High health care costs continue to hit Coloradans hard, with two in three respondents to a new
survey saying they delayed or went without health care due to cost in the last 12 months,
reports CPR News. The issue is even more pressing for low-income respondents and those with
disabilities, who reported even higher rates of delays and foregone care. Across the board, a
large majority, 83 percent, reported being worried about their ability to afford health care costs in
the future. According to the survey, more than nine out of ten respondents backed more reforms, like requiring hospitals, doctors and insurers to provide consumers with upfront cost estimates, and, if an insurer drops your doctor, to make it easy to switch to another health plan.

Colorado’s cap on insulin costs was associated with significant reductions in out-of-pocket
spending for insulin prescriptions, with the mean out-of-pocket payment per thirty day supply
decreasing by almost half, according to a study in Health Affairs. Colorado was the first state to
cap out-of-pocket spending for insulin prescriptions in 2020, requiring fully insured health plans
to cap out-of-pocket spending at $100 for a thirty-day supply. Average out-of-pocket spending
per prescription fell by roughly 40 percent, and patients filling insulin prescriptions saved an
average of $184 per year. At the same time, prescription volume and days’ supply increased,
suggesting that insulin use may have been rationed by some patients prior to the cap’s
implementation.

The Colorado Behavioral Health Administration launched an online portal aiming to increase
transparency and accountability and help the administration offer better care to Coloradans who
need it, reports The Colorado Sun. The Performance Hub includes data showing who is
accessing services—Southern and Eastern Coloradans accessed behavioral health care
services more often than people in other regions of the state—and additional information about
providers licensed by the agency. State leaders say additional data will be added over time to
help identify gaps in care, make systemic improvements and address health care inequities.

Colorado’s overall medical debt burden is lower than most other states, but its racial and ethnic
disparities are wider, reports KFF Health News. The gap between the debt burden in ZIP codes
where residents are primarily Hispanic and/or non-white and ZIP codes that are primarily non-
Hispanic white is twice what it is nationally. Medical debt in Colorado is also concentrated in ZIP
codes with relatively high shares of immigrants, many of whom are from Mexico. Colorado has
taken steps to protect patients from medical debt, but the complexities of many assistance
programs remain a major barrier for immigrants and others with limited English proficiency.

Colorado lawmakers have advanced several policies in recent years to lessen the burden of
medical debt, reports Colorado Newsline. One such policy removes medical debt from
consumer credit reports, impacting an estimated 700,000 residents. Another recent law caps the
allowable interest on the debt to 3 percent and aims to ensure transparency with consumers.
About 11 percent of Coloradans have medical debt in collections, with a median amount of
$693.

A new report finds Colorado's standardized health-insurance plan, known as the Colorado
Option, is changing how consumers interact with insurance, reports Public News Service. In
2024, more than 93,000 Coloradans enrolled in Colorado Option plans, more than doubling
enrollment in 2023 and representing more than a third of all enrollments through Connect for
Health Colorado. More insurers are also offering plans, providing much-needed competition in
12 counties. Primary goals for the Colorado Option were to make insurance easier to
understand and more affordable, and to improve health outcomes for historically disadvantaged
communities.

Colorado’s Prescription Drug Affordability Board (PDAB) has appointed 15 people to the
Prescription Drug Affordability Advisory Council, hosted a five-part learning series, adopted
rules and policies to guide their work, and selected five drugs for affordability review, according
to NASHP. The board has created opportunities for stakeholders to engage and provide
feedback to incorporate consumer voices in its decision-making. In the upcoming year, the
board will continue to review affordability review summary reports and, if a drug is deemed
unaffordable, consider setting an upper payment limit.

OmniSalud, Colorado’s health insurance plan for low-income undocumented and DACA
recipient residents, filled all 11,000 spots for coverage with additional financial assistance in two
days when enrollment began at the beginning of November, reports 9News. Eligible residents
can still enroll in OmniSalud, but will have to pay monthly premium costs. Advocates say this
indicates that many undocumented residents are struggling to access health care and
underscores the necessity of the program.

