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Tipping Point in Health Care?

I’ve been in health care for over 30 years and as I think about most of the problems with healthcare… access, quality, cost, safety, etc., many of the solutions to these issues were obvious even back in those early days of my career. We knew then that fee for service reimbursement created perverse incentives and that outcome based payments aligned incentives for better care and lower costs. In general, care was siloed, inefficient and demanded vertical and horizontal coordination along with tools such as electronic health records (EHR). The problem was that there was no pressure to change unless it was self-generated. Today, many of the same problems exist, but the impetus and external pressures to improve are upon us.

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APCD Harnesses the Power of the Internet

Originally appeared in the November/December issue of Colorado Medicine.

In recent years, the Internet has empowered consumers to make informed choices on products and services on everything from restaurants to books to plumbing. Yet, when it comes to health care, we’ve been essentially stuck in the horse-and-buggy days.

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My Prescription is How Much?

When we think of filling our prescriptions with generic drugs, we generally consider them a low cost, equally effective alternative to a brand name medication. We’ve also heard about the power of generics to move the price of brand name drugs and lower prescription medication spending overall. A recent example of this is Lipitor. Lipitor (generic name Atorvastatin) is a widely used cholesterol lowering medication that became available in the last half of 2012 as a generic. The generic version provided a lower cost option at less than one third of the cost of the name brand Lipitor. CIVHC analysis of data from the Colorado All Payer Claims Database pre and post-introduction of the generic version of Lipitor shows that the price per day for the brand Lipitor also dropped substantially as a result of generic competition which provided consumers with more alternatives.

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SIM. What's All the Excitement About?

On December 16, 2014, the staff at CIVHC spontaneously started yelling and dancing. No, we were not celebrating the upcoming holidays with synchronized glee, nor were we working on “Colorado APCD: The Musical”. We were throwing a party because the long awaited Centers for Medicare and Medicaid Innovation State Innovation Model Round 2 funding awards were released and two long years of work were being rewarded. Colorado was awarded $65 million dollars to implement the Colorado state innovation model and was one of only 11 states awarded dollars to fund implementation of a statewide plan. While we here at CIVHC have been living and breathing SIM for the past two years, it might not be as familiar to all of you. Let me give you a brief history of the work that has been put into SIM and hopefully you’ll see why we’re so excited.

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CO APCD Data in Action

Over the last two years, the Colorado APCD team has worked very hard with stakeholders across the state of Colorado, as well as across the country, to make the state’s most comprehensive health care claims database accessible and valuable for the benefit of Coloradans. According to the legislation establishing the database, the purpose of the CO APCD is to “facilitate the reporting of health care and health quality data that results in transparent and public reporting of safety, quality, cost and efficiency information at all levels of health care.” We’ve come a long way towards realizing that public purpose from 2012 to now and I’d like to highlight some of the exciting ways organizations are using the custom data for health care improvement.

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Informing Opportunities for Colorado

After joining CIVHC last year, I made a point of pouring through all of our past grants and reports to gain as much historical knowledge as possible. I wanted to understand our roots, our challenges, our successes and the progress we’ve made in the few short years since our inception as an organization. The Colorado All Payer Claims Database (CO APCD) annual legislative report was one in particular that I found intriguing given the astounding progress made between the time the APCD was signed into law in 2010 through last year’s 2013 recap. The 2014 annual legislative report just released is yet another reminder of how far we’ve come in such a short amount of time. While it’s important to celebrate the accomplishments made over the past year, we continue to set our sights on where we need to take this important statewide resource to ensure it is providing the highest value possible to Colorado.

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Building a Blueprint: Solving Data Integration at 10.10.10

In March I attended a unique event called 10.10.10. This inaugural gathering brought together tech entrepreneurs and health care experts to mull solutions to health care’s most vexing problems: health data, Alzheimer’s, childhood obesity, and others. The basic construct: ten entrepreneurs, ten wicked problems, ten days to work on them. The gathering yielded what you often get when you bring a diverse group of people together: different viewpoints, and resulting insights into one’s own area by seeing it through different eyes.

