government

Claims-based database promises greater transparency

A Colorado bill that would create the online tool is backed by the state medical society.

By Chris Silva — Posted May 3, 2010

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Colorado legislators are proposing a claims-based, all-payer database to provide state residents information about the cost and quality of health plans and procedures.

Backers of the bill, which has passed the state House and has the support of the governor, said the database would result in greater transparency when it comes to the safety, quality, cost and efficiency of health care.

The bill would direct the state's top health policy official to appoint a panel to make recommendations on how to launch the database. If the bill is passed, the database would be operational by Jan. 1, 2013.

Rep. Daniel Kagan introduced the bill with co-sponsor and fellow Democrat Rep. John Kefalas.

"We're working to get Colorado health care consumers the information they need to make informed choices about their care," Kagan said. "This bill will greatly improve our understanding of how Colorado is spending its health care dollars."

The measure calls for claims information to be compiled on everyone who uses, provides or pays for health care in the state. Specifically, it calls for collecting and disseminating "performance data on quality, health outcomes, health disparities, cost, utilization and pricing in a manner accessible for consumers, public and private purchasers, providers, and policymakers."

Kagan said little information is available in the marketplace today that would allow consumers to determine and compare the cost of health care services.

Physician support

The Colorado Medical Society agreed the legislation should help streamline health care by providing patients a more accurate assessment of services provided.

"This will help direct medicine and really try to improve the health care community rather than produce disconnected services," said Lynn Parry, MD, the society's past president and a member of the group's council on legislation. "From a quality standpoint, we feel this is absolutely essential."

Dr. Parry noted the success of a similar program in Vermont, the Blueprint for Health. That initiative, overseen by the state health department, consists of a health information exchange with a strong focus on wellness and prevention programs.

Consumers are often confused by existing health plan ratings for physicians, which generally slot doctors into "low" or "high" performance categories, Dr. Parry said. "When consumers have a chance to view all the information through the database, they will be able to see a better and more accurate representation of what physicians are actually doing."

The database should also greatly improve care coordination programs such as pay-for-performance and patient-centered medical homes, Dr. Parry said.

Privacy concerns

The Colorado bill has raised privacy concerns with at least one organization, however.

Linda Gorman is director of the Independence Institute's Health Care Policy Center, a public policy think tank based in Golden, Colo., that opposes expansions of government-directed care. She said the database would allow private foundations to run a health care experiment using personal data that would force people in the state to participate.

"It's a badly drawn law, it has no protections and it's privately funded," Gorman said.

The Independence Institute warned that individual identities would not be protected, and that information on a patient's sex, age, weight, race, health history, comorbidities, genetic makeup and other factors could be made publicly available.

The bill is also vague on what exactly will be measured by the database, but the intent behind it is worrisome, Gorman said. "They're making it very clear that they're doing this to control medical practice."

But Dr. Parry disagreed. She said the medical community should be focused on what the database aims to achieve, including decreased hospital readmissions and improved health outcomes for patients with chronic diseases such as diabetes.

"This is really population data we're looking at, not personal data," Dr. Parry said. "We're looking at de-identified patient data, so it's claims by diagnosis code. It would not be tied to any personal identification."

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ADDITIONAL INFORMATION

Colorado's all-payer database

Pending Colorado legislation would launch an all-payer claims database by January 2013. Under the proposal, the database would be:

  • Formed based on recommendations from an advisory committee, which would be instructed to focus on data elements that foster improved quality and facilitate value-based, cost-effective health care purchasing.
  • Presented to allow comparisons of geographic, demographic and economic factors.
  • Available to Colorado state agencies and private entities committed to improving health care.
  • Available to the public when disclosed in accordance with state and federal laws on the privacy and security of personal health information.

Source: Bill text

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