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APCD Harnesses the Power of the Internet

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.

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My Prescription is How Much?

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.

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CO APCD Data in Action

Over the last two years, the Colorado APCD team has worked very hard with stakeholders across the state of Colorado, as well as across the country, to make the state’s most comprehensive health care claims database accessible and valuable for the benefit of Coloradans. According to the legislation establishing the database, the purpose of the CO APCD is to “facilitate the reporting of health care and health quality data that results in transparent and public reporting of safety, quality, cost and efficiency information at all levels of health care.” We’ve come a long way towards realizing that public purpose from 2012 to now and I’d like to highlight some of the exciting ways organizations are using the custom data for health care improvement.

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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.

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Informing Opportunities for Colorado

After joining CIVHC last year, I made a point of pouring through all of our past grants and reports to gain as much historical knowledge as possible. I wanted to understand our roots, our challenges, our successes and the progress we’ve made in the few short years since our inception as an organization. The Colorado All Payer Claims Database (CO APCD) annual legislative report was one in particular that I found intriguing given the astounding progress made between the time the APCD was signed into law in 2010 through last year’s 2013 recap. The 2014 annual legislative report just released is yet another reminder of how far we’ve come in such a short amount of time. While it’s important to celebrate the accomplishments made over the past year, we continue to set our sights on where we need to take this important statewide resource to ensure it is providing the highest value possible to Colorado.

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Data Wonks Unite to Discuss Transparency

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:

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SGR Repeal and the End of Fee for Service Payments: A New Era for Forward Thinking Physician Groups

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.

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Comparative Performance Data for Physicians: An Important First Step for the Colorado APCD

As an economist, I know that credible information based on analysis of reliable data is worth its weight in gold. But, I also know that it is important not just to provide information, but to impart meaning and motivate action based on the results. To really make a difference, you have to engage all stakeholders in the health care community, get them to ‘take notice’ of the information and weave a story around the data to spark change.

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Raising Awareness and Asking Questions About Health Care Costs

Pop quiz: When it comes to health care, what's the difference between cost, charge, and payment?

This question opened a recent article I read regarding medical schools teaching new doctors to talk to patients about price. Knowing the nuances between the definitions of cost, charge and payment isn’t something most consumers understand, nor do they really have to. I believe simply raising awareness that there can be a big difference in what you (or your insurance company on your behalf) might pay for health care depending on where you go and treatment options you choose is just as important. Training doctors to understand the potential financial impact of their recommendations and having those conversations with their patients is an important step in the right direction in raising awareness of price transparency.

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A Recipe for Success

Thanksgiving is rapidly approaching which brings to mind all the things I’m grateful for - including some amazing family recipes. Each ingredient on its own is unique and important, but when you put them together it can be downright magical. We talk a lot about the power of organizational collaboration in Colorado in the same vein, but the same can be true when combining data sources.
 

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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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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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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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CIVHC Status - Data and Analytics Top 5s

We took a moment to chat with Dave, our VP of Analytics and Data Ops, to learn about his team, the coolest projects happening at CIVHC, and the new vendors

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Change Agent Profile - Southeast Health Group

Change Agent Profile Series (formerly CIVHC's Spotlight on Innovation) - Southeast Health Group's Tipping Point Integrated Care Pilot

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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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CIVHC Status - Strategy & Business Development Top 5s

We took a moment to catch up with Tracey Campbell, our VP of Strategy & Business Development. These are the top 5s on things to know about her team, featured Change Agents and their projects, and how CO APCD data is being used.

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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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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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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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Staying Hopeful About Health Reform

 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.

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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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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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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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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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Change in Seasons Offers Fresh Perspectives

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.

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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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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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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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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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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 www.cohealthdata.org

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 www.cohealthdata.org.
 

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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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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 www.cohealthdata.org doesn’t reflect all of the claims received or all health care services provided in Colorado.

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CIVHC Awarded National Center for Healthcare Transparency Planning Grant

CIVHC was recently awarded a Regional Data Center Collaborative planning grant from the Center for Healthcare Transparency (CHT). The CHT is a national initiative led by the Network for Regional Healthcare Improvement (NRHI) and Pacific Business Group on Health (PBGH) that seeks to coordinate and leverage the innovative work being done by 14 state and regional health care improvement organizations.

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Scholarship Funding Enabling Triple Aim Projects in Colorado

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.

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Big Data: Key Ingredients for Informing Innovation

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.

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Seeing the Whole Picture

Ana-English.gifAnyone 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.

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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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Plaintalk Blog Series

Plaintalk-Blog-Icon.jpgIntroduction to the series, and administrating the Colorado All Payer Claims Database (CO APCD).

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