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Comparative Performance Data for Physicians: An Important First Step for the Colorado APCD

As an economist, I know that credible information based on analysis of reliable data is worth its weight in gold. But, I also know that it is important not just to provide information, but to impart meaning and motivate action based on the results. To really make a difference, you have to engage all stakeholders in the health care community, get them to ‘take notice’ of the information and weave a story around the data to spark change.

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Moving Forward

Similar to the ever-changing health care landscape in Colorado, CIVHC has evolved over the years to address the key health care needs of our state. CIVHC was originally created in 2008 by Executive Order of the Governor in recognition of the need to have a systemic, statewide approach to advancing the Triple Aim of better health, better care and lower costs.

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Making the Right Care Available When it Matters Most

Several years ago, a friend of mine was diagnosed with an aggressive cancer at a very young age. Treatment options were uncertain and sometimes experimental. He and his family were lucky and were enrolled in a high-quality palliative care program that addressed not just his pain and symptoms, but also helped his family make choices about care in the future, supported his wife in her new role as a caregiver, connected them to resources at the hospital and beyond that could work with them as the disease progressed, and most importantly for him, helped his young daughter come to terms with what his illness could mean for her.

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Moving Forward, Part II

In my last blog I talked about the importance of CIVHC’s five pillars to support our strategies and advance our mission to cultivate initiatives that improve health, health care, and lower costs in Colorado. This month I’ll share with you what we’re calling CIVHC 2.0 – taking our work and support to the next level to advance health care in Colorado.

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Raising Awareness and Asking Questions About Health Care Costs

Pop quiz: When it comes to health care, what's the difference between cost, charge, and payment?

This question opened a recent article I read regarding medical schools teaching new doctors to talk to patients about price. Knowing the nuances between the definitions of cost, charge and payment isn’t something most consumers understand, nor do they really have to. I believe simply raising awareness that there can be a big difference in what you (or your insurance company on your behalf) might pay for health care depending on where you go and treatment options you choose is just as important. Training doctors to understand the potential financial impact of their recommendations and having those conversations with their patients is an important step in the right direction in raising awareness of price transparency.

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A Recipe for Success

Thanksgiving is rapidly approaching which brings to mind all the things I’m grateful for - including some amazing family recipes. Each ingredient on its own is unique and important, but when you put them together it can be downright magical. We talk a lot about the power of organizational collaboration in Colorado in the same vein, but the same can be true when combining data sources.
 

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Alternative Payment Model Shift

Jay-Want-CIVHC.jpgOn April 27th, CMS released proposed rules for the implementation of the Medicare and CHIP Reauthorization Act (MACRA), an act that heretofore was famous for containing the repeal of the Sustainable Growth Rate (SGR).

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Colorado Rises in National Health System Performance Rankings

Guest Blogger: Douglas McCarthy

In 2010, the CIVHC-led Data and Transparency Advisory Group set long-term goals for Colorado to move into the top tier of performance among states on key measures of health system performance. Thanks to the collaborative efforts of public and private stakeholders, the state has taken strides to realize these goals.

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Achieving our Olympic Vision

It is fair to say that the Olympics and supporting the greater Olympic community is a family passion. During The Games, we follow the athletes in their events, celebrating and commiserating through victory and defeat. We treasure our own Olympic moments and cheer on close friends who are still working to achieve their dreams.

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Plaintalk Blog - Understanding CO APCD Data Releases

In our last blog, you learned what an All Payer Claims Database (APCD) is and what type of information CIVHC collects. We talked about how each health care claim is a tiny, jumbled Rubik’s Cube and how each color represents a different piece of information (encrypted personal information, provider identifiers, diagnosis codes, etc.). We also discussed that CIVHC’s job, as administrator of the Colorado APCD (CO APCD), is to make sense of all these little cubes and ensure that each side of each cube is the same color.