Cost reductions from Colorado’s health insurance programs have saved $245 million, which the
state will receive in federal pass-through funding, reports Colorado Politics. The funding comes
from the state’s reinsurance program and the Colorado Option, marking the first time a state has
been awarded federal pass-through funding for a combined program. The funding will be used
to lower premiums through the reinsurance program, provide direct subsidies for Connect for
Health Colorado consumers, and support the OmniSalud Program, which allows undocumented
immigrants to obtain health insurance from Colorado Option plans.

Approximately two million unnecessary health care services were delivered in Colorado in 2021,
leading to $134 million in costs, reports Health Payer Intelligence. The top five low-value
services provided were opioid prescriptions, Vitamin D deficiency screening, prostate cancer
screening, imaging tests for eye disease, and coronary angiographies; these services combined
contributed almost two-thirds of Colorado’s low-value care spending (63%). Commercial health
plans were most likely to spend on low-value health services.

Colorado has passed a law limiting the use of copay accumulators, reported by the Lupus Foundation of America. Copay accumulators prevent third-party financial assistance from counting toward a patient's deductible and out-of-pocket maximum, which can increase patient costs and limit access to care. Colorado's SB23-195 ensures that financial assistance can be used toward a patient's deductible and other cost-sharing requirements.

Colorado passed legislation directing the Department of Health Care Policy and Financing to track hospital price transparency compliance and refer those in violation to the attorney general, reports CBS News Colorado. The state is aiming to enforce federal price transparency requirements, which advocates argue federal regulators have failed to do. It will be considered a deceptive trade practice if hospitals do not post their prices, with an accompanying fine of $20,000 per violation.

Colorado passed legislation capping the out-of-pocket cost for a two-pack of epinephrine auto-injectors at $60, reports The Denver Post. While the law only applies to state-regulated health insurance plans, residents who do not have a state-regulated plan or Medicaid or Medicare coverage will still be able to access epinephrine auto-injectors for $60 by applying for an affordability program, beginning next year.

Colorado passed legislation eliminating the practice of “spread pricing,” that is, up-charging up prescription drugs by middlemen, on state-regulated individual and group policies and the state’s Medicaid program beginning January 2025, according to the Colorado Department of Health Care Policy and Financing. The legislation contains a provision enabling self-insured employers to opt-in to the policy. Eliminating spread pricing is estimated to save currently impacted employers an average of 10-25 percent on their prescription drug costs. The legislation also requires transparency reporting from pharmacy benefit managers and insurance carriers.

Colorado has passed a law ensuring additional protections against medical debt for consumers, reported in Lexcology. Senate Bill 23-29 caps the interest rate on medical debt at 3 percent annually and requires debt collectors or collection agencies to provide consumers with an itemized statement of debt and allows them to dispute its validity, among other provisions related to debt collection practices. It also requires health care providers to provide an estimate of the total cost of a health care service upon request to a person who intends to self-pay for the service and sets a cap that the final cost may exceed the self-pay estimate by 15 percent.

Colorado Governor Jared Polis signed legislation eliminating co-pays for pharmacy and other health care services for Colorado’s Medicaid program, reports State of Reform. Colorado residents with Medicaid coverage will have services such as hospital services, physician services, and prescription drugs covered without any cost-sharing, beginning in July. Additionally, the legislation will enable the state to pay providers more and access additional federal funding to make up the difference from the lost co-pay revenue.

A health equity analysis of data from Colorado’s APCD found that social factors such as income, housing, race, and education are strongly associated with potentially preventable visits to the emergency department, according to the Center for Improving Value in Health Care. In urban areas, all five social factors evaluated (income, education, employment, housing/transportation, and race/ethnicity/language) were all strongly correlated to greater preventable emergency department visits and adults not receiving preventive care. However, in rural areas, only income and education levels impacted potentially preventable emergency visits and only income levels influenced adults not getting preventive care. Statewide, the social factors analyzed did not show an impact on children and adolescents receiving preventive health care.

Colorado’s Center for Improving Value in Health Care released the first health care transparency tool of its kind in Colorado, showing how provider payments vary across the state, reports AboutHealthTransparency.org. The provider payment tool is the first comprehensive
analysis that identifies how much providers are paid for thousands of services, using claims information from the state’s APCD.

