Where’s the Actionable Data on Cost and Affordability?

It isn’t often that healthcare costs can be made into a riveting story or an engaging topic, but that is exactly what Mylia Christensen, Executive Director of Oregon Health Care Quality Corporation (Q Corp), did at the KHC’s June Forum. She explained that Oregon was experiencing improvements in quality and patient experience, yet there was less actionable data to address the cost and affordability of healthcare in the state.

Mylia leads one of the five trailblazing regional healthcare improvement collaboratives that joined forces to develop regional total cost of care information with the Network for Regional Healthcare Improvement (NRHI), with support from Robert Wood Johnson Foundation. In comparing total cost of care across providers in Oregon, they were able to see considerable cost variation among clinics and between regions. They also found that rural clinics had higher cost and lower quality, on average. As part of the first national total cost of care comparison report, Oregon was shown to have higher commercial costs than other states.

© 2016 Network for Regional Healthcare Improvement – From Claims to Clarity: Deriving Actionable Healthcare Cost Benchmarks from Aggregated Commercial Claims Data

To determine what issues contributed to higher pricing, they identified several drivers of cost and utilization. The factors affecting commercial pricing were provider and plan market power, cost-shifting due to low Medicare reimbursement, regional cost of living, and location of service. The factors affecting utilization were health status (morbidity), physician practice patterns, patient cost-sharing level, state mandates, and providers in network. Mylia also noted that states with lower utilization like Oregon often have higher prices of service.

During the event, participants identified the following needs for moving to greater transparency in the community: interest, funding, data infrastructure, trust, and market cooperation. The KHC will continue this dialogue at NRHI’s National Affordability Summit, “Why Does Healthcare Cost So Much? And What Can We Do About It?” The September Summit is open for registration. We look forward to learning what other trailblazers like Oregon are doing to address the affordability of healthcare in their communities.