But what, you may ask, do we do with all of the claims in the CO APCD?
 

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CIVHC Status - Data and Analytics Top 5s

We took a moment to chat with Dave, our VP of Analytics and Data Ops, to learn about his team, the coolest projects happening at CIVHC, and the new vendors

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Change Agent Profile - Southeast Health Group

Change Agent Profile Series (formerly CIVHC's Spotlight on Innovation) - Southeast Health Group's Tipping Point Integrated Care Pilot

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Plaintalk Blog: Why Did Colorado Want An APCD and What Are We Supposed to Do With It?

So, we’ve explained what an All Payer Claims Database is and all the exciting things that it can do; but, why on earth would Colorado what such a thing? How did the CO APCD come to be and what, exactly, is Colorado supposed to do with it?

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Change Agent Profile: American Physical Therapy Association - Colorado Chapter

APTA-logo.pngThe Colorado Chapter of the American Physical Therapy Association is a nonprofit, professional organization with nearly 2500 members.
 

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Common Post-Launch All Payer Claims Database Questions

As many of you are aware, Colorado’s All Payer Claims Database went live on November 1st at www.cohealthdata.org. The initial response has been very positive and the APCD has enjoyed extensive press coverage both locally and nationally. Along with the initial flurry of website activity and news coverage we've received some common questions which are answered below. For the complete list of APCD Frequently Asked Questions, click here.

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Crunch Time in Health Care

This time of year is sports fan’s heaven but unfortunately I seem to have been born without the “sports fan gene”. Family, friends and colleagues exchange sad, knowing glances at my pathetic mixed sports metaphors and attempts to engage in post-weekend sports banter.  Despite that, as I write this first health care blog of 2013, all I have are sports metaphors floating in my head.  I apologize ahead of time to all sports fans out there.

Having crossed into 2013, the trigger date of 2014 for implementing the biggest elements of the health care law seems imminent...

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Colorado's HIEs and APCD: Two Important Data Sources for Triple Aim Advancement

Tracey CampbellColorado’s bipartisan Blue Ribbon Commission for Healthcare Reform and other national health care leaders recognize the power of data to support improving health care. The Colorado All Payer Claims Database (APCD) and statewide Health Information Exchanges (HIE) were both identified by the Commission in 2008 as critical sources of data to enhance efforts towards the Triple Aim of better health, better care and lower costs. Colorado’s APCD and HIEs both serve a distinct and essential purpose for health care transformation as outlined in a new issue brief CIVHC developed in partnership with Quality Health Network (QHN) and the Colorado Regional Health Information Organization (CORHIO).

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Accessing the Power of Colorado's All Payer Claims Database

A recent Denver Post article highlighted findings from a Dartmouth Institute study that found significant variation in the percent of Medicare patients undergoing costly invasive treatments versus non-invasive lower cost procedures for similar diagnoses. Those that received costly surgical and invasive procedures for the same diagnosis didn’t necessarily have the best health outcomes. In many cases, the evidence suggests that patients can realize better outcomes from less intensive treatments including rest, physical therapy and other alternatives. This study provides a great example of the type of analysis that is possible using Colorado’s All Payer Claims Database (APCD) and highlights just a few of many possible examples.

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Why Focus on Palliative Care to Achieve Triple Aim? Part II in a Series of FAQs

Considering the fact that CIVHC ‘s expansive charge is to improve the quality of care and bend the cost curve for health care across the state of Colorado, many people wonder why CIVHC has committed to an effort so specific as improving access to high quality palliative care, especially at such an early stage in our organization’s development. Perhaps an organization such as CIVHC should be more focused on “big picture” issues in Colorado, by identifying where we have the greatest opportunities to impact the quality and cost of care for the largest segments of our population. In 2008, the members of CIVHC’s planning committee took on that exercise, and identified palliative care as one of those opportunities.

