Getting to Affordability: Regional Total Cost of Care

In the pursuit of advancing payment reform, the Network for Regional Healthcare Improvement (NRHI) is leading a multi-regional innovation initiative focused on the production, sharing and use of information about the total cost of care. With funding from the Robert Wood Johnson Foundation, five pioneering regional health improvement collaboratives (RHICs) are now joined by six additional regions in a unique approach to standardizing how they report cost information. Balancing local customization with alignment to national efforts makes the information consistent, relevant, and actionable.

To learn more about the project and to connect with team members join the G2A online community here.

The community is a great place to access resources, talk with the G2A Project Team, and view our learning modules on everything from the technical measure to building stakeholder engagement around reporting total cost in your region.

Advancing Affordability – Funding Opportunity

Is your community concerned about the affordability of healthcare? We have funding opportunities for everyone – even if you haven’t started the conversation in your community.  After four years of experience, the Getting to Affordability team knows that effective engagement of stakeholders is an essential step to bringing cost transparency to your community.  It’s far more than a technical exercise and we are offering funding to help support your efforts regardless of where you are along the continuum of addressing affordability.

Grant Period:                   November 1, 2017 – October 31, 2018

Funding Ranges:             $10,000 – $60,000 (Depending on level of participation)

The Getting to Affordability (G2A) initiative has issued a Request for Proposals for Round 2 of its third phase of funding from the Robert Wood Johnson Foundation.  Opportunities for different levels of participation are available and include options that do not require current access to claims data. These options include:

  • Standardized Regions (Requires access to data)
  • Alignment Sites (Limited or no access to data)
  • Development Sites (No access to data necessary)

Regions will be reviewed by a selection team and awarded funding based on the following criteria:

  • Ability to meet the requirements and deliverables
  • Assessment of capability and capacity to meet deliverables in the timeline specified
  • Geographic location to achieve desired spread
  • For Alignment and Development sites, diversity and relevance of topics to overall initiative goals and deliverables
  • Preference given to Regional Health Improvement Collaboratives (RHICs) with a strong track record of multi-stakeholder engagement

Don’t miss your chance to join a group of experts whose experience you can leverage to effectively lead affordability efforts in your region.

Important Information and Dates:

  • Review the Request for Proposals and access other resources found here
  • Submit your questions through the  web form
  • Register and attend the informational webinar on September 7th, 2017 from 2:00 – 3:00 PM ET

Follow the steps outlined in the RFP and submit your written proposals, no later than 5 PM ET on Monday, October 2nd, 2017, to:

Network for Regional Healthcare Improvement
Attn: Mary Isabel Aromando, Project Manager
For general questions, feel free to contact either Ellen Gagnon, Executive Director, Healthcare Affordability at . For proposal questions, contact Mary-Isabel Aromando at .

Register now for the National Affordability Summit 

The rising cost of healthcare is a growing threat for patients, employers, Government, and the U.S. economy. Ten years of U.S. wage growth has been lost to healthcare cost increases and American businesses struggle to remain competitive and provide coverage. More and more families are losing their discretionary incomes to out of pocket expenses and are facing barriers to needed care due to costs. Though the national debate has focused largely on insurance coverage and access, there is growing recognition that coverage will not be affordable until healthcare is affordable. But to make healthcare affordable we must address fundamental issues like pricing, overuse, incentives, and care delivery. And we need the information to identify and pay for high value care. The good news is that care can be made better and more affordable without compromising access.

Register for NRHI’s National Affordability Summit, Why Does Healthcare Cost So Much? And What Can We Do About It? The event will be held in Washington, D.C. on Wednesday September 27, 2017, at the Ronald Reagan Building and International Trade Center, with a welcome reception scheduled for the evening of Tuesday September 26th.

FMI Contact Ellen Gagnon, .

NRHI’s Total Cost Of Care (TCOC) Project Team Releases First-in-the-Nation Cost Comparison Report

NRHI’s Getting to Affordability Total Cost Of Care (TCOC) project team has released the first ever report comparing what commercial insurers are paying for healthcare in different regions across the country. The report highlights variation across five regions nationwide: Utah (HealthInsight UT), Maryland (Maryland Health Care Commission), St. Louis (Midwest Health Initiative),  Minnesota (Minnesota Community Management) and Oregon (Oregon Health Care Quality Corporation).

