Using Data to Drive Value: Advancing the Triple Aim through Payer & Practice Collaboration

1. Using Data to Drive Value: Supporting Payer & Practice Collaboration to Advance the Triple Aim Pete Sheehan • VP of Business Development

2. Our Mission We strive to empower individuals, communities, and organizations through collaborative support services and health care information to advance the Triple Aim: Better Health, Better Care, Lower Cost We are: • Non-profit • Independent • Objective

3. Who We Serve Change Agents Individuals, communities, or organizations working to lower costs, improve care, and make Colorado healthier. Non-Profits Employers Consumers Hospitals Clinicians Government Health Plans Researchers

4. Focus Areas Public CO APCD Data Identify opportunities for improvement in your community through interactive reports and publications Data Literacy Attend data academies to learn how to use available data resources across the state and country Custom CO APCD Data License data from the most comprehensive claims database in CO to address your specific project needs Turning Data into Actionable Information

5. History of the CO APCD 2012 CO APCD operational; website goes live; begin providing custom data requests 2017-Present Transition to new data vendor; enhanced capabilities; launched new website and additional public data 2008 CO APCD recommended by Blue Ribbon Commission for Health Care Reform 2013-2016 Enhancements to public data/infrastructure; added more payers/Medicare; increased custom data fulfillments 2010 CO APCD Legislation (HB 10-1330); CIVHC named administrator by HCPF

6. What’s in the CO APCD Health Insurance Payers We receive claims from Medicaid, Medicare, Medicare Advantage, and over 37 commercial payers Claims The Colorado APCD has over 800+ million claims (Medical, Pharmacy, and Dental) Unique Lives The Colorado APCD represents over 4 million unique lives, and over 70% of insured Coloradans

7. Claims Data Availability Medicare Part D Data is refreshed once every two months

8. Barriers to High Value Care Cost Transparency Providers and Clinicians need information to help them contain costs, negotiate with insurers, and cope with ever-changing requirements from regulatory agencies. Price Transparency Patients needinformation so they know how much they are going to have to pay for treatment.

9. Health Care Costs in Colorado Continue to Rise

10. CO Costs Higher Than Other States

11. CO Cost Drivers • Total Cost Driven By: • 5% higher Utilization • 13% higher Prices • Only state with higher than average total cost and prices across all service categories

12. Prices are Going Up • Most Significant Increases in Inpatient and Outpatient Services

13. Significant Regional Variation in CO

14. Transparency to Inspire Meaningful Change

15. Data to Inform Practice Innovation Data can enable Providers and Clinicians to see utilization and spending patternsoutside their offices compared to their peers, giving them insights regarding the most high-value referral options.

16. Data to Inform Practice Innovation Evaluation and Benchmarking

17. Getting to Value – Quality Measures • CO APCD can provide hundreds of NQF-endorsed quality measures • Examples of currently available measures: • Prevention • Breast Cancer Screening • Well Child Visits • Treatment • A1c testing patients with Diabetes • Medication management for Asthma • Safety • Use of Imaging Studies for Low Back Pain • All-cause Unplanned Readmissions • Potentially Avoidable Complications

18. Data to Benchmark Provider Prices (CPT4 Report) • Understand your negotiated rates compared to your market (zip code and county-level) for commercial payers, and as a percent of Medicare

19. Data to Inform Practice Innovation Use Case – Children’s Hospital Colorado • Project: Children’s Hospital uses CO APCD data to identify children with medical complexity throughout the state and the providers serving them. • Outcome: Children’s Hospital has been able to identify care coordination partners and develop processes for children who had needs that are not being met by existing health care modes and identify cost savings opportunities.

20. Data to Inform Practice Innovation Use Case – Melissa Memorial Hospital • Project: Melissa Memorial used CO APCD data to understand where patients were going for care and what services they were seeking. • Outcome: Based on their findings, Melissa Memorial implemented an orthopedic program that tripled the total surgical volume and added an optometry clinic with optical retail store providing access to 1500 visits in 2017. Patients don’t have to travel which saves them money and time.

21. Public Data to Inform Consumers The Shop for Care tool helps consumers locate facilities with the lowest price and best patient experience, and supports reducing health care spending.

22. Prices Vary Widely Comparing prices across Colorado providers for expensive procedures such as births, hip & knee replacements, and MRIs can help Coloradans realize significant cost savings. Use this tool to shop for prices and quality by named providers

23. Consumers Can Save Thousands “Good news. The hospital settled at the reasonable level of $2,226. Using data from CO APCD, I was able to make a case for a $14,000 reduction in the $16,385 bill. - Colorado Patient

24. Future Support for Statewide Initiatives

25. Polis-Primavera Administration Goal: Lower healthcare costs to save people money

26. Questions? • Pete Sheehan • VP of Business Development • psheehan@civhc.org Join our email list at www.civhc.org for updates on new data and events