Skip To Content

Voices On Value RSS Feed

The All Payer Claims Database: Tools and Transparency to Make Informed Health Care Choices

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?

Read Post

CBO report: Silver Lining for controlling health care costs

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.

Read Post

The All Payer Claims Database will Help Coloradans

Lalit BajajBy Lalit Bajaj, M.D., M.P.H., and Nathan Wilkes - APCD Advisory Committee Members

Featured in Denver Post, Guest Commentary 4/27/12

We've all heard the old adage you can't manage what you don't measure. The same is true for health care. In Colorado and across the nation, costs for health care services continue spiraling out of control, gobbling up higher percentages of our wages while taking away from resources that could improve our schools and infrastructure.

Read Post

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.

Read Post

New Ways to Pay for Medical Care Can Lower Costs

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.

Read Post

CO Health Change Agent - HopeWest

Death is a taboo topic in America. In many cases, the reticence to discuss end-of-life concerns extends to serious diagnoses, such as cancer, which may not be terminal.

Read Post

SIM. What's All the Excitement About?

On December 16, 2014, the staff at CIVHC spontaneously started yelling and dancing. No, we were not celebrating the upcoming holidays with synchronized glee, nor were we working on “Colorado APCD: The Musical”. We were throwing a party because the long awaited Centers for Medicare and Medicaid Innovation State Innovation Model Round 2 funding awards were released and two long years of work were being rewarded. Colorado was awarded $65 million dollars to implement the Colorado state innovation model and was one of only 11 states awarded dollars to fund implementation of a statewide plan. While we here at CIVHC have been living and breathing SIM for the past two years, it might not be as familiar to all of you. Let me give you a brief history of the work that has been put into SIM and hopefully you’ll see why we’re so excited.

Read Post

CIVHC Celebrates Five Year Anniversary and New Staff

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.

Read Post

Supreme Court Decision Aside, Colorado Needs to Continue Fast-Tracking Improvements for Our Health Care System

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. 

Read Post

Readmission Penalties Give Hospitals a Reason to Spend Money on the Right Things

There was a story in the Denver Post this week about Medicare’s penalty for readmissions being charged to 27 Colorado hospitals that participate with Medicare. On average, these hospitals were penalized 1/3 of one percent of their total Medicare reimbursement. In the case of one large hospital system, this amounted to about $300,000 out of a total revenue stream of $2.7 billion, or about 1/100 of one percent. At this level, one might wonder if it’s worth the trouble to administer, or if anyone is really paying attention.

Read Post

What's the Difference Between Palliative Care and Hospice Care? Part I in a Series of FAQs

Despite some interesting “discussions” at the federal level on end-of-life care over the last few years, CIVHC continues our commitment as a convener and leader to improve access to high-quality palliative care across Colorado. Along the way, we’ve received many questions from stakeholders about palliative care and our decision to focus on this topic, especially in the light of highly charged political rhetoric associated with end-of-life care over the last couple years. Over the course of the next few months, I will be answering some of the questions we get most often in an effort to demystify palliative care. Today's question focuses on a common misperception that palliative care and hospice care are one and the same.

Read Post

Integrating Public Health to Achieve Triple Aim Goals

In 2011, CIVHC worked extensively with members of its Payment Reform, Delivery System Redesign, and Consumer Engagement Advisory Groups, along with other interested stakeholders, to lay out a framework for moving the payment system toward outcomes-based reimbursement for care in Colorado. The advisory groups developed a six milepost framework that offers a path for communities to evolve to the destination of highly integrated systems of health and health care delivery. The destination includes community and public health as full partners with providers paid risk-adjusted, performance-based global payments, and patients fully informed, engaged, and empowered.

Read Post

No Magic Bullet for Health Care Reform

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.

Read Post

CIVHC Convenes Innovation Challenge Applicants with Foundation, Payers to Leverage Triple Aim Projects

The spirit of innovation is alive and well in Colorado health care. And, even as providers, patient advocates and health plans respond to local needs, they’re identifying many of the same problems. Even more striking: they agree that the changes they need to make to improve health, improve care and control costs can’t be done without radically transforming the way we pay for health care.