By collaborating across regions, the team demonstrated proof of concept that you can standardize the measurement of total cost of care sufficiently to publish regional benchmark measures.  Since the inception of the NRHI-Robert Wood Johnson Foundation Total Cost of Care project, developing and testing this methodology for regional benchmarking has been a priority and is an essential step toward healthcare affordability.

The results are supplemented by underlying local practice level variation reports in each region which enable key stakeholders to gain a better understanding of healthcare cost drivers. To learn more about our model which provides data down to the practice level, gathers and vets local data and collects multi-payer results which are subject to rigorous analysis/centralized quality assessment, click the following link to read the full report: From Claims to Clarity: Deriving Actionable Healthcare Cost Benchmarks from Aggregated Commercial Claims Data.  

Expanding TCoC Reporting from Commercial to Public Payers

In order for primary care practices to get the most out of healthcare cost comparison reports we need to provide them with the most comprehensive view of their patient panels.  This will allow them to  focus on areas where strategic intervention can have the most impact.  In 2015, as part of  NRHI’s Getting to Affordability initiative, regions across the country have produced and shared attributed practice level Total Cost of Care reports for over 5 million commercial patients attributed to 20,000 individual providers. Understanding the importance of providing the same information to patients enrolled in Medicare and Medicaid, we worked to apply the Total Cost of Care methodology to public payer populations. Read more about these efforts in the  Medicare Issue Brief and the Medicaid Benchmark Report.

New Learning Modules

The Getting to Affordability initiative has released two new Total Cost of Care (TCOC) learning modules entitled, “Building Stakeholder Engagement” and “Reporting Total Cost of Care.” We know that many of you are working on finalizing your Phase III RFPs and we hope these new modules will assist you in that process. To view the Learning Modules, you need to be a member of the Getting to Affordability (G2A) online community. To join the G2A community go to and select “join” in the upper right hand corner. If you have any questions please contact our Community Navigator Lucy McDermott, . Happy learning!

Case Studies: New Resources in Overcoming Barriers to TCoC Reporting
One of the goals of Total Cost of Care Phase III is to spread TCoC reporting across more regions. Recognizing that not everyone is at the same place in terms of readiness, during the second phase of the project, we selected four regions as Development Sites. Each of these regions selected a specific barrier that was impeding their progress toward healthcare cost transparency. They were funded to develop and implement strategies to overcome their barriers and didn’t need to start from scratch but leveraged the experience and lessons learned from those regions who have already reported TCoC. These case studies were written by the Development Sites and are intended to assist other regions who might have similar barriers and give them encouragement that barriers are surmountable. Below are links to these valuable resources:

Join the Getting to Affordability (G2A) Community

To gain a more thorough understanding of the Total Cost of Care project, access our Learning Modules, obtain more resources and interact virtually with others embarking on this work, we strongly suggest you join the Getting to Affordability community. The registration process is open to everyone by clicking on the following link: If you have any issues or questions about the G2A Community, please contact Lucy McDermott, G2A Navigator at .

TCoC HealthDoers Release Technical Resource

The Total Cost of Care Project Team, in collaboration with the APCD Council, released the Technical Resource for Measurement of Total Cost of Care Using Multi-Payer Data Sets.  Filled with Voices from the Field, readers will benefit from the insights, guidance and tips from the five original TCoC pilot regions. This documents three major phases of the work (data preparation, assignment of risk scores and the use of the HealthPartners software) and includes the detailed analytic steps leading to the calculation of TCoC using a multi-payer data set.

This effort was funded by the Robert Wood Johnson Foundation to promote spread of standardized TCoC measure across the country. To continue conversations, share best practices and get peer support around measurement of Total Cost of Care – join the Getting to Affordability Community by emailing .

Purchaser Roadmap: Pathway to Better Value 

Following the National Employer Leadership Seminar guidance for employers was distributed to attendees. Purchaser Roadmap: Pathway to Better Value  provides purchasers an overview of opportunities and best practices associated with the implementation of various value-based purchasing strategies shared at the two-day seminar.

