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Colorado on Top of Exchange Momentum

A long plane ride this week gave me some time to peruse some of my favorite blogs and daily updates. By happenstance, I read four in a row in which a common thread was the implementation of the ACA and in particular, insurance exchanges. Each article pulled me in a different direction but there were some unifying themes. I was reminded that while we’ve come a long way and are making great strides on providing coverage, we still have significant hurdles to overcome and need to bear in mind that there will still be remaining gaps to fill.

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Colorado APCD Data to Hit the National Transparency Scene

The latest long, fairly difficult to remember acronym to come into play for CIVHC and the Colorado All Payer Claims Database is “HRCMT”. While none of us have been waiting around to learn another health care acronym, the Healthcare Regional Cost Measurement and Transparency project has the promise to make a big impact nationally using data from the Colorado APCD and other similar databanks in other states.

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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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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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Risk Adjustment and Burden of Illness in Colorado: APCD Total Cost of Care Compared to Expected Reports

Part II: Understanding health care claims data available on

Last month, in the first installment in this series, I explained risk adjustment and burden of illness concepts in more or less plain English to give readers and my fellow health data policy wonks (there’s that word again!) a better sense of what these concepts mean in practice. In this second installment, I will demonstrate how these concepts apply to the Total Cost of Care Compared to Expected (C2E) reports available on

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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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Tipping Point on Health Care Prices?

Captain Renault in “Casablanca” was “shocked – shocked!” to discover there was gambling taking place in Rick’s Café. Of course, he wasn’t shocked at all; in fact, he uttered that line as he was being handed a pile of money by a croupier. That brief encounter brilliantly encapsulated a cynical culture in which everyone was on the take, yet pretended they weren’t.

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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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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 - How We Create and Price Non-Public Data Requests

Preparing CO APCD data for non-public, custom requests is a completely different process than getting it ready for public reporting. So, what info is included in a custom request and how does CIVHC pull it together and price it?

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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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Answering Consumer Questions on Health Care Costs

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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Staying Hopeful About Health Reform

 Originally posted on

Will we ever be able to stop “reforming” our health care system?

I’ve been working on health policy issues for more than 20 years, and from the beginning my efforts were framed around health “reform.” Indeed, neither the problems under discussion nor the thrust of the proposed solutions has changed much over that time period. But change is hard, particularly when agents of change are ranged against deep-pocketed industries, entrenched guilds and bureaucratic inertia.

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New CO APCD Release Reveals More Cost Variation

At the forefront of efforts to achieve the “holy grail” of health care cost and quality transparency, CIVHC continues to add data to and enhance public reporting based on the Colorado All Payer Claims Database (APCD). The latest APCD release added an additional 400,000 covered lives. New interactive reports give users more analysis opportunities, including “Professional Claims” and “Percent Covered Population,” as well as a new static report on facility costs and utilization rates for knee replacements. These reports provide new views into variation across Colorado’s health care landscape. What continues to strike me, as someone who loves to dig into data and find interesting “nuggets,” is the fact that regardless of the metric you choose to analyze with the APCD, there seems to be significant variation everywhere.

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Protecting Colorado Health Data While Making Costs Transparent

The news is riddled with stories of frustrations over the cost of health care and the lack of transparent information available to patients and employer purchasers. Look at the responses to the recent Time magazine article about bloated hospital costs, and the release of Medicare information about the wide variations in hospital pricing: consumers are aghast at high and wildly varying prices, especially in light of little information about quality.

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Specialist Health Reform Survival Tips

I was asked by a good friend who is an orthopedic surgeon to put together a list of action items that a forward-thinking orthopedic surgery group should be considering during these dynamic health care times. From my former experience running a successful orthopedic practice and my current work with CIVHC focusing on health care reform specific to paying for high-value health care, I have assembled a list of suggested “to-dos” that specialists should consider to remain vital in the upcoming years.

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What Makes the Cut for Colorado APCD Public Reports?

