Center for Improving Value in Health Care
Dec 12, 2014 | 0 comments | Posted by Global Administrator
Consumer Engagement, Health Reform, Price Transparency, Colorado All Payer Claims Database
Originally appeared in the November/December issue of Colorado Medicine.
In recent years, the Internet has empowered consumers to make informed choices on products and services on everything from restaurants to books to plumbing. Yet, when it comes to health care, we’ve been essentially stuck in the horse-and-buggy days.
Health Reform, Price Transparency, Colorado All Payer Claims Database
When we think of filling our prescriptions with generic drugs, we generally consider them a low cost, equally effective alternative to a brand name medication. We’ve also heard about the power of generics to move the price of brand name drugs and lower prescription medication spending overall. A recent example of this is Lipitor. Lipitor (generic name Atorvastatin) is a widely used cholesterol lowering medication that became available in the last half of 2012 as a generic. The generic version provided a lower cost option at less than one third of the cost of the name brand Lipitor. CIVHC analysis of data from the Colorado All Payer Claims Database pre and post-introduction of the generic version of Lipitor shows that the price per day for the brand Lipitor also dropped substantially as a result of generic competition which provided consumers with more alternatives.
Jan 21, 2015 | 0 comments | Posted by Global Administrator
Delivery System Redesign, Health Reform, Integrated Care, Colorado All Payer Claims Database
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.
Feb 13, 2015 | 0 comments | Posted by Global Administrator
Payment Reform, Medicare, Health Reform
Originally featured on wanthealthcarellc.com.
There was a significant announcement out of HHS on Monday, January 26th, about payment reform. Here is an excerpt from an industry article:
“The new goal is that by the end of 2016, 30 percent of fee-for-service Medicare payments will become value-based payments through alternative payment models like Accountable Care Organizations (ACOs) or bundled payment arrangements. This will increase to 50 percent of payments by the end of 2018.
HHS has also set a goal of 85 percent of all traditional Medicare payments shifting to quality-based by 2016 and 90 percent by 2018. This will happen through programs like Hospital Value Based Purchasing and the Hospital Readmissions Reduction programs.”
Mar 11, 2015 | 0 comments | Posted by Global Administrator
Health Reform, Payment Reform, Price Transparency, Delivery System Redesign
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.
Apr 16, 2015 | 0 comments | Posted by Global Administrator
Health Reform, Price Transparency, Consumer Engagement
In case you missed it, last month was the Second Annual Transparency Summit in Washington, a fabulous wonk sprint of two and a half days on all things transparent and emergent in health care transformation. While these conferences are always biased toward the true believers of the concept in the conference title, I left with a number of insights:
May 15, 2015 | 0 comments | Posted by Global Administrator
Health Reform, Colorado All Payer Claims Database
In March I attended a unique event called 10.10.10. This inaugural gathering brought together tech entrepreneurs and health care experts to mull solutions to health care’s most vexing problems: health data, Alzheimer’s, childhood obesity, and others. The basic construct: ten entrepreneurs, ten wicked problems, ten days to work on them. The gathering yielded what you often get when you bring a diverse group of people together: different viewpoints, and resulting insights into one’s own area by seeing it through different eyes.
Feb 28, 2017 | 1 comments | Posted by Global Administrator
Cost Transparency, Health Reform, Payment Reform, Controlling Costs
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.
Oct 9, 2013 | 0 comments | Posted by Philip B. Kalin
Health Reform, ACA
You could generally count on the old TV westerns having at least one wild bar fight in which people were having bottles and chairs busted over their heads while others were being thrown over the bar and out the window. Usually the reason for the argument was lost and forgotten after the first chair was thrown and the melee stopped the second the sheriff strode in and fired his six shooter up into the ceiling. The chaos of a government shutdown over funding of the Affordable Care Act (ACA) reminds me of those old bar fights. In this case, I wish the American consumer could play sheriff, knock some heads together and say “we have the answer right here in front of us…now let’s do the right thing.”
Jul 10, 2015 | 0 comments | Posted by Global Administrator
Health Reform, Payment Reform, Delivery System Redesign
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.