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Colorado All Payer Claims Database Launching in November

The Colorado APCD website goes live November 1st, 2012, and will allow us for the first time to start evaluating the big drivers affecting health care cost and utilization in our state. To celebrate this important milestone, CIVHC is hosting a launch event at The Colorado Trust from 10-11:30am. Please join us and other health care leaders in the state as we share some of the early data and findings in the APCD and demonstrate how to use the interactive website to search the health data of interest to you.

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What is CIVHC Doing to Address Palliative Care? Part III of III in a Series of FAQs

In Parts I and II of my series, “What is Palliative Care?”, and “Why Focus on Palliative Care?”, I explained why palliative care has become a specific focus area for CIVHC to address the Triple Aim of improving health, enhancing health care quality and containing costs. In this final post, I'll explain CIVHC’s work to date convening task forces and implementing recommendations to address palliative care Triple Aim opportunities.

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A Solid Foundation Helps Meet a Health Data Challenge

Developing an information resource as complex as the Colorado All Payer Claims Database is a difficult and challenging undertaking. Although sophisticated technology is available, creating a functional database from complex claims information submitted by multiple payers and spanning several years is no easy task. The reality is that even the large and well established health payers face challenges in synthesizing and making sense of their own claims data.

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Data and Quality Measures Essential for Better Health Care

by Ned Calonge, MD, originally published in Health Policy Solutions November 2, 2012

This week we saw the first presentation of the Colorado All Payer Claims Database, a project of the Center for Improving Value in Health Care (CIVHC) that is jointly funded by the Colorado Health Foundation and The Colorado Trust.

We at The Trust believe that the claims and costs data collected through the APCD, as well as specific measures of quality, will provide an essential missing part of the spectrum of data needed to inform health care decisions by business leaders, policymakers, providers, payers and, of course, health care consumers.

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All Payer Claims Database Debut Supports Colorado’s Health Care Journey

Last Thursday, November 1, marked a big milestone for health care in our state with the launch of Colorado’s All Payer Claims Database. As the appointed administrator of the APCD, CIVHC is honored to serve as the steward for this unique Colorado resource. We were thrilled by the crowd of more than 200 health care leaders and stakeholders that gathered at The Colorado Trust. Enthusiasm in the room was palpable as participants saw the APCD in action for the first time. Multiple policy wonks admitted that their post-event work plans were “shot” because they planned on spending the afternoon pouring through the APCD site to see what information they could glean. This initial version of the APCD is designed to stimulate important policy discussions towards the goal of better health, better care and lower costs.

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New Database will Provide Valuable Health Care Cost Info

Originally published in the Denver Business Journal, Nov. 9, 2012

by William N. Lindsay III, President of the Benefits Group-Denver for Lockton Companies

While the rate of increase in health insurance costs for Colorado employers has slowed, it continues to outpace inflation. If we want to slow this rate of growth still further, we need to understand what’s driving it. Finally, Colorado is getting a tool that will help us do just that.

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CIVHC Status - Strategy & Business Development Top 5s

We took a moment to catch up with Tracey Campbell, our VP of Strategy & Business Development. These are the top 5s on things to know about her team, featured Change Agents and their projects, and how CO APCD data is being used.

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Change Agent Profile: HopeWest

Death is a taboo topic in America. In many cases, the reticence to discuss end-of-life concerns extends to serious diagnoses, such as cancer, which may not be terminal.

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Change Agent Chat Briefing: HopeWest

Summary of the Change Agent Chat featuring HopeWest's President and CEO, Christy Whitney.

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We've Only Just Begun

2017 marks the 5th Anniversary of implementation of the CO APCD. We continue to look forward to increasing the use and availability of the data in years to come.

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Plaintalk Blog - What is a Bundled Payment?

What are bundled payments, and how do they help providers reduce waste and deliver better care? Take a look at our interpretation.

