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HCPF Delivery System, Payment Reform, and Cost Analysis
Alignment of public and private payers of Health Care is needed to achieve efficiencies in health care administration and lower costs.
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John Bartholomew, CFO
HCPF Delivery System, Payment Reform, and Cost Analysis Alignment - - PowerPoint PPT Presentation
HCPF Delivery System, Payment Reform, and Cost Analysis Alignment - - PowerPoint PPT Presentation
HCPF Delivery System, Payment Reform, and Cost Analysis Alignment of public and private payers of Health Care is needed to achieve efficiencies in health care administration and lower costs. John Bartholomew, CFO 1 Colorado Delivery System
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Colorado Delivery System and Payment Reform:
- Current/Future Transformation Initiatives follow
core precepts
- Provider Accountability: e.g. especially to those with
cost-based rates; reasonable overhead costs.
- State Accountability: e.g. to not have overly
burdensome regulations; transparency of cost based rates
- Attaching Service Reimbursement to Performance
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Who Gets Payments for Services
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FY15-16 data
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Provi vider er Accountab ability
- Look at:
- Providers with cost-based rates or those
with rates based on cost
- Federally Qualified Health Clinics
- Hospitals
- Nursing Facilities
- What you’re paying for matters!
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FQHC R Report
- rt Car
Card
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Ho Hospital al A Anal alysis
- Payment to Cost Ratio
- Hospital Cost/Overhead Variance
- Hospital Utilization
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What's happening in Colorado's market?
Payment to Cost Ratio
Payer Type 2009 2015 Overall 1.05 1.08 Medicare 0.78 0.72 Medicaid 0.54 0.75 Insurance 1.55 1.58 CICP/Self Pay/ Other 0.52 1.11
CICP is the Colorado Indigent Care Program Data is from the Colorado Hospital Association
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Hospital Overhead Costs: A Primer
Note: In their Medicare Cost Reports, hospitals detail their expenses using designated cost centers. We devised a process to aggregate and adj ust certain cost centers to be included as “ Overhead.” Not all cost centers are included (e.g., costs not allowed by Medicare are removed), and for hospitals that are part of systems, we allocated some system-level costs to hospital overhead.
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The Four States in the Study
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Four States: Four Rates of Hospital Overhead Costs
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Rat es Vary Widely Across Regions
Hospital Overhead Costs by Insurance Rating Region
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Rat es Vary Widely Across Regions – and Within Regions
Hospital Overhead Costs by Insurance Rating Region
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Rat es Vary Widely Across S yst ems
Hospital Overhead Costs by Hospitals and Systems
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Rat es Vary Widely Across S yst ems – and Within Systems
Hospital Overhead Costs by Hospitals and Systems
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Rat es Vary Widely Wit hin Rural and Urban Regions and Wit hin S ize Cat egories
Urban and Rural Hospital Overhead Costs
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Rat es Vary Widely Across Regions and Wit hin Cat egories
Administrative and Capital Costs: A Breakdown
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Hospital Utilization
- DOI S
ingle Rating Region study found:
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ignificant variation in utilization across DOI rating regions
- S
- me cost variation across DOI rating regions
- Initial Medicaid data analysis found:
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imilar reimbursement variation across DOI rating regions
- Different utilization patterns as compared to
commercial insurance
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Now What?
- Continue to better understand what is driving cost
and utilization differences across the state between payers
- DOI and HCPF is working on this
- We need more transparency/ data to truly answer
- Arizona Hospital Annual Report
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tatutory requirement to provide information to state Medicaid agency
- https:/ / azahcccs.gov/ shared/ Downloads/ Reporting/ ReportOnUncompensatedHospitalCostsAndProfitability.pdf
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