Case Studies

Resource	Category	Carriers	Purpose
Identify care outcome improvement opportunities by combining medical claims with EMR data for approximately 100,000 Medicaid patients over a four year period. The Scalable Architecture for Federated Translational Inquiries Network (SAFTINet) is a multi-state consortium of stakeholders dedicated to… State: Colorado
Bundled Payment Analysis for Health Plans This health plan is part of a bundled payment learning collaborative aiming to analyze and understand bundled payment opportunities. Claims data in… State: Colorado
Testing Bundled Care Analytics to Improve Care and Lower Costs Goals: Test the applicability of certain costs of care metrics such as total severity-adjusted patient costs, episode-level severity-adjusted costs,… State: Colorado
Evaluation of Availability and Cost for Optometrist Services to Enhance Access for Medicaid Patients. Goal: Determine financial impact that an increase in reimbursement would have on the overall Medicaid budget and the number of Optometrists and… State: Colorado	Medicaid, Providers	Medicaid
Prior Coverage Analysis Goal: Evaluate prior coverage analysis, de-identified and aggregated by payer, which depicts measures of data quantity (number of members, number of… State: Colorado	Consumers, Health Reform, Population Health, Providers, Researchers	Commercial, Medicaid	Utilization
Cost Transparency in Colorado Hospitals Data from this project will provide a baseline for these consumers to evaluate whether they are being charged appropriately. More broadly, this… State: Colorado			Cost
Inform Rate Setting and Provide Network Development As a result of the data, Colorado HealthOP was able to get a better understanding of patterns of care in rural/western slope areas, and the… State: Colorado	Insurance Department
Assessing the Impact of Cost-Sharing Policy Changes on the Use of Preventive Services One of the first provisions of the federal Affordable Care Act to be implemented was the requirement that Medicare and all private insurance plans… State: Colorado			Cost
Develop Innovative 21st Century Ambulatory Health Care Model Historic claims file for a list of Medicaid patients. This healthcare provider was awarded a cooperative agreement from CMS and Medicaid Innovations… State: Colorado			Cost
Identify Opportunities to Reduce Use of Potentially Harmful Medications During and Post Surgery This research entity will define patterns of opioid analgesia and prolonged opioid use in a large cohort study of patients that underwent major… State: Colorado	Consumers, Population Health, Providers, Researchers		Utilization
New Long-Term Opioid Prescription-Filling Behavior Arising in the 15 Months After Orthopaedic Surgery in Virginia This study determined the rates of long-term opioid prescription-filling behavior after common orthopaedic surgical procedures in patients who were… State: Virginia	Consumers, Population Health, Researchers	Commercial	Utilization
Small-Area Variation in the Care of Low-Risk Neonates in Massachusetts and Texas A research study that measures special care days (SCDs) (intermediate or intensive), length of stay, and readmission rates among low-risk neonates… State: Massachusetts, Texas	Providers, Researchers	Commercial	Quality, Utilization
Pharmacy Quality Alliance Opioid Prescribing Measurers in Washington State, 2014-18 Washington State Office of Financial Management staff used the WA-APCD to run Pharmacy Quality Alliance Opioid Prescribing Measures for 2014-2018. State: Washington	Consumers, Employers, Health Reform, Population Health, Providers, Researchers	Commercial, Medicaid, Medicare	Cost, Quality, Utilization
Data Byte: Low Birthweight and Birth Outcomes in Colorado This analysis presents the number and count of deliveries and births that occurred between 2014-2018 for Commercially insured and Medicaid insured… State: Colorado	Consumers, Health Reform, Insurance Department, Medicaid, Population Health, Researchers	Commercial, Medicaid	Cost, Utilization
Colon Cancer Screening and Colonoscopy Billing This analysis helps to answer, of the people who have a fecal screener: 1. How many insured lives in Colorado have a colonoscopy within a year?, and… State: Colorado	Consumers, Health Reform, Insurance Department, Medicaid, Providers, Researchers	Commercial, Medicaid, Medicare	Cost, Utilization
Nurse Midwife Payment Evaluation The Nurse Midwife Payment Evaluation data set provides payment comparisons for common procedures provided by Nurse Midwives, OB/GYNs, Primary Care… State: Colorado	Consumers, Insurance Department, Medicaid, Researchers	Commercial, Medicaid, Medicare	Cost
End Stage Renal Disease and Dialysis Dependence The Utah Department of Health, Office of Health Care Statistics (OHCS) produced this report at the request and under the direction of the… State: Colorado	Consumers, Insurance Department, Medicaid, Providers, Researchers	Commercial, Medicaid, Medicare	Cost, Utilization
Exploring the Cost of Cataract Surgery in Utah The Utah Department of Health, Office of Health Care Statistics (OHCS) produced this report at the request and under the direction of the… State: Utah	Consumers, Employers, Providers		Cost, Quality
Exploring the Cost of Colonoscopy in Utah Consistent with this mission, the Transparency Advisory Group selected colonoscopies as a procedure with high health care value for Utahns. This… State: Utah	Consumers, Employers, Providers		Cost, Quality
Determinants Associated With Longitudinal Adherence to Annual Lung Cancer Screening: A Retrospective Analysis of Claims Data This investigation was undertaken to assess links between lung cancer screening (LCS) annual adherence and demographic, comorbidity, health care… State: Colorado	Population Health, Providers, Researchers	Commercial, Medicaid, Medicare	Utilization

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