National Employer Leadership Seminar Summary Report

Click here to read the full summary report from NRHI’s National Employer Leadership Seminar. The Report offers tools, case studies and best practices for employers working to accelerate healthcare transformation. The Report summarizes lessons learned during the National Employer Leadership Seminar (NELS) in Charlotte, North Carolina, on May 5 and 6, 2016. The landmark seminar was supported by the Robert Wood Johnson Foundation as part of NRHI’s Getting to Affordability initiative and focused on three objectives for moving the private sector from volume to value in healthcare:

  • Create a shared understanding of the national landscape, present and future, and the role of stakeholders toward paying for value.
  • Identify levers available for employers to influence and drive the availability of higher quality, affordable healthcare.
  • Demonstrate how regional, multi-payer data can be utilized as a catalyst for change.


2nd National Physician Leadership Seminar Held in Stanford, CA August 4-5, 2016

On August 4-5, 2016 the Network for Regional Healthcare Improvement (NRHI) brought together physician leaders, healthcare measurement experts and colleagues from across the country to look at comparative health care cost reports and analyze their usefulness in identifying cost variations and interventions as well as how they can be used to influence and energize teams in clinical transformation.

“The National Academy of Sciences consistently releases reports that show 30-40% waste in healthcare services and spending. This is a national economic crisis. We can make progress and data is a critical tool,” said Arnie Milstein, MD, Clinical Excellence Research Center Director at Stanford University.

This was the second National Physician Leadership Seminar organized by NRHI and funded by the Robert Wood Johnson Foundation as part of the Total Cost of Care Initiative, which seeks to produce actionable, practice-level reporting structures to identify the drivers of regional healthcare costs and develop strategies to reduce spending at the community level.

Click here to read the full press release.

Project Updates
  • The Total Cost of Care Phase II Project takes on a new look as part of NRHI | Getting to Affordability
    • If you’ve been following the Total Cost of Care project since its beginning in 2013, you know that the name of the project has evolved over time to reflect the HealthPartners measure which is at the center of the work.
    • While the Total Cost of Care measure is still the foundation of cost measurement and reporting, the second phase of the project expands on stakeholder engagement and identifying methods to more rapidly scale a standardized and aligned approach to reporting on cost of care.
    • To better reflect the breadth of the project, Total Cost of Care Phase II will now fall under NRHI | Getting to Affordability.
    • To understand the vision for this work and for an example of its impact, read our overview one-pager, on NRHI | Getting to Affordability.
    • To learn more about the NRHI | Getting to Affordability approach and the 11 regions now participating, view the Total Cost of Care Accelerates Healthcare Affordability one-pager.
    • NRHI’s Total Cost of Care Project Receives Phase III Funding Press Release




Recordings and Events
  • 2nd National Physician Leadership Seminar Held in Stanford, CA August 4-5On August 4-5, the Network for Regional Healthcare Improvement (NRHI) brought together physician leaders, healthcare measurement experts and colleagues from across the country to look at comparative health care cost reports and analyze their usefulness in identifying cost variations and interventions as well as how they can be used to influence and energize teams in clinical transformation. Click here for the press release.
  • National Summit: Cost Transparency from the Ground Up  April 30, 2015 On April 30, 2015 more than 125 stakeholders representing Regional Health Improvement Collaboratives (RHICs), physicians and healthcare systems, public and private payers and insurers gathered in Washington, DC to learn from the five (RHICs) that have worked together to implement and standardize Total Cost of Care reporting across their regions. To learn more about the event, view the materials and presentations, click here.
  • National Physician Leadership Seminar August 14-15, 2014 This Leadership Seminar, held August 14-15, 2014 at Stanford University, provided a forum where physician leaders from around the country and measurement experts gained a better understanding of cost measurement to improve care.  This Seminar offered a game-changing opportunity to enable physician leadership to lead change in the community.


About Total Cost of Care Pilot - Phase I (November 1, 2013-April 30, 2014)

NRHI and five of its member collaboratives worked together on a seminal study that makes significant inroads in addressing healthcare costs.  The goals of the initiative were to:

  1. Measure and publicly report the total cost of care (TCOC) and resource use in a standardized way across five regions;
  2. Create a process for benchmarking multi-payer commercial healthcare costs;
  3. Identify the best ways to share cost information with key stakeholders in local communities to identify drivers and reduce healthcare costs;
  4. Conduct focused work with physicians to help them use cost information to adopt practices that will reduce costs and improve care, and to encourage them to serve as leaders in their communities

Participation in the Total Cost of Care Pilot (Phase I) includes the following Regional Health Improvement Collaboratives (RHICs):

More resources and updates available about Phase I are available above.