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CO APCD Change Agent Profile: Division of Vascular Surgery and Endovascular Therapy, University of Colorado Hospital Department of Surgery

UCHealth-Logo-(1).pngThe University of Colorado Hospital (UCHealth) is the only academic medical center focused on specialized care in Colorado. Providers practicing at UCHealth are Specialists and Surgeons, offering care to the residents of Colorado and several other neighboring states.

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Top 5 Things to Know About CIVHC's Palliative Care Team

Top 5s:

Things to Know About CIVHC’s Palliative Care Team

Ways CIVHC is Engaging in Palliative Care Work in Colorado

Myths about Palliative Care

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The All Payer Claims Database: Tools and Transparency to Make Informed Health Care Choices

As a patient, would you like to know how much a medical procedure will cost you before you get it? As a buyer of insurance, would you like to know how the providers in one health plan’s network compare on cost and quality measures with those in another? As a Colorado taxpayer, would you like to know how new initiatives from Medicaid, the Child Health Plan Plus and public health departments are affecting health outcomes and costs?

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Shedding Some Much Needed Light on the Health Care Market

As an economist, I understand all too well that there can be no meaningful and well-functioning market without accessible and actionable information to inform consumer choices. Health care is no exception, yet we currently have very few places to turn for data that helps us make educated purchasing decisions that drive value into the system. Fortunately this situation is beginning to be addressed nationally through Health Care Cost Institute’s (HCCI) national claims database and CIVHC’s more robust Colorado All Payer Claims Database (APCD).

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No Magic Bullet for Health Care Reform

Rarely does a day go by that I don’t run into another article arguing the efficacy of health care reform tactics such as medical homes, Medicare payment reform, and Electronic Health Records (EHR). A recent example is “Do Electronic Medical Records Save Money?” by the New York Times. The piece reveals the results of a 2008 federal survey showing that physicians using electronic records actually ordered more high cost tests than their peers who were still using paper medical records. This is contrary to the belief that EHR systems have the potential to save costs by reducing the number of tests being ordered.

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What's the Difference Between Palliative Care and Hospice Care? Part I in a Series of FAQs

Despite some interesting “discussions” at the federal level on end-of-life care over the last few years, CIVHC continues our commitment as a convener and leader to improve access to high-quality palliative care across Colorado. Along the way, we’ve received many questions from stakeholders about palliative care and our decision to focus on this topic, especially in the light of highly charged political rhetoric associated with end-of-life care over the last couple years. Over the course of the next few months, I will be answering some of the questions we get most often in an effort to demystify palliative care. Today's question focuses on a common misperception that palliative care and hospice care are one and the same.

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The All Payer Claims Database will Help Coloradans

Lalit BajajBy Lalit Bajaj, M.D., M.P.H., and Nathan Wilkes - APCD Advisory Committee Members

Featured in Denver Post, Guest Commentary 4/27/12

We've all heard the old adage you can't manage what you don't measure. The same is true for health care. In Colorado and across the nation, costs for health care services continue spiraling out of control, gobbling up higher percentages of our wages while taking away from resources that could improve our schools and infrastructure.

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CIVHC Celebrates Five Year Anniversary and New Staff

February 13th marked five years since Governor Ritter signed the Executive Order to develop the Center for Improving Value in Health Care. In those five years since CIVHC was merely an idea born out of the 208 Blue Ribbon Commission on Health Care Reform, much has changed for our organization and our state as a whole. The future of health care in Colorado looks bright, and I’d like to take this opportunity to introduce several new staff and highlight some new resources we made available this month in support of Colorado efforts.

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Getting Patients to Choose a Honda Over a BMW

An email with the subject line “Patients Prefer High Cost Care” came through my inbox a few weeks ago. It was spurred by a recent study in Health Affairs revealing that patients would typically select a higher cost service like an MRI over a lower cost CT scan even after being educated on the marginal difference between the results.

