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CO APCD Data In Action, New Data Available

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The Colorado All Payer Claims Database (CO APCD) is the state’s most comprehensive source of health care insurance claims information representing the majority of covered lives in the state across commercial health insurance plans, Medicare (Fee-for-Service and Advantage), and Health First Colorado (Colorado’s Medicaid program). New data now available via the CO APCD includes:

  • New Out-of-Network CO APCD Data: HB 19-1174 passed in 2019 to protect patients from receiving surprise bills for health care services from out-of-network providers. CIVHC analyses using the CO APCD are being used to determine payment limits for out-of-network services which are defined in the bill as the 50th percentile in-network paid amounts for Emergency Department visits, and the 60th percentile in-network paid amounts for Professional/Anesthesiology. New data based on 2019 calendar year claims and other related resources are now available on the Division of Insurance (DOI) website.
  • New CO APCD Primary Care Spending Data: In 2019, HB 19-1233 passed with the ultimate goal of reducing overall health care costs through investment in primary care. Annually, CIVHC provides primary care spending and payment information to the Primary Care Payment Reform Collaborative which makes recommendations on reimbursement and implementation of the bill. The second annual report, based on claims and alternative payment model (APM) information in the CO APCD, provides the percent of medical spending that goes to primary care, the share of payments that are made through APMs, and the share of payments that are not paid on a fee-for-service or per-claim basis. For more information and to see the Collaborative’s most recent recommendations, visit the Division of Insurance (DOI) website.
  • Reducing Prescription Drug Costs in Colorado: The Colorado Department of Health Care Policy and Financing released the second edition of the Reducing Prescription Drug Costs in Colorado Report in early January. The report is a follow up to the initial report published in 2019 and outlines strategies for Colorado to reduce the cost of prescription drugs – one of the major drivers of rising health care prices. The second edition of the report includes the first public release of drug rebate information collected in the CO APCD, which began in 2019.

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