The Centers for Medicare and Medicaid (CMS) granted Colorado’s Section 1332 state innovation waiver to create its own state-specific public option next year, reports Fierce Healthcare. The public option plan will be sold on the state’s marketplace and is expected to lower premiums by an average of 22 percent. Under state law, the public option plan also must lower premiums by five percent in 2023, 10 percent in 2024 and 15 percent in the third year. The state’s public option plan will operate within Colorado’s reinsurance program, which is authorized to continue under the waiver through 2027. CMS will pass through any savings that the federal government receives to the state, which will in turn use that money to offer subsidies to further lower the cost of healthcare.

A new analysis from Colorado’s Center for Improving Value in Health Care shows that Coloradans received more than one million unnecessary and potentially harmful low-value healthcare services, reports AboutHealthTransparency.org. Low-value services—defined as certain treatments, diagnostic tests, and screenings where the risk of harm or cost exceeds the likely benefit for patients—were identified with 2018-2020 data from Colorado’s all-payer claims database. These services resulted in $134 million in excess costs for Coloradans and health insurers.

Almost half of Coloradans have delayed a recommended medical treatment due to affordability or access issues, reports Colorado Newsline, with 30 percent saying treatment was too unaffordable, while 19 percent said insurance denied them coverage. These results from a survey conducted in mid-January 2022 also found that people thought that the most unaffordable aspects of care were emergency department costs, surprise medical bills, health insurance deductibles, post-care bills and prescription drugs. In addition, just 34 percent of people felt very confident that they could pay for typical healthcare, underscoring affordability burdens felt across Colorado. Furthermore, 62 percent of respondents think that systemic racism is a problem in the country’s healthcare system, with Black and Hispanic or Latino respondents being more likely to see racism as an issue.

Colorado’s Center for Improving Value in Health Care (CIVHC) launched an affordability dashboard to provide users with information on healthcare cost drivers, reports CIVHC. The new affordability dashboard cost of care data digs deeper into service categories and new categories for spending, including long-term care and dental services. Additionally, the new dashboard investigates the outpatient service spending category and highlights the subcategories of spending that drive outpatient costs, including other uses (includes radiology, chemotherapy, hemodialysis and physical therapy), emergency department use and pharmacy (drugs administered in an outpatient setting).

Colorado residents can now indicate that they are uninsured and interesting in finding out if they quality for free or low-cost health coverage on their tax returns, according to Connect for Health Colorado. Residents who do so can qualify for a special enrollment period for coverage on Colorado’s marketplace or they can be connected to coverage on Colorado’s Medicaid program, as part of the state’s effort to reduce the uninsured rate. 

Colorado’s Office of eHealth Innovation has released a refreshed version of the Colorado Health Information Technology Roadmap, a framework for leveraging technology to address gaps in the state’s healthcare systems, reports Colorado Newsline. The roadmap highlights three overarching goals: supporting better data sharing infrastructure; increasing access to healthcare through coordinated systems; and improving health equity. Success is defined as patients finding the care they need with doctors who are equipped to access shared clinical data, but connecting to the state’s health information exchanges can be difficult in rural communities. Implementing an electronic medical record system can be prohibitively expensive for smaller rural facilities. The roadmap also notes how COVID-19 highlighted inequities in telehealth use—the people who were most affected by the pandemic (the elderly and Black patients) could have been at a disadvantage for care, as they had lower rates of telemedicine adoption than the general population.

Colorado’s Center for Improving Value in Healthcare’s Community Dashboard documents the continued rise in healthcare costs for Coloradoans, reports AboutHealthtTansparency.org. The dashboard contains 2013-2020 data from Colorado’s APCD to document the increasing costs, despite positive trends showing less utilization of high-cost services and improved quality of care.

Caitlin Wells Salerno was expecting a bill for the birth of her baby, but was shocked to see a significant charge for the highest level of emergency services, reports Kaiser Health News. Wells Salerno had a routine vaginal delivery and had only checked in at the ER on her way to labor and delivery—she didn’t receive any services in the ER that are reserved for the most serious cases and receive the highest amount of reimbursement. Wells Salerno tried contacting the insurer and fighting the charge, but eventually gave up and paid the bill, noting that she was at a very vulnerable place immediately postpartum and had been taken advantage of when she wasn’t in a position to fight back.

