Center for Improving Value in Health Care
Dec 13, 2010 | 0 comments | Posted by
Payment Reform, Controlling Costs
While Colorado spends $30 billion in health care every year, costs continue to increase while value decreases. Yet, Colorado is better poised than many states to take on the challenge of improving health outcomes and stabilizing and/or decreasing costs due to its examples of structured, coordinated health care delivery systems...
Feb 1, 2011 | 0 comments | Posted by
Payment Reform, Delivery System Redesign
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.
Jan 14, 2013 | 0 comments | Posted by
Controlling Costs, Integrated Care, Payment Reform, Rewarding Value, Triple Aim, Accountable Care Organizations
Saturday’s New York Times carried a front-page story about negotiations between administrators and the physicians’ union at the New York Health and Hospital Authority over a new pay-for-performance arrangement. Physicians’ raises will be tied to their performance on indicators such as patients’ assessments of physicians’ communication with them, how quickly ED patients are transferred to beds and how quickly patients are discharged, as well as quality metrics such as 30-day readmission rates for certain diagnoses.
Feb 5, 2013 | 0 comments | Posted by
All Payer Claims Database, CIVHC Partners, Collective Impact, Controlling Costs, Delivery System Redesign, Integrated Care, Payment Reform, Rewarding Value, Triple Aim, Accountable Care Organizations
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.
Feb 5, 2013 | 0 comments | Posted by Kristin Paulson
Delivery System Redesign, Integrated Care, Payment Reform, Triple Aim, Coordinated Care
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.
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.
Mar 15, 2012 | 1 comments | Posted by
Delivery System Redesign, Payment Reform, Rewarding Value, Controlling 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.
Apr 16, 2015 | 0 comments | Posted by Global Administrator
Payment Reform, Price Transparency, Bundled Payments
The perennial “Doc Fix” debate is nearing an end. On April 14th, the Senate voted overwhelmingly (92-8) to repeal the sustainable growth rate (SGR) and implement a new payment model for physicians participating in Medicare. The House approved the bill last month with an unusually high degree of bipartisanship. President Obama has said he would sign the legislation.
Jun 21, 2016 | 0 comments | Posted by Global Administrator
Bundled Payments, Colorado All Payer Claims Database, Cost Transparency, Payment Reform, Triple Aim, All Payer Claims Database
On 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).
Feb 22, 2017 | 6 comments | Posted by Global Administrator
Controlling Costs, Payment Reform, ACA
Why you can’t fool all of the people all of the time.
I think for most people, including me at times, the effort to repeal and replace the Affordable Care Act is an exercise in taking something they didn’t understand well but have feelings about, and replacing it with something else they don’t understand well and will have feelings about. I could comment on the state of our legislative process surrounding this case, but that’s for another day and another blog.
Instead, if you can stand it, I’m going to use this column to try to explain the difficulty in reshaping the insurance pools in the ACA.
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.
Jan 8, 2013 | 0 comments | Posted by
Payment Reform, Rewarding Value, Triple Aim, payer
January is a time for stock-taking, for rear view mirror- and crystal ball-gazing. Often, that turns into a kind of “Look, Ma, no hands!” punditry that’s fun to write but doesn’t really advance the conversation.
So, having now set myself up for anyone to shoot down (my New Year’s gift to readers), I’d like to opine on something CIVHC learned over this last year and consider its implications for our work—and that of our partners—in the coming months.
In mid-2012, CIVHC surveyed the largest commercial insurers in Colorado to assess what proportion of expenditures in the commercial market are fee-for-service (FFS), and what proportion are not tied to volume (e.g., care coordination payments, bundled, global)...
Jan 9, 2013 | 0 comments | Posted by
All Payer Claims Database, CIVHC Partners, Collective Impact, Delivery System Redesign, Palliative Care, Payment Reform, Triple Aim, Decision, Exchange, Accountable Care Organizations
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...
Jul 9, 2012 | 1 comments | Posted by
Colorado Health Foundation, Coordinated Care, Delivery System Redesign, Payment Reform, Rewarding Value, The Colorado Trust, CIVHC Partners
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.
Delivery System Redesign, Payment Reform, Rewarding Value, Court, Decision, Supreme, Controlling Costs
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.
Jul 24, 2012 | 0 comments | Posted by
Rewarding Value, Payment Reform
Changing how we pay for health care – the process of moving from the current fee-for-service, pay-for-volume method to paying instead for quality and value – takes time and effort. It won’t be an easy proposition to shift to models that support care coordination, that bundle payments for chronic diseases or that reward providers for meeting cost and quality measures.
