Executive office update: Health care cost containment plot thickens

Saturday, March 01, 2014 11:05 AM

Alfred Gilchrist, Chief Executive Officer
Colorado Medical Society

The recent revelation that Colorado’s mountain resort counties incurred the highest health insurance exchange rates in the country has accelerated an already revved up policy debate over the causes and effects of health care costs. Gov. John Hickenlooper has directed Insurance Commissioner Marguerite Salazar to conduct a study on insurance rates, which will lead to further debate over regional rating methods and also likely expose its complex epidemiology. Meanwhile Garfield County has announced their intent to sue the state for being lumped into the higher cost resort counties.

At the same time, Senator-physician Irene Aguilar convened a group of leaders to float the idea of legislation to create a Blue Ribbon Commission on Health Care Costs. It would be modeled after the highly regarded SB208 Commission that produced a prescient pre-Accountable Care Act set of health system reform recommendations in 2008. As in preceding policy development consensus processes, we were eager to participate and contribute to this effort. Analyzing responses to the proposal, the senator recognized that stakeholder discussions on health care costs will not be easy, and adroitly tacked to the establishment and maintenance of an on-going forum, as opposed to a one-shot, time-limited, high-profile commission. Stakeholders understood and appreciated her point; a forum that builds trust and rapport among the appointees will be more likely to produce consensus outcomes. Legislative details of such a forum are now under discussion.

This is not by any measure the first conversation on health care costs. Just last month the University of Virginia’s Miller Center released a report at the National Press Club in Washington, D.C., co-chaired by former Colorado Gov. Bill Ritter, examining how the nation’s governors and other state leaders can transform the current health care system into one that is more integrated, coordinated, patient-centered and cost effective. Other states have preceded Colorado in attempting a consensus building approach, and others will no doubt follow. Some may progress and find common approaches, some will look more like finger pointing exercises than deliberative bodies, and some may default into a zero sum report where the participants essentially fight to a draw. 

While regional variation in health insurance premium pricing is hardly revelatory, newly available, lay-accessible (and thus politically accessible) data and studies will energize this latent, insider debate. No doubt, when the data and trends from Colorado’s All Payer Claims Database are put under the microscope of a long-term study forum dedicated to the cost of care, the questions regarding pricing and cost/value variances will no longer be rhetorical. Some variances may be well understood and able to withstand scrutiny while others may be less defensible. Make no mistake that a long-term study forum will generate heat as well as light.

In Colorado, there is a time-honored tradition of coming together under pressure when others seem to come apart, to fix problems rather than blame. Most recently, Gov. Hickenlooper convened experts and practitioners to produce a thoughtful, evidence-based set of strategies to reduce the risk of opioid abuse. Our most recent survey of Colorado physicians reflects an understanding that the urgent mission to bend the cost curve requires a similar convening to find common purpose, one that is composed of those in the exam rooms as well as the boardrooms. The issue is complicated; there is no single variable driving costs, and there are no silver bullets or villains.