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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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Readmission Penalties Give Hospitals a Reason to Spend Money on the Right Things

There was a story in the Denver Post this week about Medicare’s penalty for readmissions being charged to 27 Colorado hospitals that participate with Medicare. On average, these hospitals were penalized 1/3 of one percent of their total Medicare reimbursement. In the case of one large hospital system, this amounted to about $300,000 out of a total revenue stream of $2.7 billion, or about 1/100 of one percent. At this level, one might wonder if it’s worth the trouble to administer, or if anyone is really paying attention.

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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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Signs That Payment Reform is Here to Stay

Originally featured on wanthealthcarellc.com.

There was a significant announcement out of HHS on Monday, January 26th, about payment reform. Here is an excerpt from an industry article:

“The new goal is that by the end of 2016, 30 percent of fee-for-service Medicare payments will become value-based payments through alternative payment models like Accountable Care Organizations (ACOs) or bundled payment arrangements. This will increase to 50 percent of payments by the end of 2018.

HHS has also set a goal of 85 percent of all traditional Medicare payments shifting to quality-based by 2016 and 90 percent by 2018. This will happen through programs like Hospital Value Based Purchasing and the Hospital Readmissions Reduction programs.”
 

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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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Five Emerging Trends in Health Care

Originally featured on WanthealthcareLLC.com.

I recently attended one of the last meetings of the Aligning Forces for Quality (AF4Q) communities, sixteen communities around the country that have been doing payment and delivery system reform for almost a decade, sponsored by the Robert Wood Johnson Foundation. I’m sure when the whole program wraps up next April, there will be a formal report on the findings and learnings. For now, here‘s a sampling of what I’ve learned.

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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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Data Wonks Unite to Discuss Transparency

In case you missed it, last month was the Second Annual Transparency Summit in Washington, a fabulous wonk sprint of two and a half days on all things transparent and emergent in health care transformation. While these conferences are always biased toward the true believers of the concept in the conference title, I left with a number of insights:

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SGR Repeal and the End of Fee for Service Payments: A New Era for Forward Thinking Physician Groups

The perennial “Doc Fix” debate is nearing an end. On April 14th, the Senate voted overwhelmingly (92-8) to repeal the sustainable growth rate (SGR) and implement a new payment model for physicians participating in Medicare. The House approved the bill last month with an unusually high degree of bipartisanship. President Obama has said he would sign the legislation.

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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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How Did I End Up Here? The Tale of Green Chile Gone Wrong

Guest Blog by Matt Guy, Managing Director, Pueblo Trip Aim Corporation

I’m sure I’m not the only person to wind up in the emergency room asking this question.  I definitely know I’m not the only person to start out with a minor health issue that turned into a major problem. How my health status moved from a minor to a major problem is a story of how the Triple Aim wasn’t well implemented in my life.

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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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Plaintalk Blog - What Can You Do With CO APCD Data? A Lot...and it's Really Cool

Okay. By now, you know what an All Payer Claims Database is, what types of data releases are available, and that any data release from the CO APCD must be used to benefit Coloradans.

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Health Care Reform: Change of Administration, Change of Approach?

The election of Donald Trump was surpising, to say the least. In a victory anticipated by few, a President Trump opens the way for repeal of the Affordable Care Act, and with it, many of the provisions.

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Reflection

This time of year offers a chance to reflect. Through the hustle and bustle of our day-to-day lives, it’s easy to get caught up in the whirlwind of activity and forget to celebrate what and whom we are grateful for. This year, I am personally grateful for close family and friends, and wonderful memories of loved ones no longer with us. These wonderful memories help to shape us and provide direction as we look forward into the future.  As a part of the Colorado health care non-profit community, I’m also thankful to be part of an innovative ecosystem of organizations and colleagues focused on improving the lives of Coloradans

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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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Insurance Pools: How Do We Pay for the Expensive People?

Why you can’t fool all of the people all of the time.

