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?

That’s the landscape of health care accountability, right?
 

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. 

Having crossed into 2013, the trigger date of 2014 for implementing the biggest elements of the health care law seems imminent...

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)...

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.

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.

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.

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.
    

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.
 

Considering the fact that CIVHC ‘s expansive charge is to improve the quality of care and bend the cost curve for health care across the state of Colorado, many people wonder why CIVHC has committed to an effort so specific as improving access to high quality palliative care, especially at such an early stage in our organization’s development. Perhaps an organization such as CIVHC should be more focused on “big picture” issues in Colorado, by identifying where we have the greatest opportunities to impact the quality and cost of care for the largest segments of our population. In 2008, the members of CIVHC’s planning committee took on that exercise, and identified palliative care as one of those opportunities.

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).

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.

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. 

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.

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.