Remember that scene in Ferris Bueller’s Day Off when they visit The Art Institute of Chicago and the troubled Cameron gets lost in the impressionist painting by George Seurat? If you’ve never seen the movie (heaven forbid) or if you’d just like an excuse to reflect back to the 80s, you can find the scene on YouTube (shocker…what isn’t on YouTube these days??). The closer Cameron focuses in on the painting, the less it tells a story and becomes just daubs of paint, far removed from the carefree waterside picnic imagery the painting reveals at a distant vantage point.
Health care data is much like the daubs of paint in a painting. Each data element and source in and of itself isn’t that revealing, yet when combined and reflected on as a whole, it can be very insightful. For so many years, Colorado and the U.S. only had one paint color here or there to study individually (usually one payer type or demographic at a time), which, as it turns out, wasn’t allowing us to see how all of the colors interact and tell a story.
To illustrate this point, let’s evaluate “paintings” or studies comprised of just Medicare data. Across the nation, Medicare data has historically been the most readily available and researched. You can find lots of reports saying how certain areas of the nation are doing better or worse from a cost of care and quality standpoint. This is important information if we want to understand how we can change the Medicare system and the quality of care provided directly to the Medicare population.
But what do Medicare studies say about the rest of the health care system? Turns out, it represents only one color in the complex spectrum of our health care system. For example, the Western Slope of Colorado has long been praised for being a low cost of care and high quality region for Medicare members compared to the rest of the nation. However, with data now available for their non-Medicare residents, we now know they are paying some of the highest commercial health insurance premium rates in the state and nation, and commercial costs for certain services in the area are right in line or higher in some cases than other areas. Specific to knee and hip procedures, the Western Slope has prices 129% above Medicare rates, not as high as Northeastern Colorado with rates 272% above Medicare, but not as low as the Denver region which has the lowest rates at 77% Medicare.
Payment variation studies like the one referenced above use the Colorado All Payer Claims Database (CO APCD) and allow us to look across nearly the entire health care spectrum in the state. We say “nearly” because the CO APCD, as comprehensive as it is, representing over 75% of insured Coloradans, will never include every person in the state. Due to federal regulations, the CO APCD will likely never contain all of the claims for self-insured employers who are governed by ERISA federal laws, or federal insurance programs like the Veterans Affairs and Tricare plans. It also does not include instances when patients pay out of pocket or when charity care is provided.
In spite of the minor limitations, however, having 75% of the claims for Colorado across Medicare, Medicaid and commercial payers paints a pretty complete picture of health care in the state. What the CO APCD can’t provide alone can be filled in with additional paint daubs (data sources) like the Colorado Health Access Survey and other state databases to provide a more complete tapestry for communities and others trying to pinpoint areas to target interventions and innovation.
Understanding cost drivers and how the system is pushing and pulling as we make changes requires the ability to include as many colors of the palette as possible, stepping back and taking in the picture as a whole. As the author of an article in The Atlantic on the Western Slope phenomenon warned, “Innovation that lowers health care costs for one type of patient can sometimes push costs up for another.” Without that ability to step back and evaluate, we could end up with a painting that doesn’t quite tell the story we’re looking for – better health, better care and lower cost.