Colorado passed legislation authorizing the creation of its APCD in 2010. Today, the database houses over 718 million medical, dental and pharmacy claims from 44 payers (including 35 commercial plans). What makes Colorado’s APCD so powerful, however, is its pairing with the publicly-facing reporting and analysis that CIVHC provides.
Will the updated penalties and clarifications proposed by CMS compel hospitals into compliance? The jury is out, but the impact of the proposed updated rules depends heavily on enforcement.
Suzanne Delbanco speaks with Nate Freese, MBA, Senior Director of Data Strategy at Grand Rounds Health, a health care quality and navigation solution offering employers a data-driven clinical navigation platform paired with patient advocacy tools. Nate leads data strategy at Grand Rounds Health, where his team is responsible for building algorithms that match patients with the right providers based on billions of historical clinical interactions.
Nate offers a helpful introduction to data science by describing the three types of analyses that data science tackles as well as use-cases that help physicians, pharmaceutical companies, and patients make informed value-oriented choices. He then explores the major challenges that health tech companies face in bringing their data use-cases to life, including the siloed and unstructured nature of health data and the talent shortage of data science professionals across the country. Finally, Nate shares the approach Grand Rounds Health uses to track and improve its ability to reduce health care disparities.
Data science simplifies the unimaginably complex and predicts the future to help us make better decisions. In health care, the difference between the right and wrong decision can result in hundreds of thousands of dollars in spend, hospitalizations, or worse. In this episode, you’ll learn how Grand Rounds Health is using data science to power its clinical navigation platform and patient advocacy tools, with an eye toward health equity and cost containment.
Featured quotes:
“Messy data is another challenge for applying data science in health care. The data often requires a lot further processing to make it useful, and is often inconsistent – you have systems with different definitions of the same concept or information. Ultimately, it takes very specific skills sets and domain expertise to make health care data sets useful. And that gets to the next big challenge, which is talent shortage.”
“There’s a big disconnect between the number of companies out there that have a compelling vision for how they could use data in a health care context, and the number of companies that are actually doing so. A big factor is finding the people they need to realize that vision.”
“Data scientists are not one-size-fits-all. It’s usually not that you need 1 or 5 data scientists at your company to realize your vision for using data. It’s more likely that you need a couple of data engineers, you might need a couple of machine learning experts, a natural language processing expert, a statistician and a couple of epidemiologists. Each of these people are data scientists, but they bring a different skillset to the picture, and you need several of them to suite a particular use-case.”
Suzanne Delbanco talks with David Vivero, CEO and Co-Founder of Amino Health. A self-described “product guy,” David Vivero shares his view on where price transparency can make the biggest impact for patients and plan sponsors in the commercial health care market.
Instead of operating in a transparent arena with defined rules, employers and their contracted partners are struggling to determine who owns which data and how and when it can be shared to inform, operate, and evaluate health benefits programs.
“Are there opportunities to steer to a quality provider or facility down the street? If we can’t do that with the data, then we’re not serving the interest of our employers and their employees and getting them the health care that they need.” – Thi Montavlo, Willis Towers Watson
When the RBP vendor and provider “agree” on a rate, who pays the difference? The RBP vendor or the employer? It depends – and the outcome will likely be reflected in the vendor’s administrative fee.
Employers and consumers are eager for solutions that attack health care cost inflation at its root cause. One prominent strategy is using reference-based pricing (RBP) models that anchor commercial rates to Medicare, or some other rationalized external benchmark. Like so many health care innovations, reference-based frameworks encompass multiple branching models, and as such the term “RBP” has come to mean different things to different stakeholders.
Julianne McGarry catches up with Christopher Whaley, PhD, Policy Researcher at RAND Corporation and one of the lead authors of the RAND’s Hospital Price Transparency Study. The
Simply put, it’s not easy for employer-purchasers to put the RAND study results to use. That’s why Employers’ Forum of Indiana asked CPR to help build out its Employer Price Transparency Project website as a companion to help guide more employers on taking action.
A database might sound like something that only law students and policy wonks care about. But most stakeholders would benefit from understanding the legal constraints and opportunities that state laws create when it comes to improving the functioning of the health care system.
Sixteen states received a passing grade in CPR’s 2020 Report Card on State Price Transparency Laws. While it is a win that more consumers have access to price information to select lower-cost providers, consumer shopping is not the silver bullet to the nation’s health care cost problem.
Suzanne Delbanco chats with Zach Brown, PhD, Assistant Professor of Economics at the University of Michigan. Zach Brown used a quasi-experimental approach to analyze the impact of New Hampshire’s price
Listen in as Suzanne Delbanco chats with Gloria Sachdev, PharmD, President and CEO of the Employers’ Forum of Indiana. They discuss one of the hottest studies in health care: the
Let’s face it. Something has got to give. While employers and health care purchasers have long tried to implement market-based solutions, catalyzing consistent and long lasting system-wide change in health
Can states combat rising prescription drug costs? The rising costs of prescription drugs is a high priority for patients, providers, payers, and purchasers at the state and federal levels. Kaiser
Suzanne catches up with Niall Brennan, President and CEO of the Health Care Cost Institute (HCCI), to ask the tough questions on price and utilization data for employee-sponsored health care.
Data is beautiful, even when you’re looking at a monstrous thing like the $2.10 trillion dollars spent in U.S. health care in 2013. If you don’t believe me, check out
Can health care take a page from SpotHero’s playbook? CPR’s office is in the city of Berkeley, California, near the larger urban centers Oakland and San Francisco, and between local
“Have you checked out that place? It has a five-star review on Yelp” Without the context, you’d probably assume someone was talking about a hole-in-the-wall restaurant. What if I told
