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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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New Ways to Pay for Medical Care Can Lower Costs

People often wonder why health care costs so much. Surprisingly, the answer may lie not just in the price of medical care, but also in the way we pay for it.

Our current "system" rewards inefficient, high-cost medicine and penalizes efficient, low-cost health care. Because patients and insurance companies pay for each visit, procedure, prescription and lab test separately, there are built-in incentives for more care without regard to whether it is the right care or is making a difference in patients' health. As a result of the current health care payment structure, many experts believe that 20 to 30 percent of care provided does not add value – or even potentially harms the patient.

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

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

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Standing Up for Being Fiscally Responsible and Humane

In grad school, our cigar chomping chairman of the department would explode with a resounding Horse Sh#@t whenever somebody gave an answer that wasn’t well thought out, supported by facts or was just plain wrong. Get it wrong on all three counts and his cigar would fly across the room at about the same speed as his expletive. It got your attention.

As I held my breath waiting for the Supreme Court decision, and fearing the Accountable Care Act (ACA) would be overturned, I reflected on the times when I could have responded with my professor’s epithet when facts were being ignored or willfully misconstrued. It wouldn’t have changed a thing but would have felt good for the moment.

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New Health Care Payment and Delivery Approaches at Work in Colorado

Edie SonnChanging 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.

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

Editorial version published by Denver Business Journal 4.13.12

As the CEO of an organization deeply focused on efforts to make Colorado’s health care better and less expensive, I get a lot of questions about the Affordable Care Act (ACA, Federal Health Care Reform, aka Obamacare). Many assume that if the Supreme Court strikes the law down, the work of CIVHC and many other partner organizations somehow goes away and we hit a big re-set button for our work.  Nothing could be further from the truth. 

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

As a patient, would you like to know how much a medical procedure will cost you before you get it? As a buyer of insurance, would you like to know how the providers in one health plan’s network compare on cost and quality measures with those in another? As a Colorado taxpayer, would you like to know how new initiatives from Medicaid, the Child Health Plan Plus and public health departments are affecting health outcomes and costs?

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Shedding Some Much Needed Light on the Health Care Market

As an economist, I understand all too well that there can be no meaningful and well-functioning market without accessible and actionable information to inform consumer choices. Health care is no exception, yet we currently have very few places to turn for data that helps us make educated purchasing decisions that drive value into the system. Fortunately this situation is beginning to be addressed nationally through Health Care Cost Institute’s (HCCI) national claims database and CIVHC’s more robust Colorado All Payer Claims Database (APCD).

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Colorado Medicaid Bill Enables Important Value-Based Payment Reform

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.

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No Magic Bullet for Health Care Reform

Rarely does a day go by that I don’t run into another article arguing the efficacy of health care reform tactics such as medical homes, Medicare payment reform, and Electronic Health Records (EHR). A recent example is “Do Electronic Medical Records Save Money?” by the New York Times. The piece reveals the results of a 2008 federal survey showing that physicians using electronic records actually ordered more high cost tests than their peers who were still using paper medical records. This is contrary to the belief that EHR systems have the potential to save costs by reducing the number of tests being ordered.

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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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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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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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New Ways to Evaluate the Value of Care Coming Soon

In the near future, CIVHC will be able to measure the cost and the quality of care by facility based on everything associated with a particular service or procedure, also known as an “episode.” Based on claims data from the Colorado All Payer Claims Database (APCD), reports on these episodes will give payers, providers and facilities new ways to evaluate the value of the care they are providing. This type of analysis is critical to moving away from our current pay for volume model to a more patient-centric and value- based payment model where outcomes and lower costs reign supreme.

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Value is key to the health care discussion

Striving for improved value just might be the one goal that unites all parties in the health care system. But it will take a coordinated effort from key stakeholders across the system to bring about change.

Philip B. Kalin, president and CEO of the Center for Improving Value in Health Care (CIVHC), will facilitate a panel discussion, "An Imperative Taking Shape: Rewarding Value in Health Care," at the 2011 Colorado Health Symposium.

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