Colorado’s Office of Saving People Money on Health Care released a report documenting the burden that out-of-pocket expenses causes consumers and the importance of addressing it. The report reflects the voices of Coloradans, particularly those with chronic illnesses, who have faced affordability burdens with whom the Office engaged in research about their experiences with health challenges. The report aims to foster conversations among community members, policy makers and providers to collectively take action to further equitable access to affordable healthcare and improve the wellbeing of Coloradans.

A survey conducted by Consumers for Quality Care found that Coloradans are increasingly worried about the rising cost of healthcare, reports Public News Service. Many families report struggling to pay medical bills, even with insurance coverage. Communities of color disproportionately experience a healthcare affordability burden, with nearly half of Latinx Coloradans having an unpaid medical bill.

A report released last week by the Colorado Department of Health Care Policy and Financing (HCPF) found that Colorado hospitals have the highest profit margins in the country, leading to increased prices for payers and patients, reports AboutHealthTransparency.org. The department evaluated the Medicare Cost Report Data for Colorado’s hospitals from 2009 to 2018; however, it only included hospitals with 25 or more beds, excluding most rural hospitals. HCPF estimates that Colorado hospitals’ operating costs were $1.3 billion above the national median.

A new report from the Center for Improving Value in Health Care shows that Colorado could save up to $140 million annually and reduce potential harm to patients by minimizing low-value healthcare services, reports abouthealthtransparency.org. The report analyzed claims from 2015-2017 from Colorado’s APCD for both private and public health insurance and found that 1.36 million Coloradans received one or more low-value care service and more than half (53%) of the care was identified as wasteful or likely wasteful. The report found the top low-value services in Colorado were concurrent use of antipsychotics and opioid use for back pain.

Some private insurance companies in Colorado will soon be required to offer a state-regulated health insurance plan, reports the Colorado Sun, now that the governor has signed House Bill 1232. Insurance companies will be required to offer it in 2023 at a cost reduction of at least five percent, and the total reduction must meet 15 percent starting in 2025. The governor also signed Senate Bill 175, which creates a five-member Prescription Drug Affordability Board that will have the authority to cap the price of prescription drugs that the panel determines are too expensive. The Board is also tasked with making policy recommendations to state lawmakers on how to make prescription drugs more affordable.

Public and private employers and two purchasing coalitions have joined the Colorado Purchasing Alliance and Purchaser Business Group on Health, reports Modern Healthcare. The goal of the group is to negotiate directly with health systems to set prices for common procedures. Larimer County, who joined the group, hopes that the partnership will drop its $25 million annual healthcare costs by another 10 percentage points. The group hopes that by staying local, they can get better care for people with chronic conditions and allow regional employers to enter a common purchasing coalition but still customize their individual companies’ benefits. The group will identify high-quality medical providers in Colorado, and the not-for-profit's national employer members will also be able to opt in to the contracts that the local business group negotiates.

A new analysis found large variations in commercial health insurance payments compared to Medicare payments across Colorado hospitals, reports the Center for Improving Value in Health Care. Colorado hospitals received commercial payments for inpatient and outpatient services that were anywhere from 108% to 508% of Medicare rates for the same services at the same hospitals. In particular, outpatient services in Colorado are among the most expensive in the state and a driver of rising healthcare costs.

The Colorado Department of Health Care Policy & Financing evaluated the impact of telemedicine policy changes during COVID-19, reported State Network. The report found that the percent of telemedicine visits increased from 0.2% of services before the pandemic to 20.3% during the height of the pandemic. The top diagnoses among adult telemedicine users were opioid dependence, generalized anxiety, major depression, hypertension, diabetes and back pain. Urban providers delivered a higher proportion of services via telemedicine compared to rural providers, which may be due to lower broadband access in rural areas. Federal qualified health centers were the highest adopters of telemedicine; at the height of the pandemic, telemedicine visits were 61.3% of all visits.

In 2018 Colorado hospitals were more expensive, had higher costs, and reported higher profit margins than any other state, according to AboutHealthTransparency.org. A financial analysis conducted for the Colorado Business Group on Health using data from the Centers for Medicare & Medicaid Services found that Colorado hospitals had an average profit margin of 15.6%, which is the highest in the nation. At the same time, smaller rural hospitals had significantly lower profit margins and even lost money. A major contributing factor to the state’s high prices is the heavy concentration of hospital power into a few health systems.

