USE CASE: Studying Potential Impact of Alternative Payment Models

A non-profit advocacy organization.


Project Summary: The state of Colorado has been at the forefront of health care reform with multiple governmental and private initiatives testing new models of care delivery and reimbursement. Transitioning to new delivery system and payment models is a significant challenge for hospitals. In order to assist hospitals in this endeavor, this non-profit wished to conduct a bundled payment analysis that demonstrates the opportunities that hospitals may have to reduce variation in patient care, outcomes and cost. This analysis will be for demonstration purposes and for member education. CHIDA bundled payment analysis will not use any particular member’s data in a way that is identifiable to other members or any outside agency or organization.

Benefit to Colorado: The reports generated by this analysis were shared with hospitals, allowing them to see statewide, average, cumulative costs for medical and surgical episodes over a 90-day period, including the anchor admission.  Plus, they were also able to summarize overall patterns of utilization across hospital categories. The reports benefited Colorado by providing an opportunity for members to gain a general understanding about bundled payment models and compare themselves to a peer group (such as other rural hospitals) and the state average for the chosen medical episode group.