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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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People often wonder why health care costs so much. Surprisingly, the answer may lie not just in the price of medical care, but also in the way we pay for it.

Our current "system" rewards inefficient, high-cost medicine and penalizes efficient, low-cost health care. Because patients and insurance companies pay for each visit, procedure, prescription and lab test separately, there are built-in incentives for more care without regard to whether it is the right care or is making a difference in patients' health. As a result of the current health care payment structure, many experts believe that 20 to 30 percent of care provided does not add value – or even potentially harms the patient.

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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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In grad school, our cigar chomping chairman of the department would explode with a resounding Horse Sh#@t whenever somebody gave an answer that wasn’t well thought out, supported by facts or was just plain wrong. Get it wrong on all three counts and his cigar would fly across the room at about the same speed as his expletive. It got your attention.

As I held my breath waiting for the Supreme Court decision, and fearing the Accountable Care Act (ACA) would be overturned, I reflected on the times when I could have responded with my professor’s epithet when facts were being ignored or willfully misconstrued. It wouldn’t have changed a thing but would have felt good for the moment.
 

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Each year after the Colorado Health Symposium I come away proud of the progress we’ve made in health care in our state and re-energized by the commitment and collaboration of so many Coloradans to achieve true systemic change. Through the efforts of many, a plan of action is coming into focus on ways to solve Colorado’s health care problems. Rising costs, mediocre patient experience, a population getting less healthy, and a near total lack of transparent data that can make a broken system work better plagues our state and country. Many organizations in Colorado are pursuing strategies and engaging in interventions to address specific aspects of the solution. However, if Colorado is going to thrive we need to work faster, smarter and in a more systemic way.

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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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There is broad consensus from stakeholders that our current dysfunctional system needs to change dramatically to reach the Triple Aim objectives of better health, better care and lower costs. Making the transformation happen is the difficult part. At CIVHC, we find it useful to remind stakeholders across Colorado that efforts need to be informed by three “tsunamis of change” which we believe will alter the landscape of health care over the next decade. 

1. Financial Instability. We are on a fiscal cliff. As a country, we are out of money and the majority of our public health care costs are being financed through debt. It’s unsustainable and we are kidding ourselves to think that we will continue to push off the hard choices in health care or other areas paid for by government.
    

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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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Recently I spoke about Obamacare to two different community groups. My expectations of each group were different given their locale – one was in well-to-do neighborhood that trends quite red at the voting booth (I was braced for anything up to and including a death panel discussion) and the other was in central Denver which I guessed would be more progressive in tenor. It turns out that the conversations were nearly identical and characterized by a striking polarity in which nearly everyone simultaneously viewed Obamacare with hope and fear.

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Editorial version published by Denver Business Journal 4.13.12

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. 

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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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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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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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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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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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This week, the Congressional Budget Office (CBO) released an analysis of 10 Medicare demonstration projects undertaken over the last 20 years. All were designed to save the program money, but only one succeeded in doing so. Do these findings mean we should abandon efforts to redesign our country’s health care payment and delivery systems?

Not at all. In fact, when you look below the surface of the CBO report, you reach precisely the opposite conclusion. The reason most of these pilots did not achieve their desired goals is because they were built upon our existing fragmented delivery and fee-for-service/pay-for-piecework system—a system that incents more, not better care, pays a second time for avoidable complications and provides no and incentive for care coordination and better outcomes.

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Striving for improved value just might be the one goal that unites all parties in the health care system. But it will take a coordinated effort from key stakeholders across the system to bring about change.

Philip B. Kalin, president and CEO of the Center for Improving Value in Health Care (CIVHC), will facilitate a panel discussion, "An Imperative Taking Shape: Rewarding Value in Health Care," at the 2011 Colorado Health Symposium.

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