Skip To Content

Voices On Value RSS Feed

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.

The site, featuring the new name CO Medical Price Compare (accessible through www.comedprice.org and www.cohealthdata.org), will present information about four inpatient hospital services—total knee replacement, total hip replacement, uncomplicated vaginal birth, uncomplicated cesarean birth.

Here’s what’s important about the site:

  • You will be able to see the median price paid across all commercial health insurers (including patient copays/deductibles) and Medicaid payments to a given hospital for that procedure. Note that these are paid amounts, not what the hospital charged. Hospital charges are important information for many purposes (and will be displayed as a starting point for those without insurance), but they are not a good representation of what an insurer actually pays, because health plans negotiate a price that can be considerably lower than the charged amount. CO Medical Price Compare will be the first time we’ve been able to get a good picture of what insurers and patients are actually paying for hospital-based care.
  • You can look up prices for a specific hospital, as well as see variation in prices across hospitals. The pricing information will be presented with the relative complexity of the patients receiving that procedure at that facility (i.e., do they tend to be sicker than or more healthy than those at other hospitals). Pictures of variation in pricing are important, because they prompt discussions about “why?” There are many reasons that prices can vary between facilities: sicker patients, higher cost structure (e.g., because a hospital trains medical residents), market power, even reputation. Regardless of whether the reasons for the variation are perceived to be “good” or not, an understanding of the differences in pricing is essential to identifying the right ways to moderate prices.
  • If you’re like the majority of people out there, you’re concerned about how much you will have to pay, not just how much your health plan is paying. The site will include a cost calculator where you will be able to choose the name of your insurer and enter information about your benefit package (e.g., $1500 deductible, 10 percent coinsurance) to get a more targeted estimate of what you can expect to pay. This is vital information for any consumer, and even more essential for people with high-deductible health plans. Most insurers offer cost calculators of their own for patients, but they can be difficult to find and cumbersome to use. More importantly, they only provide info about the plan you currently have. But if you are shopping for health insurance—for example, when open enrollment time comes around—CO Medical Price Compare will help you get a sense of the relative impacts of different insurer and benefit options.
    • We also have a link to the Connect for Health Colorado site so that people who don’t have insurance can go there to learn about their coverage options.
  • Finally, because “value” does not depend on price alone, we’ve also provided information about quality on the website. We worked closely with the Colorado Hospital Association (CHA) to identify the most appropriate quality indicators for hospitals.

We’re excited about our baby’s strengths, but there are important limitations to bear in mind. Currently the APCD does not contain claims from self-insured employers—a significant chunk of the commercially-insured market. As a result, hospitals with a large volume of self-insured business may appear on our site to perform fewer procedures than they actually do. Accordingly, we’ve worked with CHA to set up a link to hospitals’ self-reported volumes information, so consumers can get an accurate sense of how many procedures a given hospital performs. We’re confident, though, that the absence of self-insured claims does not significantly affect the pricing information on the website. This is because insurers negotiate with hospitals on behalf of all their customers at once; in most cases, they don’t negotiate one price for fully-insured customers and another for self-insured. In fact, as we have validated data with key hospitals, we’ve found that our pricing information matches their internal records to the dollar.

In addition, Medicare data is just beginning to be collected in the APCD and will not be included in the initial release. We plan to include Medicare information in future releases to provide an even more expansive view of prices in the state.

It’s also important to recognize that we are starting small—showing a limited number of services, and only for hospitals. But the site will grow in the coming months with additional services (including many diagnostic tests) and facilities (ambulatory surgery centers, free-standing diagnostic facilities). This is complex work and it’s important to get it right.

In fact, we want to thank CHA for helping us to get it right. We have worked closely with them for 18 months to plan this release, but once we shared preview information with hospitals in May we all identified some important issues that needed to be addressed (e.g., the volume issue described above) to ensure that we clearly explain what the data do, and don’t, show.

We also worked directly with consumers over the past year, asking them what information they wanted and how we should present it. We plan to conduct additional focus groups after the first phase goes live, so we can fine-tune the site before we add more procedures and facilities. We’re also waiting until later this year when additional procedures become available to conduct major consumer outreach for the site.

We look forward to continuing to work with facilities to ensure the accuracy of the content, and with consumers to ensure ease of use.

We’re having a baby. We look forward to your help in raising it.

About the Author: Edie Sonn is CIVHC's Interim CEO and Vice President of Strategic Initiatives. Contact her at esonn@civhc.org.
 

Share on: DiggFacebookRedditDeliciousTwitter

Comments

Cindy
Great job in starting your transparency efforts including the public calculator. Better yet your explanation - congratulations on the birth of your baby.
7/15/2014 8:43:54 AM

Leave comment

Subscribe



 Security code