Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

Practice Management News

Colorado Launches Multi-Payer Data-Sharing Online Tool

By Ryan Mcaskill

Dr. Judy Zerzan speaks about the creation of a new database and how it will impacts payers, providers and consumers.

- Last month, it was announced that seven health plans in Colorado have come together to form a multi-payer data-sharing online tool that will help improve the quality of care for all state residents. This idea was born out of the Comprehensive Primary Care (CPC) initiative – collaboration among public and private health plans – and the aims to make it easier for primary care practice to transition to a more integrated approach.

In an interview with RevCycleIntelligence.com, Dr. Judy Zerzan, chief medical officer and deputy director, Colorado Department of Health Care Policy and Financing (Colorado Medicaid), spoke about the new online tool, how it came about and what it means for payers, providers and consumers.

As part of the Centers for Medicare and Medicaid Services (CMS) Innovation Center grants, multiple payers were required from a broad cross-section of practices. Currently, there are 74 practices that are a part of this new database. The comprehensive care initiative also required several different payer steps and milestones in order to receive annual funding. One of these milestones is the data aggregation tool that has been debuted.

The database itself will be created and run by Rise Health, a healthcare big data and analytics provider. According to Zerzan, they were chosen after a nearly nine month search where the payers came together to figure out what they needed and what was out their. The top two data companies then presented and Rise Health was picked.

Colorado is the first state to create a system of this kind, on this scale. The new database is going to link data together from all payers that are participating and put it together in a tool that providers can log into and see all the claims of patients in their practice.

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“Right now, I would get, it use to be paper but now more often its email, notifications from different plans saying ‘here are the patients you took care of that had diabetes and how they scored on their quality metrics’ and depending on how many different payers I have seen patients of, I would get eight, nine, or 10 different reports,” Zerzan said.

She added that it can be very difficult for providers to pull all of this information together and truly answer questions like “am I doing a good job on diabetes or not?”

“The real innovation with this tool is that you will be able to see all of your metrics and all of the quality measures on them,” Zerzan said. “You will be able to better tell the quality of care you are providing and where the areas you need to improve upon for a quality improvement project.”

She added that part of the power of this aggregated database is that a practice can really look at where it is proving excellent care and where they need to improve care. On top of that, Medicaid patients will also benefits as it can be hard to get payer attention if they only have a few Medicaid clients but when they are able to look at the whole thing it really benefits all payers.

Consumers in the state will see benefits, as the quality of care across the board should increase. Providers will have the ability to how they measure up to the competition and to national benchmarks. This is the kind of thing that can be used by providers as a catalyst for change.

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“I’m super excited about this tool. I think it is really going to make a big difference because providers don’t have a lot of ways to see the data and this is going to allow people to think creatively and improve their practice,” Zerzan said.

While the database is still waiting to be launched, Zerzan said there are already plans for keeping the program running after the project is over and expanding it. Last month, the state was one that received part of $665 million (Colorado received $65 million) in federal funding from the Department of Health and Human Services as part of the State Innovation Model. The money will be used to further develop a plan to integrate physical and behavioral health services and Zerzan said that this will also be used to help improve the database and incorporate more information.

For now, Zerzan said it is time to get the database up and running, which providers and payers are anxiously awaiting.

“We have heard from a lot of them saying ‘come on already, this is going to be such a helpful tool for us, get it going.’ They are clearly looking forward to the tool and using it,” Zerzan said.

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