Colorado launched pop-up vaccination sites in underserved areas in an attempt to eliminate the racial and economic disparities in COVID vaccine distribution, reports the Colorado Sun. The goal of the program is to reach underserved communities where they are and reduce barriers to vaccination, such as online vaccination appointment portals and inoculation sites that are far away. So far, Colorado has operated 18 of these health equity clinics, administering thousands of doses to Black and Hispanic Coloradoans who have much lower vaccination rates than their white counterparts. The Governor also says the state needs to build vaccine trust among these communities by developing ambassadors and leading by example.

Colorado is now soliciting vendors to implement the state’s Canadian Drug Importation Program, reports CBS Denver, and anticipates awarding vendor contracts later this year. The program is designed to give Coloradans access to Canada’s lower-prices drugs and was made possible through a change in federal policy enacted in November 2020, which allows FDA-authorized programs to import certain prescription drugs from Canada. A recent report from the Colorado Department of Health Care Policy & Financing posits that the average savings on importable drugs could be more than 60 percent, but savings for some drugs was greater than 90 percent.

A new report from the Colorado Department of Health Care Policy & Financing found that specialty drugs represented less than two percent of drugs prescribed to patients in Colorado but accounted for almost 50 percent of total prescription drug expenditures, reports State Network. Additionally, the report on reducing prescription drug costs found that rebates paid to middlemen such as PBMs and insurance carriers are often retained as profits. Proposed solutions include creating an affordability board to study prescription drug prices, passing along rebates and savings to employers and consumers and increasing transparency in prices, profits and rebates.

Although Colorado passed a law last year limiting surprise medical bills, the law does not apply to air ambulances, which are regulated by the Federal Aviation Administration, reports The Denver Post. As a result, when a 4-week-old baby was taken to Children’s Hospital Colorado via air ambulance for an urgent surgery, the family was left with a medical bill of nearly $82,000, of which the insurer would pay only $18,000. Ultimately, the family worked with their insurer and the private air ambulance company to negotiate the bill down to $45,000.

Colorado’s health insurance marketplace has launched a Public Benefit Corporation (PBC), which will offer healthcare ancillary products and services across the state and aims to increase consumer health literacy, according to Connect for Health Colorado. The PBC will also administer the plans and financial assistance, which will fund the state’s reinsurance program, provide financial help to people with low incomes whose net premium would increase as the individual market price for insurance decreases and set up a fund to provide financial help to people who don’t otherwise qualify under the ACA. The financial help will be in the form of a separate state-funded subsidy, available to people beginning in 2023.

Larimer County, Colorado, partnered with Healthcare Bluebook to find ways to guide their health plan members to high-value providers, resulting in significant savings for both patients and the county, reports American City and County. Through this partnership, Larimer County employees use an online tool compiled by Healthcare Bluebook that shows provider scores on both quality and costs based on healthcare providers’ health outcomes. Consumers receive a portion of the overall savings from the program—in its first year, the program produced a return on investment of over 340 percent. In the coming year, the county will launch a new pilot program with Healthcare Bluebook to eliminate member cost sharing for certain procedures when members choose a high-value provider. 

Colorado has become one of the first states in the U.S. to allow pharmacists to prescribe HIV prevention drugs, as part of a public health effort to curb rising infection rates, reports the Colorado Sun. Pharmacies can now offer the daily preventive pill or an emergency version that can be taken within 72 hours of an exposure to the virus. While rural communities may have just two or three primary care doctors, they typically have about a dozen pharmacies, making this law a true expansion of access to the medication. This new HIV protocol also allows pharmacists to collect reimbursement from insurance companies for providing consultation to patients.

More than 40 percent of surveyed Coloradans with diabetes said that high insulin costs forced them to ration their own use of the lifesaving drug at least once a year, reports the Colorado Sun. According to a new report from the state’s Attorney General, insulin costs for Colorado patients rose 262 percent in the past 10 years, which could be the result of a lack of competition among drug makers and distributors. These ‘lockstep’ price increases that have drawn lawsuits over alleged collusion. The report was ordered as part of a 2019 bill that caps copays for insulin at $100 a month and zeroes in on the fact that the insulin market is dominated by just three manufacturers and three pharmacy benefit managers. The report recommends steps that the state or federal government can make quickly to ease consumer burdens.

