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Also posted on Project Health Colorado blog

Last month, Project Health Colorado, an initiative of The Colorado Trust, asked me to address a common theme raised in posts on their website about the lack of cost information given to patients before receiving health care services. John from Colorado Springs wrote, "It's completely unacceptable that we're letting our healthcare providers get away with NOT providing us with good faith estimates of what our portion of the charges will be!" And a post by Taneil from Boulder summed it up best. "For each procedure there should be sane ways to assess benefits and costs. People are totally uninformed in both areas."

So what changes need to be made so that consumers understand the cost of their health care before they buy it?

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At the forefront of efforts to achieve the “holy grail” of health care cost and quality transparency, CIVHC continues to add data to and enhance public reporting based on the Colorado All Payer Claims Database (APCD). The latest APCD release added an additional 400,000 covered lives. New interactive reports give users more analysis opportunities, including “Professional Claims” and “Percent Covered Population,” as well as a new static report on facility costs and utilization rates for knee replacements. These reports provide new views into variation across Colorado’s health care landscape. What continues to strike me, as someone who loves to dig into data and find interesting “nuggets,” is the fact that regardless of the metric you choose to analyze with the APCD, there seems to be significant variation everywhere.

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Three national experts in bundled payment design and implementation spoke to a packed auditorium of more than 150 health care executives in Denver last week at CIVHC’s Bundled Payment Seminar to make the case that bundled payments are changing the face of health care across the country and illustrate how Colorado providers, payers and purchasers can—must—embark on this path. The consistent message from all presenters was that bundling is not just, or even first, about controlling costs. It is a critical technique for improving quality and creating a more patient-centric health care system.

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I read with great interest the Health Affairs Article, “Focus Groups Highlight That Many Patients Object to Clinicians’ Focusing on Costs.” This study found that patients will opt for a more expensive treatment or diagnostic option even if the more expensive choice offers only a slightly improved chance for a better outcome. I am paraphrasing and simplifying the scope of the study but the general sense is that when it comes to a patient’s decision on what medical intervention they want, cost is not important. My professional experience as a physical therapist and orthopedic practice administrator has shown me that costs can play a major role in a patient’s decision to seek elective care. I would like to contrast the Health Affairs study using focus groups’ responses to a hypothetical situation with the real world experience of actual patient dollars being part of the patient’s decision.

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Only a self-admitted data wonk has a favorite health care economist. Mine is Dr. Uwe Reinhardt of Princeton. Over the years he’s amazed me with his witty and succinct analyses of the health care marketplace and why it is so profoundly broken. He just came out with his latest blog, “U.S. Health Care Prices Are the Elephant in the Room”. I highly recommend this article for the nuggets of insight it provides as well as a range of other resources and articles that he points to.

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