The Colorado APCD currently contains approximately 86 million medical claims and about 100 million pharmacy claims submitted by commercial health insurance companies and Medicaid. These claims currently reflect health care utilization and spending for the period 2009 through 2012 and represent nearly 3.1 million unique Coloradans. I speak from personal experience when I say that this is a lot of claims data! Despite the vast amount of claims currently in the APCD, the public website doesn’t reflect all of the claims received or all health care services provided in Colorado.

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Making Sense of Variation in Colorado Health Care Pricing

Medicare made news recently by releasing data demonstrating variation in hospital inpatient and outpatient charges and payments. Colorado is uniquely positioned to couple the Medicare information with other payer data contained in the Colorado All Payer Claims Database (APCD) to better understand and identify variation in our own backyard. Medicare’s data showed substantial variation between prices charged and actual payments, which in the world of health care isn’t exactly new news. Nor is the fact that charges for similar services by one hospital can be vastly different than the one down the road. Making the data public for the first time, however, does give us an opportunity to review Medicare payments alongside commercial and Medicaid payments in Colorado to start making sense of it all.

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Consumers are More Than Ready

My two 79 year-old parents recently marveled at the ease at which they can see results from lab tests and x-rays from University Hospital’s patient portal at their own convenience before going to see their doctors for their follow-up visit. They were thrilled that their personal health information is available to them, right in front of them, just as their physician sees it. And shouldn’t they? This is their health information and it’s vital to help them engage and take care of themselves.

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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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CO APCD Change Agent Profile: National Bureau of Economic Research

The National Bureau of Economic Research (NBER) was founded in 1920, and is the nation's leading nonprofit economic research organization.

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Having Data Isn't Enough: It’s About Using Data to Improve Performance

Earlier this week, Phil Kalin and I had the pleasure of attending Health Datapalooza IV in Washington D.C. The event is the brain child of Todd Park, the Chief Technology Officer of the United States (what an incredibly cool job title!). The conference brought together many of the brightest minds in the country who are working to solve the health care challenges we face today by releasing health care data, or as Todd Park put it, “Data Liberacion!”. Just four years ago, this event was a meeting of 46 people in a small conference room in DC. These visionaries understood how the release of health care data could change the way we deliver health care in this country and committed to expanding the availability and uses of health care data for public good. This year, the event had over 2000 attendees including IT experts, health care providers, government agencies and policy institutes.

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Bundled Payments: The Process Begins with the Patient

Three national experts in bundled payment design and implementation spoke to a packed auditorium of more than 150 health care executives in Denver last week at CIVHC’s Bundled Payment Seminar to make the case that bundled payments are changing the face of health care across the country and illustrate how Colorado providers, payers and purchasers can—must—embark on this path. The consistent message from all presenters was that bundling is not just, or even first, about controlling costs. It is a critical technique for improving quality and creating a more patient-centric health care system.

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Colorado Providers - Importers or Exporters of Services?

A potentially game-changing innovation for improving quality and controlling costs arrives on the health care scene next month. Unfortunately, though, Colorado health care facilities are not part of it…yet.

Beginning in 2014, large national employers including Wal-Mart and Lowes, will begin offering their employees the opportunity to travel to national Centers of Excellence (CoE’s) for total hip and total knee replacements. If the employee travels to the CoE for care, they will have no out of pocket costs for any of their treatment and all travel and meal expenses, for the employees and a “helper/companion”, will be paid for by the employer. (see [Insert link] for more details). There are no Colorado providers on this CoE list and, as a result, Colorado will begin exporting some of its most profitable medical procedures beyond its borders beginning next month.

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What’s all this about Risk Adjustment and Burden of Illness?

If you’ve spent time looking at health care cost, utilization and quality data (and who hasn’t!), you have no doubt come across the terms risk adjustment and burden of illness. Unless you are a down in the weeds health policy data wonk (that term is used here in the most affectionate way!), you may be utterly baffled as to what all of this means.

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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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