Behavioral health experts are partnering with primary care physicians in 30 UCHealth primary care clinics across Colorado so that patients can easily get their mental and emotional needs met in the same setting, reports KOAA News5. The goals of this program are to increase access to behavioral health services and decrease stigma by normalizing these services for patients.

Citing challenges to addiction treatment access in Colorado, a new state program has transformed six RVs into mobile clinics to reach isolated communities, reports Kaiser Health News. As brick-and-mortar addiction clinics have closed or stopped taking new patients due to COVID-19, these mobile clinics have become more crucial to rural residents seeking addiction care. Each RV has a nurse, a counselor and a peer specialist who has personal experience with addiction. And because broadband access is often limited in rural areas, these RVs provide a telehealth bridge to medical providers in cities, so that rural residents can be prescribed medicine to fight addiction and overdose. 

A new interactive Community Dashboard provides information on the cost of care, quality of care, access to care, and utilization of services across payers by region and county in Colorado, reports the Center for Improving Value in Health Care. In general, the data show that quality of care in Colorado has been improving over time, but costs of care continue to rise and people in Colorado aren’t always using their healthcare benefits. From 2013 to 2018 the percentage of people who don’t use their health insurance at all has increased by 3 percent, and percent of users who don’t have chronic conditions and use preventative care has decreased by 24 percent.

The Colorado Governor and Behavioral Health Task Force have released a blueprint for making substance use and mental health services more accessible and affordable, reports the Office of the Governor. Although over 1 million people in Colorado have a behavioral health condition, Colorado performs poorly on measures of access to mental healthcare compared to other states. The blueprint recommends a number of reforms, including creating a statewide behavioral health administration, increasing telehealth for behavioral health services, and creating a regional care coordination system to help consumers navigate care in the state.

Envida, a local nonprofit, offers a ride service to those experiencing a mental health crisis in El Paso and Teller Counties, as transportation can often be a barrier to care for some individuals, reports KOAA News 5. The service was rolled out as a test program last year, and Envida has seen their ridership quadruple since the COVID-19 pandemic hit. The drivers are trained in behavioral and mental health issues, and the program also provides home healthcare services to people with disabilities, older adults and those experiencing financial challenges.

Native American communities across the country are experiencing five times the hospitalization rates and 40 percent more deaths than whites due to COVID-19, concerning state officials in Colorado, reports 9 News. The executive director of Denver Indian Health and Family Services, Adrianne Maddux, notes that factors such as food insecurity, lack of access to fresh water, healthcare and PPE make the communities even more vulnerable to the disease. The Colorado Department of Public Health and Environment is partnering with Denver Indian Health and Family Services to create a COVID-19 Native Responses team, that will be made up of community members trained in crisis counseling and will work to provide resources and mental health services to support the communities. The state will also provide free testing for Native Americans across Colorado and is working to develop culturally responsive public service announcements related to prevention.

Young adults in Colorado, and millennials in particular, are more likely than Generation X or baby boomers to be facing financial challenges that directly affect their health, reports the Colorado Health Institute. Not only do millennials earn, on average, less than other working-age adults, but they are also the most likely among those three generations to report having problems paying medical bills.

Prior to the COVID-19 pandemic, telehealth use was already increasing, reports State of Reform. Using the Colorado all-payer claims database, the Center for Improving Value in Health Care report shows telehealth utilization increased 33 percent among commercially insured patients, 91 percent for Medicaid beneficiaries and 13 percent for Medicare Advantage patients between January 2018 and February 2020. Telehealth utilization is especially high among females and young adults aged 18-22, as well as in some (but not all) rural counties.

Months after having an emergency appendectomy and a second surgery to remove a large blood clot that was likely a complication from the appendectomy, Shannon Harness is still fighting to negotiate and pay off his hospital bills. In this edition of Kaiser Health News’ Bill of the Month, we learned that as an uninsured patient Shannon was charged $80,232 for both surgeries, which is three to four times what an insurer would pay for the same surgeries. Paradoxically, uninsured patients have the highest medical bills because they don’t benefit from the discounted rates negotiated by insurers. After months of negotiation with the hospital, Shannon was able to lower the bill down to $22,304.17 and is working on a payment plan with the hospital.

