Contact: Colorado APCD
Email: ColoradoAPCD@civhc.org
Background: Colorado HealthOP is a new nonprofit, consumer-directed health plan formed under provisions of the Affordable Care Act. As a new health plan, Colorado HealthOP lacked historical data on populations it intended to serve, and was seeking APCD data along with other data sources to model financial outcomes deriving from innovations in provider contracting and plan design. Colorado HealthOP’s mission is to offer lower cost products while improving health outcomes for Colorado residents by contracting with providers who share this mission and enrolling members in plan designs that promote healthy living.
Goal: Gain an understanding of cost breakdowns by types of service and patient demographics across different geographies in Colorado for the purposes of provider contracting and rate development.
Data Analyzed: Geographically segmented data in the insured population by facility, professional, pharmacy, DRG, specialty (especially primary care) and drug class and by age and gender.
Results: 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 percentage of various care types that stay local vs. traveling to other areas. “Deeper dive” geographic variations identified were influential in development of plans to serve the underserved and uninsured in the high-cost rural resort/western slope areas.