Executive office update: Fun with numbers – not

Sunday, March 01, 2015 11:07 AM
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by Alfred Gilchrist, CEO Colorado Medical Society

Alfred Gilchrist

In the fall of 2013, Steven Brill spoke to a Denver audience of business and health policy leaders on his findings and recommendations to flatten the health cost curve. You may recall that Brill also published a widely read issue of Time magazine devoted to his views on health care cost drivers, which exposed and antagonized a wide array of stakeholders in care delivery. Colorado Medicine interviewed Brill while he was in Denver and subsequently launched a yearlong series on health care costs in 2014 with guest opinions drawn from a pool of veterans and experts. Last fall, Brill published his observations in a more comprehensive book version, further warming up the topic just as legislatures across the country were convening and considering how health care costs threaten to crowd out other infrastructure investments in transportation, education, water and energy. As noted in previous columns, a serious debate had been launched that would lead to public policy initiatives, and we intended to engage with all interested stakeholders.

The political momentum behind this earnest debate led to the creation of Colorado’s Commission on Affordable Health Care by the 2014 General Assembly, an effort CMS applauded and supported. To further engage professionally with the Cost Commission over its three-year life span, we have created a Task Force on Health Care Costs and Quality, comprised of some of medicine’s most experienced and thoughtful physician experts who will convene for the first time in March. We assessed that absent a more adult, depoliticized, evidence-based approach, the debate could deteriorate into a zero-sum contest of finger-pointing and misdirection.

The state’s Cost Commission can’t hit its stride soon enough. For instance, legislation currently planned to be filed was drafted by one national health plan to cap out-of-network charges to a percent of Medicare and change the way disputes over out-of-network charges are addressed, giving an upper hand to the plans. The spreadsheets eventually provided to us by the health plan fairly screamed “outlier,” so we brought in a national expert on practice analytics and pricing to evaluate and opine. Our expert did not find any case where the average billed charge could be defined as a statistical outlier and concluded that “their claims of unreasonable charge patterns are fatally flawed, based on poor logic and incomplete to the degree that they have left no way to validate and verify their findings.”

The last few years have brought unprecedented change in health care. Health plans are engaged in their own zero-sum competition over market share. Hospitals are intensely competitive, expanding and employing more physicians, and some are taking out insurance licenses. HIT-HIE adoption continues. Patients increasingly want full access to their medical information and price transparency. Policymakers want balanced budgets and better value for taxpayer dollars. Physicians, often caught in the middle, are burning out from increased administrative tasks, insurance complexities and dysfunctional EMRs.

Today’s market dynamics are complicated and demand proposals and initiatives tied to evidence and an underlying epidemiology. We all have skin in this very serious game – physicians, patients, hospitals, pharmas, medical devices, health plans and public officials. And while the easier path forward is to designate a devil for the crusade and attack, we must step up in the shared responsibility and collaborate in a manner that builds trust and rapport, and most importantly produces solutions that work.

Posted in: Colorado Medicine | Health System Reform


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