Oct 3, 2012 | 0 comments | Posted by
Coordinated Care, Delivery System Redesign, Payment Reform, Rewarding Value, Triple Aim, Controlling Costs
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.
Nov 6, 2012 | 0 comments | Posted by
With the President’s re-election, the concepts embodied in the Affordable Care Act will pick up steam. One of those is the Accountable Care Organization (ACO) model. ACOs are voluntary organizations that focus on coordination for patients across care settings, including doctors’ offices, hospitals, and long-term care; the coordination is made “accountable” through payment models that reward quality and share (potentially) both up-side and down-side risk. While the ACA enabled ACOs specifically for Medicare, this vision of coordinated, accountable care is being used for all populations and a variety of payers. So this seems like an opportune time to share some information and observations about ACOs—both nationally and within our state.
Dec 5, 2012 | 3 comments | Posted by
Controlling Costs, Coordinated Care, Integrated Care, Payment Reform, Triple Aim, Decision, Supreme, Collective Impact
Recently I spoke about Obamacare to two different community groups. My expectations of each group were different given their locale – one was in well-to-do neighborhood that trends quite red at the voting booth (I was braced for anything up to and including a death panel discussion) and the other was in central Denver which I guessed would be more progressive in tenor. It turns out that the conversations were nearly identical and characterized by a striking polarity in which nearly everyone simultaneously viewed Obamacare with hope and fear.
Mar 30, 2017 | 0 comments | Posted by Global Administrator
Bundled Payments, Care Transitions, Change Agents, CO APCD, Colorado All Payer Claims Database, Cost Transparency, Delivery System Redesign, Health Reform, Palliative Care, Payment Reform, Price Transparency, Triple Aim, All Payer Claims Database
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.
Apr 7, 2017 | 0 comments | Posted by Global Administrator
Bundled Payments, CO APCD, Colorado All Payer Claims Database, Controlling Costs, Payment Reform, Plaintalk Blog, Triple Aim, Analytics, fee-for-service, All Payer Claims Database
What are bundled payments, and how do they help providers reduce waste and deliver better care? Take a look at our interpretation.
Apr 16, 2012 | 1 comments | Posted by
Controlling Costs, Delivery System Redesign, Payment Reform, Rewarding Value, CIVHC Partners
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.
Mar 5, 2012 | 0 comments | Posted by
Delivery System Redesign, Payment Reform, Rewarding Value, Claims, Payer, All Payer Claims Database
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?
May 23, 2012 | 1 comments | Posted by
Payment Reform, Rewarding Value, Medicaid, Coordinated Care
This week, Governor Hickenlooper will sign HB 1281, setting up 2-year payment reform pilots within Colorado’s Medicaid program. Brief pilot programs might seem like baby steps – but for a program as large and challenging as Medicaid, they are essential “proofs of concept.” And these pilots will likely have a big impact on how Medicaid takes shape in the coming years. This legislation is important both for the path it lays out for Medicaid’s future, and for the broad bipartisan and multi-stakeholder consensus it reflects.
Jun 6, 2012 | 0 comments | Posted by
Controlling Costs, Coordinated Care, Delivery System Redesign, Payment Reform, Rewarding Value, EHR, All Payer Claims Database
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.
Apr 27, 2012 | 1 comments | Posted by
Colorado Health Foundation, Delivery System Redesign, Payment Reform, The Colorado Trust, Claims, All Payer Claims Database
By 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.
Mar 6, 2013 | 1 comments | Posted by
CIVHC Partners, Delivery System Redesign, Payment Reform, Triple Aim, All Payer Claims Database
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.
May 8, 2013 | 0 comments | Posted by Ana English
Controlling Costs, Cost Transparency, Delivery System Redesign, Payment Reform, Rewarding Value, Triple Aim, Bundled Payments
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.
May 29, 2013 | 0 comments | Posted by
Cost Transparency, Integrated Care, Payment Reform, Medicaid, Coordinated Care
Originally posted on CCMU.org
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.
Jul 11, 2013 | 0 comments | Posted by Ana English
Cost Transparency, Integrated Care, Payment Reform, Triple Aim, Coordinated Care
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.
Jan 23, 2012 | 0 comments | Posted by
Delivery System Redesign, Payment Reform, Controlling 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.
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.
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
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.
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.
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