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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. Preparing for 2014 seems like building towards winning the Super Bowl or World Series for health care. We had some must-wins before, including the Supreme Court decision, but it still feels a bit like the pre-season. We need to bring our “A” game as there are lots of opposing fans out there who would like to see the law get crushed.    

That said, Colorado has a deep health care bench and a lot of wins under our belts. We are well positioned towards achieving the Triple Aim goals of better health, care and lower costs. Gretchen Hammer, the Executive Director of Colorado Coalition for the Medically Underserved, had a great blog post last week in which she highlighted how far we’ve come in the five years since the Blue Ribbon Commission for Healthcare Reform. The progress of our Health Information Exchanges, coverage and provider fee expansions, accountable care initiatives, medical home and care transition efforts, community partnerships, and creation of the Colorado Health Benefit Exchange (COHBE) are all huge building blocks for success. CIVHC itself emerged from the Commission’s recommendations as did Colorado’s recently launched All Payer Claims Database (APCD) for which CIVHC is the administrator. We have much to be proud of but it’s all building towards a much bigger goal.

The Governor’s announcement to expand Medicaid was a welcome kickoff to the 2013 season. It acknowledges what many of us know…Coloradans need coverage and better access to care. It not only is the right thing for individuals and families but is also good for business. We have to stop the cost shift to private payers and give Coloradans a chance to stay healthier if we are to get our arms around sky-rocketing costs. The Governor’s step is the right one but as Monday’s lead Denver Post editorial said, keeping costs under control will be an important measure of success, as will ensuring new Medicaid patients have access to providers. 

Getting Colorado's health benefit exchange up and running is another project that is front and center in 2013 with its October 1st launch date and health plans going into effect on January 1st, 2014.  The COHBE team is working diligently to get the online health insurance marketplace ready, and its implementation is critical to help make the market for health care coverage work. 

Right here at CIVHC we have many projects that build on the work of others and our own over the last couple of years. At the top of the list is expanding the scope and use of the APCD. While we have provided some interesting first rounds of data, the next critical step is to get risk and severity information that provides both cost and quality measures into the hands of consumers, providers, businesses, policy-makers and others. We are laser-focused in 2013 on giving stakeholders the information on “value” that can impact the marketplace and move us towards better quality and lower costs.

Other key CIVHC efforts include using the APCD and other data sources to build performance reports and metrics on how the health care system in Colorado is performing. We continue to build upon and launch new payment reform efforts and are looking forward to publishing a palliative care study in early 2013 that will shed light on important elements of cost, quality and patient centeredness at the end of life. A statewide “umbrella” campaign for care transitions is also scheduled to roll out in 2013 that will bring together the great work happening in our state to reduce readmissions and avoidable ER visits.

Most importantly, CIVHC continues to help convene and align efforts across the state that will support and accelerate Triple Aim for Colorado. We are fortunate to work with so many organizations across the state that are focused on achieving the same health care improvement goals for Colorado.  We couldn’t have selected a better set of teammates who are up for the tasks at hand.

We look forward to the important preparatory work ahead of all of us in 2013. It’s crunch time for health care and we can’t afford to lose any momentum in the months ahead.

About the Author: Phil Kalin is CIVHC's President and CEO. Contact him at

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