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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.

Last week was particularly telling with new Medicare payment proposal announcements and the latest Report Card on State Price Transparency release from the Catalyst for Payment Reform and HCI3. Colorado moved from a “C” to a “B” in this year’s transparency report and sits among the top three states in the nation on providing transparent health care price information for consumers. Colorado is one of only two states to receive a “B” (along with Maine), with New Hampshire receiving the only “A” due to their online price comparison tool. The other 45 states received an “F” in transparency progress, although the report did note that many states were still in legislative session when the analysis was conducted and could have made more progress than indicated this year.

This release marks the third annual edition of the transparency report card, and each year Colorado moves up a notch thanks in large part to the forward-thinking 2010 legislation that established the state’s All Payer Claims Database and the availability of public price information on As this year’s report points out, Colorado’s “B” rating reflects the infancy stage we’re in with the number of health care services available on the public site (currently births and knee and hip replacement), but as CIVHC works to expand that number over the next year, we intend to see Colorado in the “A” rating in the future.

Two potentially significant Medicare proposed payment changes were also released last week in support of the government’s goal to move towards pay-for-value. In January 2015, HHS announced that it intends to change 30 percent of current fee-for-service payments to alternative payment models such as bundled payments and Accountable Care Organizations by the end of 2016, and 50 percent by 2018. In support of this goal, last week Medicare announced a “Comprehensive Care for Joint Replacement” model that would hold hospitals financially responsible for cost and quality of care during and after knee and hip replacement surgery. Though it’s encouraging that Medicare is serious about pay-for-value changes and is taking steps to implement alternative payment models, this approach is not without criticism. Payment reform experts like Harold Miller, with the Center for Healthcare Quality and Payment Reform, argue that the proposed model isn’t structured to encourage care coordination, quality improvement or cost savings, and could stifle innovation and decrease quality overall.

Medicare has also proposed to begin paying physicians for end-of-life counseling and advance directives planning as part of the physician fee schedule. Although this is a “traditional” fee-for-service payment proposal and doesn’t cover the full array of palliative care services necessary for those with serious illnesses, it is important that Medicare has recognized the need to pay physicians for having end-of-life discussions with their patients. As our recently released Palliative Care in Colorado report indicates, Colorado has significant gaps in care provided to those with serious illnesses – beyond end-of-life concerns – and paying for comprehensive palliative care services that can make a positive impact on quality of life and cost of care is the number one barrier to access.

It’s incredible to me what can happen in just a week, and having been in health care for a long time, I can attest to the pace picking up significantly. The continued forward momentum in concert with the decision to uphold the ACA by the Supreme Court indicates to me that our country is no longer satisfied with the status quo on health care. We may not all agree on the precise formula for change, but we know change must occur, and it has to happen now.

About the Author: Ana English is CIVHC's President and CEO. Contact her at

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