I think for most people, including me at times, the effort to repeal and replace the Affordable Care Act is an exercise in taking something they didn’t understand well but have feelings about, and replacing it with something else they don’t understand well and will have feelings about.  I could comment on the state of our legislative process surrounding this case, but that’s for another day and another blog. 

Instead, if you can stand it, I’m going to use this column to try to explain the difficulty in reshaping the insurance pools in the ACA.
 

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Change Agent Chat Briefing, Southeast Health Group

On February 24th, CIVHC's CMO, Jay Want, sat down with Southeast Health Group's Integrated Care Director, Jackie Brown, to discuss their TIPPING Point program that integrates mental and physical health through health navigators. Listen to the recording of the Change Agent Chat and read a summary of the conversation.

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Undoing American Healthcare

Why assuming we’re rational about health care may be a dangerous assumption

I am reading a wonderful book called The Undoing Project by Michael Lewis, about the development of behavioral economics by two of its pioneers, Daniel Kahneman and Amos Tversky.  One point of their work over five decades is that while we think we make decisions rationally and objectively, in actuality, our thinking and valuation of things are fluid, and uses different criteria with different weights at different times.

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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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Is A Better Way Actually Better?

In the current debate over the Affordable Care Act's repeal and replacement, we are watching the collision of two world views.

 

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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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Five Things I think About the Next Phase of Health Care Reform

By Jay Want, MD, CIVHC CMO

This is not the end of Obamacare; it’s the beginning.

In a surprising move, Paul Ryan pulled the American Health Care Act, the Republican ACA repeal and replace bill, last Friday. It had become clear that there was no movement to the left or the right that would garner enough votes to allow passage in the House.

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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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Community Change Agent Chat Briefing - Colorado PERA

The Change Agent Chat Series is a collection of interviews with boots-on-the-ground organizations and individuals working to advance lower cost and better care for all Coloradans. Join us on the 4th Friday of every month from 12-12:30pm MT.

On April 28th, 2017, CIVHC's CMO, Jay Want, sat down with Colorado PERA’s Executive Director, Greg Smith, to discuss the PERACare Select program that bundles hip and knee replacements into one payment.
 

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Plaintalk Blog: Quality Matters - How Do You Know if The Health Care You’re Getting is Good?

Deciding where to get health care is a pretty big deal. But, unlike most other big-deal purchases, today’s industry doesn’t allow us to comparison shop.

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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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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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Community Change Agent Profile: Aurora Mental Health Center & the Chambers Hope Health and Wellness Clinic

Profile: Founded in 1975 by residents determined to bring services to their city, the Aurora Mental Health Center (AUMHC) began in a donated space. In the 42 years since inception, the center has grown to over 400 employees, 16 specialty clinics, seven counseling centers, six residential facilities, and an active presence in public schools and homes across Aurora

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Five Things I Think About How the Health Care Delivery System is Changing

Originally featured on WantHealthcareLLC.com.

I have the opportunity to speak to a number of provider groups in the course of my work, and many recently have asked about the big picture of how care is changing.

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King vs. Burwell Decided: Starter Gun Goes Off for Insurer Consolidation

Originally featured on WanthealthcareLLC.com.

In a long awaited decision, the Supreme Court of the United States handed down a 6-3 decision in favor of the administration in King vs. Burwell, a challenge to the legality of subsidies for the poor in the federal health care exchange. I am not a legal scholar, so can’t comment on the legal nuances of the case. Nonetheless, there are big implications to the law standing that even I can understand.

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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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Cultivating the Network of Care: Building Transformation from the Inside Out

Originally featured in Healthy Transitions Colorado's July newsletter.

On Friday, June 26th Healthy Transitions Colorado held its very first symposium: Building Transformation from the Inside Out. The symposium was the first in a series of three with a complementary learning series titled Cultivating the Network of Care. Thank you to everyone who made the event such a success! Over 70 partners came out for networking and learning more about how to prepare their facilities for community-based 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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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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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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