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

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 CIVHC is a non-profit, non-partisan, objective organization We were formed out of a recommendation from a multi-stakeholder recommendation of the 208 Blue Ribbon Commission on Health Care Our mission is to serve those across Colorado working to improve health and health care, and lower costs

Who We Serve Change Agents Individuals, communities, or organizations working to lower costs, improve care, and make Colorado healthier. Clinicians Hospitals Employers Government Consumers Researchers Non-Profits We work with change agents across the spectrum of health care value who are dedicated to improving health and making health care better for themselves or others. We work with each of these stakeholders who ultimately do the work they do to improve the lives of Coloradans. Health Plans

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

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 In 2008, the CO APCD was recommended by a multi-stakeholder commission and in 2010 legislation was passed establishing the CO APCD, and CIVHC as administrator on behalf of HCPF In 2012, the database was operational and the first public reports were issued and shortly thereafter we started providing the first custom reports to stakeholders From 2013-2016 we increased access to public data, added over 25 new commercial payers, brought on Medicare and significantly increased the stakeholders we served with custom data. In 2017 we transitioned to new data vendors, and since then we’ve been focused on increasing the quality and speed at which we are providing both public and non-public data.

What’s in the CO APCD Health Insurance Payers Claims Unique Lives 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 There are other sources of claims out there, but they are all subsets of claims data. Plans have their own claims, and there are national aggregators, but they don’t have the depth of our database. The CO APCD contains claims from all public and private payers, and is Colorado’s most comprehensive claims data set available: Contains over 800 mllion medical, dental and pharmacy claims Represents over 4 million unique lives And represents 70+% of insured Coloradans. Only missing – some of the self-insured ERISA based plans (submitted voluntarily); federal programs like Tricare/VA, and any uninsured/self-pay patients. Our APCD is top in nation for the breadth and depth of our data AND our public/custom reporting.

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

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 need information so they know how much they are going to have to pay for treatment.

Health Care Costs in Colorado Continue to Rise

CO Costs Higher Than Other States

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

Prices are Going Up Most Significant Increases in Inpatient and Outpatient Services Category 2015 2016 Percentage Point Change Total Cost Overall 17% 19% +2% Inpatient 16% 21% +5% Outpatient 30% 34% +4% Professional 5% 2% -3% Pharmacy 24% 28% Resource Use (Utilization) 11% -6% 0% -8% 25% 3% -4% -7% 23% 22% -1% Price 6% 13% +7% 31% +15% 4% 15% +11% 7%

Significant Regional Variation in CO

Transparency to Inspire Meaningful Change

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

Data to Inform Practice Innovation Evaluation and Benchmarking

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

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

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. An example of an organization using a CIVHC data set, updated annually, is Children’s Hospital Colorado Their project is using CO APCD data to identify children with medical complexity and enhance care coordination

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. An example of an organization that has used a custom report is the American Physical Therapy Association (APTA) APTA used CO APCD data to understand the percentage that physical rehab services make up of total health care expenditures in CO, driving legislation to minimize out of pocket costs for these services.

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.

Use this tool to shop for prices and quality by named providers 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. The interactive Shop for Care Tool is available on our website for patients to find the lowest price, highest patient experience provider of imaging services. Prices across named Colorado facilities are available for nearly 40 procedures including high cost procedures such as births and hip and knee replacements. Prices for a large array of imaging procedures is also available, from MRIs to common X-Rays. Using this tool, patients and their health insurance company can save up to $35,000. Use this tool to shop for prices and quality by named providers

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

Future Support for Statewide Initiatives

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

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