Healthcare Affordability

Healthcare costs are driven by the health of population, prices, waste, and a payment system that incentivizes volume over value.

At the end of 2013, NRHI received funding from Robert Wood Johnson Foundation to lead a multi-region initiative to measure and report on differences in the total cost of care (TCoC) within and across regions. Five Regional Health Improvement Collaboratives participated in Phase I (2013-15) with nine more full and affiliate members joining at Phase II (2015-16). The initiative led to in-person summits and seminars, virtual tech talks, local case studies, and 3 benchmark reports. Phase III of the initiative closed in 2019, however, NRHI members continue working on improving transparency of healthcare costs at local and national levels. 

Getting to Affordability Timeline:

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October 2019: 3rd National Affordability Summit is held in Minneapois, MN

. The Summit presentations and discussions focused on the paths of reaching affordable healthcare. Access Summit presentations

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October 2018: 2nd Affordability Summit is held in Washington D.C. The one-day event focused on solutions, exploring how three key issues − health, price, & waste − influence the affordability of healthcare.

During the summit, NRHI launched it’s Affordable Care Together initiative as a solution to addressing the affordability crisis by calling on everyone to take an active part in solving the problems we’ve collectively created

February 2018: Healthcare Affordability: Untangling Cost Drivers In February 2018, NRHI released it’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. Read the full report today: Healthcare Affordability: Untangling Cost Drivers.

November 2018: NRHI releases the third and final benchmark report  “Data is the Spark, Collaboration is the Fuel” of Phase III of the Total Cost of Care Initiative, funded by Robert Wood Johnson Foundation.  The report compared the total cost of care for those with private insurance in various U.S. regions. It explores why costs differ and reveals how varied care delivery patterns and local prices contribute to the cost differences between Colorado, Maryland, Minnesota, Oregon, St. Louis, and Utah.

August 2018: Future Consideration for Reporting TCOC  This paper discusses several technical considerations when applying the HealthPartners Total Cost of Care measure to multiple payer data sets or comparing results across regions.  Future Consideration for Reporting TCOC.

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September 2017: 1st National Affordability Summit is held in Washington, D.C. 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 1st National Affordability Summit 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.

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November 2016: The Network for Regional Healthcare Improvement (NRHI) receives $3.6M funding for Phase III of the Total Coast of Care (TCoC) Project from the Robert Woods Johnson Foundation.

In the two years of its execution, TCoC Phase III would continue to improve transparency of healthcare costs by standardizing how healthcare costs are measured and reported and how the data is used across different regions of the country. 

October 2016: The first benchmark report "From Claims to Clarity: Deriving Actionable Healthcare Cost Benchmarks from Aggregated Commercial Claims Data" is published. comparing what commercial insurers are paying for healthcare in different regions across the country. The report highlights variation across five regions nationwide: Utah (NRHI members: HealthInsight, now Comagine Health, and University of Texas Public Health Department), Maryland (NRHI member: Maryland Health Care Commission), St. Louis (NRHI Member: Midwest Health Initiative), Minnesota (NRHI Member: Minnesota Community Measurement) and Oregon (Oregon Health Care Quality Corporation). 

August 2016: 2nd National Physician Leadership Seminar 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. 

October 2016: The first benchmark report "From Claims to Clarity: Deriving Actionable Healthcare Cost Benchmarks from Aggregated Commercial Claims Data" is published. comparing what commercial insurers are paying for healthcare in different regions across the country. The report highlights variation across five regions nationwide: Utah (NRHI members: HealthInsight, now Comagine Health, and University of Texas Public Health Department), Maryland (NRHI member: Maryland Health Care Commission), St. Louis (NRHI Member: Midwest Health Initiative), Minnesota (NRHI Member: Minnesota Community Measurement) and Oregon (Oregon Health Care Quality Corporation). 

August 2016: 2nd National Physician Leadership Seminar 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. 

May 2016: National Employer Leadership Seminar is held in Charlotte, NC with the support by the Robert Wood Johnson Foundation as part of NRHI’s Getting to Affordability initiative. It 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.

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.

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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. View a sample multi-payer commercial report and read more about these efforts in the Medicare Issue Brief and the Medicaid Benchmark Report.

April 2015: 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. 

May 2015: NRHI is awarded $1.2M from Robert Wood Johnson Foundation for Phase II of the Total Cost of Care (TCoC) initiative. Nine more full and affiliate members join the five RHICs that participated in pilot (Phase I) of the initiative. 

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August 2014: National Physician Leadership Seminar at Stanford University, Palo Alto, CA, kicks in Phase I of the Total Cost of Care (TCoC) Initiative led by NRHI. Robert Wood Johnson Foundation funded Phase I for the amount of $583K and included five RHICs and 13 regions.

 

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:

Washington Health Alliance (Alliance): A Case Study in Operating a Voluntary All Payer Claims Database

Wisconsin Health Information Organization (WHIO): A Case Study Measuring Total Cost of Care in a Capitated Environment

University of Texas Health Science Center at Houston: (UTHealth): A Case Study in Physician Engagement in Transparency

The Health Collaborative of Greater Cincinnati: A Case Study in Public Reporting

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.

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.


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

 


Recently Released

  • In this recent Besler podcast, Meredith Roberts Tomasi and Jonathan Mathieu discuss the results of an NRHI study that measured and reported on the differences in the total cost of care within and across regions in the U.S. Listen here.

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