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Answering Consumer Questions on Health Care Costs

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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New CO APCD Release Reveals More Cost Variation

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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Protecting Colorado Health Data While Making Costs Transparent

The news is riddled with stories of frustrations over the cost of health care and the lack of transparent information available to patients and employer purchasers. Look at the responses to the recent Time magazine article about bloated hospital costs, and the release of Medicare information about the wide variations in hospital pricing: consumers are aghast at high and wildly varying prices, especially in light of little information about quality.

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One Year Milestone Celebrations

These past couple months have been full of milestones both personally and for CIVHC. As I get older I’m more cognizant of both the passing of time and what I make of it. I’m trying to be more attentive to key milestones and take every opportunity to celebrate them . As I prepared to write about a couple of key one year milestones for CIVHC, I couldn’t help but think about the one year milestone (6/22) of having become a first-time grandfather to Theo.  I am incorrigible about showing pictures of him and am certain that all of our health care readers will be equally as interested in seeing documentation of how far Theo has come as he hits his first year milestone.

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CO APCD Change Agent Profile: CDPHE Hypertension and Diabetes Medication Adherence

The Colorado Department of Public Health and Environment (CDPHE) is dedicated to protecting and improving the health and environment of the people of Colorado.

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The Train Hasn’t Merely Left the Station

I recently had the opportunity to travel to Spain for a cousin’s wedding, and every time I visit Europe I’m struck by the remarkably advanced transportation system they have in place. You can get just about anywhere you want to go in Europe by train, and in most cases a high speed option is available. As I was periodically checking in to the health care scene stateside while I was away, the cliché “The Train Has Left the Station” kept coming to mind. Significant changes are taking place in health care signaling an uptick in momentum. Not only has the train left the station when it comes to transparency and payment reform, but it’s well on its way towards the final destination – lower costs and better care.

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Change in Seasons Offers Fresh Perspectives

I was shocked this week to see a few leaves turning signaling the first signs of fall, especially only a few short days following 90-plus degree weather. This time of year always seems to sneak up too quickly with school back in session, cooler nights and the hours of daylight diminishing. At the same time, the crisp night air and brisk mornings are a welcome change to the summer heat and I’m reminded again of how privileged I am to live in Colorado where with each change in season we’re surrounded by a new, unique perspective.

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We Have Money for You (Seriously)

In six years of college, I never heard the phrase, “we have a scholarship for you.” No, it didn’t take me six years to finish a college degree; that was my little brother, who ironically enough was actually offered a scholarship. In my six years between undergraduate and graduate school, the phrase “we have a bill for you” was the one I heard. Back then I never would have anticipated that one day I would help run a program to provide scholarship money to organizations in pursuit of improving health care.

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A Letter From CIVHC's New CEO: Ana English

I am excited to be a part of CIVHC and working again in Colorado! My first official day was August 4, 2014, and within a few days I was in awe of the number of health care improvement activities occurring in Colorado and all there is to learn. To get up to speed as quickly as possible, my calendar is already full of meetings with staff, key stakeholders and business leaders that play an essential role in the success of CIVHC. Of critical importance is hearing directly from you and understanding the important role you play in Colorado’s health care landscape and what support CIVHC might be able to provide you along your journey.

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CO APCD Top Ten List 2013

As I look back on my first year with CIVHC as the Director of the Colorado All Payer Claims Database (APCD), and the first full year with an operational APCD, I think it is important to reflect on how this state resource has grown and how it’s being used across Colorado. I’m going to borrow from David Letterman’s “Top Ten List” approach to benchmark the progress of Colorado’s APCD and leave you with the APCD goals for 2014.

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Colorado APCD Data to Hit the National Transparency Scene

The latest long, fairly difficult to remember acronym to come into play for CIVHC and the Colorado All Payer Claims Database is “HRCMT”. While none of us have been waiting around to learn another health care acronym, the Healthcare Regional Cost Measurement and Transparency project has the promise to make a big impact nationally using data from the Colorado APCD and other similar databanks in other states.