Proponents are continuing to set up the Colorado Purchasing Alliance, despite setbacks caused by the coronavirus, reports the Colorado Sun. The alliance, a group that brings together employers and individuals to use their collective leverage to negotiate better deals from providers and insurance companies, will launch in 2021 with as many as 200,000 people enrolled. Similar to the other purchasing alliance in Colorado, the Peak Health Alliance, the Colorado Purchasing Alliance aims to significantly reduce healthcare costs and improve coverage. 

Coloradans with individual health insurance plans can expect to save an average of 17.4% on their premiums in 2021, reports the Colorado Division of Insurance. In addition, two of the eight insurance companies that offer plans on the individual market will expand into new counties in the state. Colorado is one of fourteen states with a state-based reinsurance program, which works by paying a portion of high-cost claims so insurers can charge lower premiums for individual health plans. Recently passed legislation in Colorado has extended the reinsurance program for another five years.

Colorado has four new health insurance laws focused on improving access and affordability for state residents, reports Summit Daily. The first law creates the Health Insurance Affordability Enterprise, which extends Colorado’s reinsurance program for five years and expands coverage to those who were initially left out. The law also aims to provide more access to insurance for low-income people who receive federal subsidies, as the program caused those individuals to spend more on health insurance than they had before. The second law deals with reimbursement for telehealth services and requires that insurance carriers cover telehealth visits for behavioral, mental and physical healthcare. The state has also simplified the health insurance enrollment process by enabling people to enroll while filing their taxes and allowing working adults with disabilities over the age of 65 to participate in the Medicaid buy-in program.

The Colorado Center for Improving Value in Health Care has expanded Shop for Care, a transparency tool that allows consumers to compare price and quality information for select services and procedures at Colorado healthcare facilities, according to AboutHealthTransparency.org. The newly improved tool includes updated 2018 prices for imaging services like X-rays, CT scans and MRIs, as well as episode prices for 11 new hospital and outpatient procedures including hysterectomies, colorectal resections and more. The tool shows that price and quality vary significantly across Colorado, and higher prices do not necessarily signal better patient experience or outcomes.

Timothy Regan went to the ER in April after experiencing a severe cough, low-grade fever, and chest pain. Despite having COVID-like symptoms, he was not given a COVID-19 test because they were in short supply at the time. He was sent home after his chest X-ray and electrocardiogram results were normal and told to quarantine for 2 weeks as a precautionary measure. In this edition of Kaiser Health News’ Bill of the Month, we learn that Timothy was billed $3,278 for the ER visit, of which the insurer paid $1,042 and Timothy was responsible for $2,236. Since Timothy's ER visit, many insurers have announced waiving cost-sharing for COVID-19 testing-related visits and treatment to remove barriers to care. After an appeal, Timothy’s insurer agreed to bill Timothy as a COVID-19 patient and waive all cost-sharing for the ER visit, giving Timothy his happy ending.

A brief from the Colorado Health Institute looks at how telemedicine has boomed due to the COVID-19 crisis and whether Colorado will continue to use telemedicine at current levels once the COVID-19 pandemic has passed. The Colorado Health Institute identified five strategic policy areas that federal and state leaders have targeted to expand telemedicine, summarized with the acronym RAPID: reimbursement; access to services; professionals; information; and definitions. This brief also outlines key questions and research opportunities to guide policy discussions and offers profiles of how different providers have begun to use telehealth within the state.

Colorado’s Medicaid program is projecting well over half a million (563,000) more Coloradans will enroll in Medicaid between April and December, according to a new report from the Colorado Health Institute on the impacts of COVID-19 on state hospitals. This would be the biggest surge in Medicaid enrollment in Colorado’s history—larger than its peak during the 2014 Medicaid expansion. Most of the expected new Medicaid beneficiaries formerly had employer-sponsored insurance, which reimburses hospitals at a much higher rate than Medicaid. This surge is expected to reduce the revenue of Colorado hospitals by $500 million over the next year.

Colorado lawmakers decided to table their public option plan because consumers, providers and other stakeholders haven’t been able to weigh in on the bill because of the COVID-19 pandemic, reports Modern Healthcare. The bill’s sponsors promised to resurrect the effort next year, arguing that the economic fallout from the outbreak demonstrates a need for more affordable health coverage plans in the state. The Colorado Hospital Association has denounced this public option plan, instead pushing its own plan for a statewide healthcare budget similar to policies in Oregon and Massachusetts.

