Insights for Employers from the CO APCD Ana English, CEO & - - PowerPoint PPT Presentation

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

$5,860 $9,960 $19,910 $6,700 $12,730 $23,650 $4,720 $8,050 $14,440

$0 $5,000 $10,000 $15,000 $20,000 $25,000 Vaginal Delivery Cesarean Delivery Knee Joint Replacement

Average Allowed Amounts for High Volume Services, 2014 CO APCD Data

Employer HSR Employer Denver Metro HSR

Health Plan Drug Payment Variation

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

Payer 1 Payer 2 Payer 3 Payer 4 Payer 5 Payer 6 Payer 7 Payer 8 Payer 9

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