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Debt, Data and Deciders

The landscape in American health care is changing, and it's affecting us here in Colorado. At CIVHC we talk about three major trends in American health care: debt, data and deciders. These tsunamis of change are affecting every aspect of American life, not just health care.

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What’s all this about Risk Adjustment and Burden of Illness?

If you’ve spent time looking at health care cost, utilization and quality data (and who hasn’t!), you have no doubt come across the terms risk adjustment and burden of illness. Unless you are a down in the weeds health policy data wonk (that term is used here in the most affectionate way!), you may be utterly baffled as to what all of this means.

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Risk Adjustment and Burden of Illness in Colorado: APCD Total Cost of Care Compared to Expected Reports

Part II: Understanding health care claims data available on www.cohealthdata.org

Last month, in the first installment in this series, I explained risk adjustment and burden of illness concepts in more or less plain English to give readers and my fellow health data policy wonks (there’s that word again!) a better sense of what these concepts mean in practice. In this second installment, I will demonstrate how these concepts apply to the Total Cost of Care Compared to Expected (C2E) reports available on www.cohealthdata.org.
 

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Risk Adjustment and Burden of Illness in Colorado APCD Utilization Compared to Expected Reports

(The third installment in an ongoing series dedicated to helping Coloradans
better understand health care claims data available on www.cohealthdata.org)

Previous articles in this series attempted to explain risk adjustment and burden of illness concepts and demonstrate how these concepts apply to Total Cost of Care Compared to Expected (C2E) reports available on the Colorado APCD website. This third installment explains how risk adjustment and burden of illness concepts apply to Utilization C2E reports and provides examples of how this information can be used to better understand potential reasons for observed variation in the use of health care services in Colorado.
 

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Consumers are More Than Ready

My two 79 year-old parents recently marveled at the ease at which they can see results from lab tests and x-rays from University Hospital’s patient portal at their own convenience before going to see their doctors for their follow-up visit. They were thrilled that their personal health information is available to them, right in front of them, just as their physician sees it. And shouldn’t they? This is their health information and it’s vital to help them engage and take care of themselves.

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Getting Mad with the APCD

When people have to pay more than others for the same services, and the reasons are unclear, it’s not surprising when anger ensues. We’ve seen this play out recently with the health insurance rates in Colorado’s resort communities, and Colorado’s Division of Insurance has responded by evaluating data to search for potential solutions. It was a perfect illustration of how data from the All Payer Claims Database can inform those debates and help shape responses.

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What Makes the Cut for Colorado APCD Public Reports?

The Colorado APCD currently contains approximately 86 million medical claims and about 100 million pharmacy claims submitted by commercial health insurance companies and Medicaid. These claims currently reflect health care utilization and spending for the period 2009 through 2012 and represent nearly 3.1 million unique Coloradans. I speak from personal experience when I say that this is a lot of claims data! Despite the vast amount of claims currently in the APCD, the public website www.cohealthdata.org doesn’t reflect all of the claims received or all health care services provided in Colorado.

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CIVHC is Having a Baby — and You're Invited to Help Us Raise It

On July 31, the Colorado All Payer Claims Database website will launch the first phase of comparative price and quality information for hospitals in Colorado. While this phase will be modest—a baby step—it is nonetheless significant, marking the first time Coloradans will be able to see real pricing information across all commercial payers and Medicaid for hospital-based services.

To understand this better, let’s explore what our baby looks like now, and our plans for helping it grow.
 

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Data. The Foundation of Improvement

During my first 30+ days it has been exciting to hear positive feedback from our various stakeholders regarding CIVHC, its staff and management team, and our future potential. Most see the value of the Colorado All Payer Claims Database (CO APCD) and the strong potential of claims data in informing and driving health care reform. In fact, at the national level we recently received a letter of commendation from Dr. Len Nichols, Director of the Center for Health Care Policy Research and Ethics at George Mason University, highlighting the value of the recent launch of consumer-focused price information and how the CO APCD differentiates health care price transparency in a way unlike any other APCD in the country. We consider ourselves stewards of this important resource for the state and it is our commitment to continue to make this valuable data and information more readily available and actionable.

