the pandemic.

“We’ve almost doubled in size over the course of the pandemic because of the work coming in,” Paulson says. “It was great on one hand because it provided financially secure. On the other hand, it has resulted in a lot of new work and trying to recruit people through the pandemic has been very challenging.”  

Though Paulson says hiring is a primary focus, CIVHC is also moving forward a number of long-term goals like bringing in vital statistics and social health equity information. For example, CIVHC is collaborating with Contexture/CORHIO, Mile High Health Alliance and Colorado Access on a project that will help providers and care coordinators identify high-risk individuals in need of social intervention.”

“We’re working with folks like Contexture/CORHIO to figure out how we can bring together the data from across systems,” Paulson says, acknowledging that the datasets from both Contexture/CORHIO and CIVHC can identify trends that could be helpful in addressing population health issues and reducing health inequities.

CIVHC is also figuring out how to better collaborate with partners in and out of state to do more data benchmarking.

"We're fleshing out the larger picture and putting more context to the data because right now, claims is only one piece of the puzzle,” Paulson says. “We’re figuring out what pieces fit where and how we can expand."