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NYSHealth Hosts “Leveraging Big Data to Create a Value-based Health System: A Conversation with Ana English”

March 3, 2015

On March 3, 2015, NYSHealth hosted a conversation to discuss how an all-payer database (APD) can be used as a consumer-friendly price transparency tool to support payment reform. 

For New York State to achieve its goals of integrated health care delivery and value-based payments, investments in big data systems are essential. Virtually all states engaged in innovative payment and delivery reforms rely upon robust APDs to inform and drive change. Colorado's APD, for example, provides a complete picture of health care costs, quality, and utilization based on data from government and private payers alike. Moreover, those data provide consumers with the information they need to make smart decisions as they shop for care and lie at the heart of efforts to reduce hospital admissions and reform reimbursement methods.

Ana English, President and CEO of Center for Improving Value in Health Care (CIVHC), provided insights on how health care gets delivered, paid for, and used in Colorado. CIVHC is the nonprofit administrator of Colorado’s APD, which was mandated in 2010 and currently includes 330 million medical and pharmacy claims (representing 3.5 million individuals and 65% of insured Coloradans) through data collection from Medicaid, Medicare, and the state’s largest commercial payers.

Ms. English stated, “Colorado is doing a lot of things that are right” when it comes to the procurement of data, development of an APD, and transparent presentation to the public. Seen as a model for other states, Colorado focused intensively on stakeholder engagement to get buy-in and input early on from all constituents. “We have to be Switzerland,” said Ms. English of CIVHC, explaining the need to support all stakeholders in a neutral and credible fashion. CIVHC took a rigorous approach to privacy protection, security, and anti-trust concerns associated with the release of health data. Public accessibility was an essential element to the Colorado APD, as CIVHC sought to establish a trustworthy, accurate tool with the overarching requirement that the APD be used to benefit the health of all Coloradans.

In July 2014, CIVHC launched its consumer-facing health care price and quality tool, www.comedprice.org, which includes prices based on actual payments for all of the services related to a health care procedure, such as a knee replacement. The comprehensive data indicate wide variation in price and quality among providers, which Ms. English attributes not to the complexity of patient care but to the location, supply, and demand of the providers. As CIVHC builds up this consumer tool, it plans to conduct outreach to and engage with employers and physician groups to promote the use of the website.

Beyond its ability to raise awareness about variation in health care price and quality, the Colorado APD is seen by CIVHC as an impetus for new payment models, such as bundled and global payments, and delivery reform, such as patient-centered medical homes. Ms. English emphasized the need to produce actionable data and analytics to make meaningful impact on health care redesign. She closed by remarking that this is all about changing culture and embracing the potential for big data to catalyze long-term changes in the health care system.

View the PowerPoint slides from the event.

Watch a video of the event below: