Getting to Affordability: Regional Total Cost of Care





What does healthcare cost in my community? Why does healthcare cost more in some places than others? What’s driving the differences in costs for the same services or procedures? These are the questions the Network for Regional Healthcare Improvement (NRHI) continues to address through our multi-region initiative to measure and report on differences in the total cost of care (TCoC) within and across regions. With funding from the Robert Wood Johnson Foundation, five pioneering regional health improvement collaboratives (RHICs) will be joined by thirteen 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. NRHI’s regional partners:

  • Produce standardized, high-quality data analyses
  • Share information and experiences
  • Use the resulting information to compel fundamental change

Learn more about the project and connect with team members by joining the G2A online community.

Spotlight – Healthcare Affordability: Untangling Cost Drivers

Healthcare Affordability: Untangling Cost Drivers is NRHI’s second annual report comparing the total cost of care for those with private insurance in various U.S. regions. The report uses the average cost of healthcare for comparable populations as its benchmark, and compares each state to that average. Like other recent studies, Untangling Cost Drivers finds that healthcare costs vary widely between states. The NRHI report, however, digs into the “why” and reveals how different care delivery patterns and local prices contribute to the significant cost differences between Oregon, Utah, Colorado, Minnesota, and Maryland. Join us Tuesday, March 13 from 3:00-4:00 pm ET to learn more about the report and how regions are using this information to address healthcare affordability.


Upcoming Events

  • Tech Talk Tuesday – Addressing Healthcare Affordability: Untangling Cost Drivers – Tuesday, March 13, 3:00-4:00 pm ET. Register today.

Past Events

All resources from past events can be found in the G2A Community online community. To join, go to g2a.healthdoers.home and select “Login or Signup” in the upper right hand corner. If you have any questions, please contact our Community Navigator, .

  • 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. To address this central issue, NRHI hosted the National Affordability Summit on September 27, 2017 in Washington, D.C. The summit brought together 200 stakeholders from across the healthcare industry to discuss the healthcare crisis and what we can do about it. To learn more about this important topic, please check out resources from the summit and continue the conversation by joining the G2A community. For more information, contact Ellen Gagnon.
  • Tech Talk Tuesday: How to Find Needles in Haystacks and When to Stop Looking In July 2017, Mary Jo Condon from the Midwest Health Initiative and Brantley Scott from the Utah Office of Health Care Statistics led this dynamic conversation around data quality assessment and improvement in July of 2017. You can watch the recording here.
  • Getting to Affordability Community Classroom: The Cost Shift Conundrum In June of 2017, we held our first G2A Community classroom where thought leaders from across the country sat down to discuss the past and future thinking around healthcare cost shift. We all understand that savings in one area of healthcare that only show up as increased costs somewhere else certainly won’t move us toward affordability. We heard national perspectives as well as regional and local solutions during this Community Classroom. You can watch the recording here.
  • Tech Talk Tuesday: How Episode Analytics Can Add Value to Your Reports In June of 2017 Jonathan Mathieu from CIVHC provided an overview of the PROMETHEUS software developed to analyze episodes of care based on claims data to support value based payment models and comparative cost and quality performance assessment. CIVHC has developed Tableau dashboards that allow a user to manipulate the PROMETHEUS results along multiple dimensions to address a number of provider level, comparative performance related questions. Jonathan provided examples of the drill down capabilities of the Tableau dashboards and highlighted opportunities to inform payers and providers regarding comparative cost and quality performance for acute care episodes. You can watch the recording here.
  • Tech Talk Tuesday: Risk Adjustment In April of 2017 Doug Rupp of Q-Corp moderated a session featuring Amy Salls, Product Director, DST Health Solutions. Sallis shared how the Johns Hopkins Adjusted Clinical Groups (ACG) system is applied to risk adjust the population in the Total Cost of Care performance measurement. You can watch the recording here.
  • Tech Talk Tuesday: The National Benchmark Report In February of 2017 members of the G2A Project Team spoke about the recently released National Benchmark Report, you can watch the recording here.
  • 2nd National Physician Leadership Seminar, August 2016, Stanford University, Palo Alto, CA 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 Employer Leadership Seminar, May 2016, Charlotte, NC The National Employer Leadership Seminar (NELS), supported by the Robert Wood Johnson Foundation as part of NRHI’s Getting to Affordability initiative, focused on three objectives for moving the private sector from volume to value in healthcare:
    • Creating a shared understanding of the national landscape, present and future, and the role of stakeholders toward paying for value.
    • Identifying levers available for employers to influence and drive the availability of higher quality, affordable healthcare.
    • Demonstrating how regional, multi-payer data can be utilized as a catalyst for change.

Read the report here.

  • National Summit: Cost Transparency from the Ground Up, April 2015, Washington, D.C. 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 2014, Stanford University, Palo Alto, CA 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. Read the press release here.


Resource Use Index: For a quick orientation to the Resource Use Index, watch our video below:

Total Cost of Care Index: For a quick orientation to the Total Cost Index, watch our video below:

First-in-the-Nation Cost Comparison Report In early 2017, NRHI’s Getting to Affordability Total Cost Of Care (TCOC) project team 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 Measurement) and Oregon (Oregon Health Care Quality Corporation). 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.

Learning Modules The Getting to Affordability initiative has a series of Learning Modules developed to help those of you who are working on reporting total cost of care in your region. 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!

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.

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. Click the links below to download these valuable resources:

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.

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 The National Employer Leadership Seminar Summary Report summarizes lessons learned during the National Employer Leadership Seminar (NELS) in May 2016, and offers tools, case studies and best practices for employers working to accelerate healthcare transformation.

The Getting to Affordability Vision provides a high level, one page overview or those interested in understanding why this work is valuable and needed, including use cases.

The Getting To Affordability (G2A) Community

More resources can be found on our Getting to Affordability online learning community. To join go to and select “Join” in the upper right hand corner of the page. For more information contact Lucy McDermott, G2A Navigator, at .

Press Releases
            • Healthcare Cost Disparities Across States Driven by Differences in Care Patterns and Price Press Release
            • Total Cost Of Care (TCOC) Cost Comparison Report Press Release
            • NRHI’s Total Cost of Care Project Receives Phase III Funding Press Release
            • 2nd National Physician Leadership Seminar, August 2016, Press Release
            • National Employer Leadership Seminar, May 2016 Press Release