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When Doctors Get a Union Card

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.

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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.

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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. 

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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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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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Moving Forward

Similar to the ever-changing health care landscape in Colorado, CIVHC has evolved over the years to address the key health care needs of our state. CIVHC was originally created in 2008 by Executive Order of the Governor in recognition of the need to have a systemic, statewide approach to advancing the Triple Aim of better health, better care and lower costs.

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Making the Right Care Available When it Matters Most

Several years ago, a friend of mine was diagnosed with an aggressive cancer at a very young age. Treatment options were uncertain and sometimes experimental. He and his family were lucky and were enrolled in a high-quality palliative care program that addressed not just his pain and symptoms, but also helped his family make choices about care in the future, supported his wife in her new role as a caregiver, connected them to resources at the hospital and beyond that could work with them as the disease progressed, and most importantly for him, helped his young daughter come to terms with what his illness could mean for her.

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Moving Forward, Part II

In my last blog I talked about the importance of CIVHC’s five pillars to support our strategies and advance our mission to cultivate initiatives that improve health, health care, and lower costs in Colorado. This month I’ll share with you what we’re calling CIVHC 2.0 – taking our work and support to the next level to advance health care in Colorado.

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How Did I End Up Here? The Tale of Green Chile Gone Wrong

Guest Blog by Matt Guy, Managing Director, Pueblo Trip Aim Corporation

I’m sure I’m not the only person to wind up in the emergency room asking this question.  I definitely know I’m not the only person to start out with a minor health issue that turned into a major problem. How my health status moved from a minor to a major problem is a story of how the Triple Aim wasn’t well implemented in my life.

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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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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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Colorado’s Journey Towards Payment Reform

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)...

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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...

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Colorado's HIEs and APCD: Two Important Data Sources for Triple Aim Advancement

Tracey CampbellColorado’s bipartisan Blue Ribbon Commission for Healthcare Reform and other national health care leaders recognize the power of data to support improving health care. The Colorado All Payer Claims Database (APCD) and statewide Health Information Exchanges (HIE) were both identified by the Commission in 2008 as critical sources of data to enhance efforts towards the Triple Aim of better health, better care and lower costs. Colorado’s APCD and HIEs both serve a distinct and essential purpose for health care transformation as outlined in a new issue brief CIVHC developed in partnership with Quality Health Network (QHN) and the Colorado Regional Health Information Organization (CORHIO).

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The Power of Collective Impact

Each year after the Colorado Health Symposium I come away proud of the progress we’ve made in health care in our state and re-energized by the commitment and collaboration of so many Coloradans to achieve true systemic change. Through the efforts of many, a plan of action is coming into focus on ways to solve Colorado’s health care problems. Rising costs, mediocre patient experience, a population getting less healthy, and a near total lack of transparent data that can make a broken system work better plagues our state and country. Many organizations in Colorado are pursuing strategies and engaging in interventions to address specific aspects of the solution. However, if Colorado is going to thrive we need to work faster, smarter and in a more systemic way.

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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.

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A Solid Foundation Helps Meet a Health Data Challenge

Developing an information resource as complex as the Colorado All Payer Claims Database is a difficult and challenging undertaking. Although sophisticated technology is available, creating a functional database from complex claims information submitted by multiple payers and spanning several years is no easy task. The reality is that even the large and well established health payers face challenges in synthesizing and making sense of their own claims data.

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Three Tsunamis are Driving Disruptive Innovation

There is broad consensus from stakeholders that our current dysfunctional system needs to change dramatically to reach the Triple Aim objectives of better health, better care and lower costs. Making the transformation happen is the difficult part. At CIVHC, we find it useful to remind stakeholders across Colorado that efforts need to be informed by three “tsunamis of change” which we believe will alter the landscape of health care over the next decade. 

  1. Financial Instability. We are on a fiscal cliff. As a country, we are out of money and the majority of our public health care costs are being financed through debt. It’s unsustainable and we are kidding ourselves to think that we will continue to push off the hard choices in health care or other areas paid for by government.
     

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Data and Quality Measures Essential for Better Health Care

by Ned Calonge, MD, originally published in Health Policy Solutions November 2, 2012

This week we saw the first presentation of the Colorado All Payer Claims Database, a project of the Center for Improving Value in Health Care (CIVHC) that is jointly funded by the Colorado Health Foundation and The Colorado Trust.

We at The Trust believe that the claims and costs data collected through the APCD, as well as specific measures of quality, will provide an essential missing part of the spectrum of data needed to inform health care decisions by business leaders, policymakers, providers, payers and, of course, health care consumers.

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All Payer Claims Database Debut Supports Colorado’s Health Care Journey

Last Thursday, November 1, marked a big milestone for health care in our state with the launch of Colorado’s All Payer Claims Database. As the appointed administrator of the APCD, CIVHC is honored to serve as the steward for this unique Colorado resource. We were thrilled by the crowd of more than 200 health care leaders and stakeholders that gathered at The Colorado Trust. Enthusiasm in the room was palpable as participants saw the APCD in action for the first time. Multiple policy wonks admitted that their post-event work plans were “shot” because they planned on spending the afternoon pouring through the APCD site to see what information they could glean. This initial version of the APCD is designed to stimulate important policy discussions towards the goal of better health, better care and lower costs.

