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Colorado Must Push for Improved Health Care System

Original editorial published in the Denver Business Journal

As the CEO of an organization deeply focused on efforts to make Colorado’s health care better and less expensive, I get a lot of questions about the Affordable Care Act (ACA, Federal Health Care Reform, aka Obamacare). Many assume that if the Supreme Court strikes the law down, the work of CIVHC and many other partner organizations somehow goes away and we hit a big re-set button for our work. Nothing could be further from the truth.

While the ACA provides many important supports to improve health care - including expanded insurance coverage and financial support - the reality is that with or without the ACA, Colorado must take charge of creating its own solutions towards better health care. Our future depends on it.

Quite simply, health care in Colorado and the U.S. costs too much, leaves too many people without coverage and by many measures does not match the quality of other industrialized countries. While the debate about the ACA tends to fall along partisan lines, the fact is that containing health care costs while improving quality is something both parties can agree upon. The cost of health care is swamping Colorado citizens and businesses, and will continue to take away from education, infrastructure and all that makes Colorado such a great place to live and work. We cannot afford to take our focus off of health care improvements for one second.

The good news is that if we aggressively focus on quality and cost, regardless of the ACA, Colorado will continue to be a magnet for businesses and workers.

While the health care situation is urgent, Colorado’s response to the challenge we face is inspiring. There are so many important innovations being developed in our state that will continue regardless of what happens with the ACA.

The “A List” of health care initiatives in Colorado is too long for this column, but I can mention a few of the standout efforts.

My organization, the Center for Improving Value in Health Care (CIVHC), is creating an All Claims Payer Database (APCD) that will inform consumers, providers, businesses, policy makers and others about the costs, utilization and quality of the health care provided in Colorado. The APCD will, for the first time, give providers comprehensive tools to measure and improve the quality of care that patients receive and help inform the design of more efficient and effective health care delivery. It will also help Colorado consumers and businesses identify the providers who give the best value in terms of quality and cost.

Health Information Exchanges are being built across the state to allow records to flow along secured electronic superhighways between providers and health care facilities. The quality and efficiency gains made possible by these networks are essential to us putting the brakes on runaway costs while improving quality and patient satisfaction.

Colorado is known for its patient-centered medical home projects that pay providers “care coordination” payments to enable them to fund the infrastructure (nurse care coordinators, electronic medical records, etc.) that help them coordinate care for their patients. Colorado is unusual in that both commercial insurers and Medicaid have partnered on a common medical home approach. Imagine a world where your primary care provider is coordinating all aspects of your care – medications, tests and diagnoses with all your other providers, so that a health care team is determining the best possible solution to your health care needs. Shouldn’t be a groundbreaking idea, but it is.

“Care Transitions” projects are also defining a better health care future for Coloradans. The key here is ensuring patients who leave the hospital after treatment don’t return to the hospital unnecessarily because of things like lack of follow-up with a primary care provider, or insufficient communication between the hospital and the primary care providers after discharge. These readmissions to the hospital are a quality red flag, and they are hugely expensive for us all.

It would be a shame if some of the benefits of the ACA are lost if the Supreme Court strikes it down. The biggest risk would be losing the expansion of health care coverage for the uninsured. The health care safety net is full of holes, and the holes the uninsured and underserved are falling through will only get bigger without some strategy that gets everyone in the health care tent. However, regardless of the Supreme Court outcome, it falls to us Coloradans to fix many aspects of the cost and quality problems of our health care. We must continue to rapidly expand and accelerate the great work currently taking place to enable a more fully integrated system focused on the patient.

Phil Kalin is the CEO of The Center for Improving Value in Health Care (CIVHC.org). CIVHC is a nonprofit organization committed to identifying and advancing initiatives across Colorado that enhance consumers’ health care experiences, contain costs and improve the health of Coloradans by creating an efficient, high quality and transparent health care system. Follow Phil on Twitter @philkalin.

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