Jul 16, 2015 | 0 comments | Posted by Global Administrator
Health Reform, Payment Reform, Redesign, System, Delivery
In a long awaited decision, the Supreme Court of the United States handed down a 6-3 decision in favor of the administration in King vs. Burwell, a challenge to the legality of subsidies for the poor in the federal health care exchange. I am not a legal scholar, so can’t comment on the legal nuances of the case. Nonetheless, there are big implications to the law standing that even I can understand.
Aug 25, 2015 | 0 comments | Posted by Global Administrator
Health Reform, Price Transparency, Triple Aim, Colorado All Payer Claims Database
I was shocked this week to see a few leaves turning signaling the first signs of fall, especially only a few short days following 90-plus degree weather. This time of year always seems to sneak up too quickly with school back in session, cooler nights and the hours of daylight diminishing. At the same time, the crisp night air and brisk mornings are a welcome change to the summer heat and I’m reminded again of how privileged I am to live in Colorado where with each change in season we’re surrounded by a new, unique perspective.
Jun 18, 2014 | 0 comments | Posted by Kristin Paulson
Health Reform, Health, Information, Controlling Costs
Lately there have been articles in journals like JAMA and Health Affairs discussing the need for physician leadership in reshaping the system. It isn’t that there hasn’t been this need before. Because of the central role granted to physicians by law and by culture, we have always needed physicians to agree, explicitly or implicitly, to changes to the delivery system. Indeed, I call the last model of physician accountability for health care the “infinite power for infinite responsibility” model. Because we had no way of measuring physician performance in the last age, how else were we going to deal with matters that were literally life and death? If you are dealing with a phenomenon that frightens us all, you want to give your agents all the power you can.
Dec 13, 2013 | 0 comments | Posted by Ana English
Controlling Costs, Cost Transparency, Delivery System Redesign, Health Reform, Payment Reform, Rewarding Value, Bundled Payments
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.
Jan 9, 2014 | 0 comments | Posted by Edie Sonn
Controlling Costs, Health Reform, Payment Reform, Medicaid, ACA
Two interesting data points about health care spending have emerged in the last week that, at first, may seem contradictory. Actually, though, they are entirely complementary, and both illustrate the need to continue efforts to control costs and improve quality in the health care system.
Feb 10, 2014 | 0 comments | Posted by CIVHCAdmin
Coordinated Care, Health Reform, The Colorado Trust, Information, ACA
Today's health care landscape is changing rapidly, and the action at the state and national level is receiving a lot of attention. However, much is happening at the local level, too. Local communities are coming together and taking the initiative to improve their own health care systems in exciting and innovative ways. Although certainly catalyzed by recent state and national health reforms, this movement has been gaining steam for years.
Feb 10, 2014 | 0 comments | Posted by Edie Sonn
Cost Transparency, Health Reform, Exchange, Controlling Costs
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.
Feb 19, 2014 | 0 comments | Posted by Jay Want
Controlling Costs, Health Reform, Data, Decision, EHR, All Payer Claims Database
The landscape in American health care is changing, and it's affecting us here in Colorado. At CIVHC we talk about three major trends in American health care: debt, data and deciders. These tsunamis of change are affecting every aspect of American life, not just health care.
Mar 11, 2014 | 0 comments | Posted by Erin Perry
Health Reform, Payment Reform, Data, Decision, Health, payer, Readmissions, Care Transitions
There has been a lot of buzz lately about the “doc fix” or the proposed repeal of the Medicare Sustainable Growth Rate formula (SGR). The SGR was put into law in 1997 as part of an attempt to regulate Medicare spending and essentially linked physician Medicare reimbursement to an economic target. The formula turned out to be rather quirky and soon resulted in proposed reimbursement cuts of more than 5 percent per year.
Apr 8, 2014 | 0 comments | Posted by Edie Sonn
Controlling Costs, Health Reform, Health, Medicaid, ACA
At the risk of sounding like a heretic and being forced to revoke my lifetime membership in the Health Policy Wonk Association, I confess that I’m tired of reading about Obamacare.