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Full Speed Ahead for Accountable Care

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.

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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.

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New Database will Provide Valuable Health Care Cost Info

Originally published in the Denver Business Journal, Nov. 9, 2012

by William N. Lindsay III, President of the Benefits Group-Denver for Lockton Companies

While the rate of increase in health insurance costs for Colorado employers has slowed, it continues to outpace inflation. If we want to slow this rate of growth still further, we need to understand what’s driving it. Finally, Colorado is getting a tool that will help us do just that.

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Obamacare: Hope, Fear and Misinformation

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.

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Clinical Integration Versus Market Consolidation: An Important Distinction

What do we mean when we use the term “integrated care”?

This question struck me as I read about a health plan’s recent purchase of a network of providers in another state. The plan CEO and the reporter both used the phrase “integration” to describe the company’s strategy. But the vision of integration that emerged was less about clinical care and more about business share—a vision that differs markedly from that of CIVHC and many other stakeholders. And it’s important to understand that distinction.

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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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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.

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Getting Patients to Choose a Honda Over a BMW

An email with the subject line “Patients Prefer High Cost Care” came through my inbox a few weeks ago. It was spurred by a recent study in Health Affairs revealing that patients would typically select a higher cost service like an MRI over a lower cost CT scan even after being educated on the marginal difference between the results.

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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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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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One Year Milestone Celebrations

These past couple months have been full of milestones both personally and for CIVHC. As I get older I’m more cognizant of both the passing of time and what I make of it. I’m trying to be more attentive to key milestones and take every opportunity to celebrate them . As I prepared to write about a couple of key one year milestones for CIVHC, I couldn’t help but think about the one year milestone (6/22) of having become a first-time grandfather to Theo.  I am incorrigible about showing pictures of him and am certain that all of our health care readers will be equally as interested in seeing documentation of how far Theo has come as he hits his first year milestone.

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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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2013 Colorado Health Symposium Reflections

Every year the Colorado Health Foundation brings together over 300 people from throughout Colorado and the U.S. to explore a wide array of health-related issues and drivers of change in the health and health care eco-system. This year’s Colorado Health Symposium topic was "Health Forward: Harnessing the Energy of Change". Throughout the three days, participants were encouraged by national experts to contemplate the forces of change — policy, consumer demand, marketplace and others — in an effort to identify innovations at play that will impact our mutual efforts to achieve the Triple Aim….better health, better care and lower costs.

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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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A Letter From CIVHC's New CEO: Ana English

I am excited to be a part of CIVHC and working again in Colorado! My first official day was August 4, 2014, and within a few days I was in awe of the number of health care improvement activities occurring in Colorado and all there is to learn. To get up to speed as quickly as possible, my calendar is already full of meetings with staff, key stakeholders and business leaders that play an essential role in the success of CIVHC. Of critical importance is hearing directly from you and understanding the important role you play in Colorado’s health care landscape and what support CIVHC might be able to provide you along your journey.

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Have You SIM’d Yet?

For the first time since the Blue Ribbon Commission for Health Care Reform (the 208 Commission) developed its recommendations for comprehensive health reform in 2007-08, Colorado is thinking big about how to transform our health care delivery and payment system. And now is the time for key informants like the readers of this column to weigh in.

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Continued Commitment to Colorado Triple Aim

It’s hard to believe that this will be my final blog post as President and CEO of CIVHC. By the time our next newsletter rolls around, I will be in the same role but with Pinnacol Assurance, Colorado’s leader in worker’s compensation insurance. The work I’ve been engaged with at CIVHC, together with our many partners, has been some of the most challenging and gratifying of my career. I’m proud to have played a small part in joining with so many caring individuals and organizations who are united in helping Colorado achieve the Triple Aim of better care, better health and lower costs. 
 

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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.
 

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CO APCD Top Ten List 2013

As I look back on my first year with CIVHC as the Director of the Colorado All Payer Claims Database (APCD), and the first full year with an operational APCD, I think it is important to reflect on how this state resource has grown and how it’s being used across Colorado. I’m going to borrow from David Letterman’s “Top Ten List” approach to benchmark the progress of Colorado’s APCD and leave you with the APCD goals for 2014.

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Data. The Foundation of Improvement

During my first 30+ days it has been exciting to hear positive feedback from our various stakeholders regarding CIVHC, its staff and management team, and our future potential. Most see the value of the Colorado All Payer Claims Database (CO APCD) and the strong potential of claims data in informing and driving health care reform. In fact, at the national level we recently received a letter of commendation from Dr. Len Nichols, Director of the Center for Health Care Policy Research and Ethics at George Mason University, highlighting the value of the recent launch of consumer-focused price information and how the CO APCD differentiates health care price transparency in a way unlike any other APCD in the country. We consider ourselves stewards of this important resource for the state and it is our commitment to continue to make this valuable data and information more readily available and actionable.

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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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