Insights for Employers from the CO APCD Ana English, CEO & President 1
Who We Are • Non-profit, non-partisan organization • Founded out of recommendation from Blue Ribbon Commission on Healthcare Reform and Governor’s office • Triple Aim Mission:
CO APCD Data for Employers • Identify lower cost, higher quality options for the most common health care services • Benchmark their costs to other commercial plans to inform cost-savings opportunities and new benefit designs • Predict cost and quality through business intelligence data to reduce complications and lower costs • Inform new payment models that incentivize high quality, low cost care
Average Allowed Amounts for High Volume Services, 2014 CO APCD Data $25,000 $23,650 $19,910 $20,000 $14,440 $15,000 $12,730 $9,960 $10,000 $8,050 $6,700 $5,860 $4,720 $5,000 $0 Vaginal Delivery Cesarean Delivery Knee Joint Replacement Employer HSR Employer Denver Metro HSR
Health Plan Drug Payment Variation Payer 1 Payer 2 Payer 3 Payer 4 Payer 5 Payer 6 Payer 7 Payer 8 Payer 9 Payer Comparison Feature in High Cost Drug Analysis Benchmarks payers to one another to show variation in allowed amounts per day for high cost drugs, along with plan paid and member liability percentages
Prometheus Episode Methodology This methodology points out Potentially Avoidable Costs (PACs) Highlights opportunities to reduce complications and lower costs
CMS CJR Knee/Hip Replacement Bundled Payment Program
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