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CIVHC Awarded National Center for Healthcare Transparency Planning Grant

CIVHC was recently awarded a Regional Data Center Collaborative planning grant from the Center for Healthcare Transparency (CHT). The CHT is a national initiative led by the Network for Regional Healthcare Improvement (NRHI) and Pacific Business Group on Health (PBGH) that seeks to coordinate and leverage the innovative work being done by 14 state and regional health care improvement organizations.

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Scholarship Funding Enabling Triple Aim Projects in Colorado

Similar to the saying, “the early bird gets the worm”, initial Colorado organizations who have applied for the APCD Scholarship awards are “the early requestors getting the data!” Three organizations have applied for and received a scholarship award for APCD data. This group of innovative organizations are focused on one or more aspect of the Triple Aim. They are using the data to improve decision-making for consumers, look at the efficacy of Accountable Care Act (ACA), and to conduct condition-based research to improve care.

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Big Data: Key Ingredients for Informing Innovation

The term “Big Data” is a popular phrase these days across social media and blogs, especially when it comes to health care. It’s not surprising given the challenges we’re facing with health care at the national level and the fact that data is key to managing any improvement effort. While the term “Big Data” is becoming synonymous with the golden ticket, it has the potential to become dangerous when used too broadly without a common definition. When it comes to data - “big” or “small” - not all are created equal, but the power of the right data can be instrumental to identify and inform meaningful, innovative change.

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Seeing the Whole Picture

Ana-English.gifAnyone who’s looked at an impressionist painting at close range knows that until you step back and look at the whole picture, it’s hard to know what you’re really looking at. The recent New York Times article, “The Experts Were Wrong About the Best Places for Better and Cheaper Health Care,” demonstrates this phenomenon perfectly.

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Why are Prices so High in Health Care?

Jay-Want-for-print.jpgFor many years we have been assuming that if Medicare costs were low in a particular region, like Grand Junction on our Western Slope, then commercial insurance costs were also likely to be relatively low.

 

 

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If You’re Poor, Where You Live Matters

In a recent article in the Journal of the American Medical Association, economists from Stanford and Massachusetts Institute of Technology (MIT) did a very interesting thing. There is a general assumption that the richer you are, the longer you live, on average. This turns out to be true.

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Is the ERISA Supreme Court Decision Doom and Gloom for Colorado?

Recently, I had the opportunity to chat with a national reporter about how the Supreme Court’s Gobeille vs. Liberty Mutual decision impacts Colorado’s All Payer Claims Database (CO APCD). She was surprised to learn that our perspective is significantly different from that of other states with APCDs, who feel the decision greatly affects the value of their database. While the CO APCD would certainly benefit from adding claims from self-insured employers that fall under the Employee Retirement Income Security Act (ERISA), Colorado is already gaining valuable insights from the database and those insights will only improve as we add voluntary claims from ERISA self-insured employers.

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Plaintalk Blog Series

Plaintalk-Blog-Icon.jpgIntroduction to the series, and administrating the Colorado All Payer Claims Database (CO APCD).

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Top 5 Things to Know About CIVHC's Research & Compliance Team

Top 5 Things to Know About the R & C Team

Top 5 Ways Compliance Impacts How Data from the CO APCD is Released

Top 5 Research Collaborations

 

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Plaintalk Blog - How We Create and Price Non-Public Data Requests

Preparing CO APCD data for non-public, custom requests is a completely different process than getting it ready for public reporting. So, what info is included in a custom request and how does CIVHC pull it together and price it?

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CO APCD Change Agent Profile: National Bureau of Economic Research

The National Bureau of Economic Research (NBER) was founded in 1920, and is the nation's leading nonprofit economic research organization.

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