Read Post

Why Focus on Palliative Care to Achieve Triple Aim? Part II in a Series of FAQs

Considering the fact that CIVHC ‘s expansive charge is to improve the quality of care and bend the cost curve for health care across the state of Colorado, many people wonder why CIVHC has committed to an effort so specific as improving access to high quality palliative care, especially at such an early stage in our organization’s development. Perhaps an organization such as CIVHC should be more focused on “big picture” issues in Colorado, by identifying where we have the greatest opportunities to impact the quality and cost of care for the largest segments of our population. In 2008, the members of CIVHC’s planning committee took on that exercise, and identified palliative care as one of those opportunities.

Read Post

Standing Up for Being Fiscally Responsible and Humane

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.
 

Read Post

Integrated Care at Safety Net Clinics is Saving Lives

Potentially preventing a teen from suicide by cleaning her teeth might seem like a far-fetched connection. But this was just one example of the power of an integrated team based approach to primary care at safety net clinics that was highlighted at this year’s Colorado Health Symposium. August commemorates clinics serving vulnerable populations through both National Health Center Week and Colorado’s Safety Net Clinic Week. In an effort to identify and promote effective, patient-centered delivery systems, CIVHC has learned that clinics like these that are treating the whole patient – mind, body and spirit – through a multi-disciplinary team approach are finding benefits they never imagined.

Read Post

Aligning Delivery and Payment Reform for Maximum Impact

As one looks at the efforts to transform health care delivery and payment in Colorado, two overwhelming impressions emerge. The first is the sheer quantity of innovation underway in our state. To see what I mean, look at CIVHC’s Inventory of Payment Reform and Delivery Redesign Strategies and the graphic that accompanies it . While we’ve done our best to be comprehensive, we know we’ve left important initiatives off these documents (and please contact us if yours is missing). But even our non-exhaustive list requires nearly two dozen pages to describe.

Read Post

What is CIVHC Doing to Address Palliative Care? Part III of III in a Series of FAQs

In Parts I and II of my series, “What is Palliative Care?”, and “Why Focus on Palliative Care?”, I explained why palliative care has become a specific focus area for CIVHC to address the Triple Aim of improving health, enhancing health care quality and containing costs. In this final post, I'll explain CIVHC’s work to date convening task forces and implementing recommendations to address palliative care Triple Aim opportunities.

Read Post

Tipping Point in Health Care?

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.

Read Post

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.

Read Post

Reality Check in a Time of Uncertainty

Change brings opportunity. And judging from the amount of change underway in Colorado’s health care community right now, we’ve got lots of opportunity! Nonprofit organizations—including CIVHC—and state agencies are undergoing leadership transitions. Foundations are reconsidering their funding approaches. Colorado’s State health Innovation Plan lays out an ambitious, multi-year agenda for health system transformation.
 

Read Post

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.
 

Read Post

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...

Read Post

Watching Physician Culture Change

Originally posted on www.wanthealthcarellc.com.

I do a fair amount of work in payment and delivery system reform, in various communities around the country.  I have been speaking to physicians about change coming for over a decade. If you have done any of this work, you may have had this common experience: that change is hard, and people have to have a really good reason to change the status quo. I admit it sometimes seemed to me that change would never come. 

Read Post

Five Emerging Trends in Health Care

Originally featured on WanthealthcareLLC.com.

I recently attended one of the last meetings of the Aligning Forces for Quality (AF4Q) communities, sixteen communities around the country that have been doing payment and delivery system reform for almost a decade, sponsored by the Robert Wood Johnson Foundation. I’m sure when the whole program wraps up next April, there will be a formal report on the findings and learnings. For now, here‘s a sampling of what I’ve learned.

Read Post

Five Things I Think About How the Health Care Delivery System is Changing

Originally featured on WantHealthcareLLC.com.

I have the opportunity to speak to a number of provider groups in the course of my work, and many recently have asked about the big picture of how care is changing.

Read Post

Putting Our Heads Together

For several months, a very broad group of stakeholders has met as part of CIVHC’s Delivery System Redesign and Payment Reform Advisory Groups.  Both groups have concluded that Colorado cannot move forward without simultaneously transforming payment systems and the delivery of care.

Read Post