Don’t get me wrong. I still support the law and believe it’s the right approach, while acknowledging that the political compromises built into it and its somewhat ham-handed implementation have curtailed its effectiveness. But I believe those glitches will be worked out in time. That’s the way both laws and markets work – they find their equilibrium over time.
May 8, 2014 | 0 comments | Posted by Cari Frank
All Payer Claims Database, CO APCD, Consumer Engagement, Controlling Costs, Cost Transparency, Health Reform, claims, Data, database, Health, Information, ACA
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.
May 8, 2014 | 0 comments | Posted by Edie Sonn
Controlling Costs, Health Reform, All Payer Claims Database
When people have to pay more than others for the same services, and the reasons are unclear, it’s not surprising when anger ensues. We’ve seen this play out recently with the health insurance rates in Colorado’s resort communities, and Colorado’s Division of Insurance has responded by evaluating data to search for potential solutions. It was a perfect illustration of how data from the All Payer Claims Database can inform those debates and help shape responses.
Jul 11, 2014 | 3 comments | Posted by Kristin Paulson
Health Reform, Data, Consumer Engagement
In my last post, I talked about the need for physician leadership in the massive amounts of re-engineering necessary to get to a sustainable American health care system. This time around I want to talk about what we need to do differently, because the old saying is true: if you keep doing what you’re doing, you’ll keep getting what you’re getting.
Jul 11, 2014 | 1 comments | Posted by Edie Sonn
CO APCD, Health Reform, claims, Data, database, Health, Information, All Payer Claims Database
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.
Sep 19, 2014 | 3 comments | Posted by Kristin Paulson
Coordinated Care, Health Reform, Data, Health, Information, Controlling Costs
In the last post, I talked about what physicians should stop doing if they wanted to have a leadership position in the rapidly evolving healthcare world. In the spirit of bringing solutions and not just problems, today’s list is five things that I think we as physicians collectively should start doing.
Oct 21, 2014 | 0 comments | Posted by Cari Frank
Health Reform, Price Transparency, All Payer Claims Database
Similar to the saying, “the early bird gets the worm”, initial Colorado organizations who have applied for the APCD Scholarship awards are “the early requestors getting the data!” Three organizations have applied for and received a scholarship award for APCD data. This group of innovative organizations are focused on one or more aspect of the Triple Aim. They are using the data to improve decision-making for consumers, look at the efficacy of Accountable Care Act (ACA), and to conduct condition-based research to improve care.
The term “Big Data” is a popular phrase these days across social media and blogs, especially when it comes to health care. It’s not surprising given the challenges we’re facing with health care at the national level and the fact that data is key to managing any improvement effort. While the term “Big Data” is becoming synonymous with the golden ticket, it has the potential to become dangerous when used too broadly without a common definition. When it comes to data - “big” or “small” - not all are created equal, but the power of the right data can be instrumental to identify and inform meaningful, innovative change.
Dec 22, 2015 | 1 comments | Posted by Global Administrator
Colorado All Payer Claims Database, Health Reform, Price Transparency, Triple Aim, CO APCD
Anyone who’s looked at an impressionist painting at close range knows that until you step back and look at the whole picture, it’s hard to know what you’re really looking at. The recent New York Times article, “The Experts Were Wrong About the Best Places for Better and Cheaper Health Care,” demonstrates this phenomenon perfectly.
Feb 17, 2016 | 0 comments | Posted by Global Administrator
Bundled Payments, CO APCD, Colorado All Payer Claims Database, Controlling Costs, Cost Transparency, Health Reform, Price Transparency, Triple Aim, All Payer Claims Database
For 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.
Apr 19, 2016 | 0 comments | Posted by Global Administrator
Recently, I had the opportunity to chat with a national reporter about how the Supreme Court’s Gobeille vs. Liberty Mutual decision impacts Colorado’s All Payer Claims Database (CO APCD). She was surprised to learn that our perspective is significantly different from that of other states with APCDs, who feel the decision greatly affects the value of their database. While the CO APCD would certainly benefit from adding claims from self-insured employers that fall under the Employee Retirement Income Security Act (ERISA), Colorado is already gaining valuable insights from the database and those insights will only improve as we add voluntary claims from ERISA self-insured employers.
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