While crisis walk-in mental health centers and mobile response teams across Colorado remain open during the coronavirus pandemic, most clinical therapy sessions have gone virtual, according to the Colorado Sun. While therapists say virtual sessions don’t provide the same level of human connection, they do have other benefits, including making it easier for clients to get to their appointments and allowing people to ease into therapy from home. Mental health professionals are operating under temporary guidance approved by federal and state agencies that will allow them to bill Medicaid, Medicare and other insurance providers the same amount for a telemental health appointment as they could for an in-person session. This is drastically different from previous rules in Colorado around telehealth, including one rule stating that therapists could only use telemental health if the client lived in a town with a population under 50,000, or that the client had to travel at least 30 miles to visit their therapist. 

Colorado has embarked on numerous healthcare reforms this year, reports Global Health News Wire. Major initiatives include creating the Office of Saving People Money on Healthcare, passing a reinsurance bill to sheild insurance plans form the costs of their sickest patients, initiating surprise billing protections, capping copays for insulin, and authorizing the Polis administration to develop a public option proposal. Though there is industry pushback to these initiatives from hospitals and insurers, there is no doubt that Colorado is ahead of the curve in healthcare initiatives. 

The Govenror and Lt. Governor of Colorado released an updated 2020 Roadmap to Savings Coloradans Money on Healthcare to reflect the progress made over the last year to lower healthcare costs for state residents. The updated roadmap notes some major inroads, including: an average reduction of 20.2 percent statewide in insurance premiums on the individual market, the design of a state public insurance option, and the establishment of a Behavioral Health Taskforce. The 2020 Action Items that the Office of Savings People Money on Health Care seeks to advance include adopting a state public insurance option, extending the state's reinsurance program, launching a statewide purchasing alliance, and launching a Prescription Drug Affordability Board. 

Colorado hospitals can operate effectively with commercial insurance rates that are at a drastically smaller percentage of the Medicare reimbursement rate  than what many are bringing in now under the state’s current healthcare system, according to State of Reform. The Colorado Department of Health Care Policy and Financing released an analysis showing that Colorado hospitals, on average, can cover their costs if reimbursed at 143 percent of Medicare rates. The conclusion is based on 2018 payment to cost ratio for Medicare payments and how much was needed to raise Medicare rates to ensure hospitals were paid their costs for seeing patients. The study also concluded that hospital across the nation, on average, cover the cost of providing care to patients at 115 percent. A RAND Corp. study found that Colorado hospitals charge privately insured patients for inpatient and outpatient, combined, on average, 269 percent of the Medicare rate, while inpatient services were billed at, on average, 221 percent of the Medicare price, indicating that commercial rates may be higher than they need to be.

High prices at hospitals are driving up the cost of healthcare more dramatically in Colorado than elsewhere in the U.S., according to CPR News. Hospital profits increased by more than 280 percent between 2009 and 2018, a state report found, and profit per patient rose to more than $1,500 a patient. The report by the Department of Health Care Policy and Financing also found that uncompensated care in Colorado is at a historic low, and hospital spending on charity care and bad debt has dropped more than $385 million a year since Medicaid expansion in the state.

In Colorado, the averae deductible in 2017 was nearly $5,800 for a bronze-level plan, and according to an analysis by the Colorado Center on Law & Policy, 1 in 4 Coloradans wouldn't be able to afford to pay the deductible over the course of a year, according to Kaiser Health News. Rural and lower-income Coloradans are increasingly likely to be unable to afford a high deductible. As such, rural residents who are transferred from smaller, rural hospitals to larger hospitals with a higher level of care may never end up paying their bills at the first hospital. While Colordo has avoided the rural hospital closures that have plagued other states, 22 rural Colorado hospitals have operated in the red in 2019. 

A recent report from the University of Colorado Denver revealed that there are 71 census tracts in Colorado where a high rate of housing insecurity and mental health needs overlap, according to The Colorado Independent. The interactive map included in the report will be used by officials and lawmakers to more efficiently target services and funding. These preliminary findings support a 2019 study by the Robert Wood Johnson Foundation that found households that struggle with greater housing cost burdens also see poorer health outcomes. Experts hope this map will allow policymakers to locate the best areas to provide additional support to produce better outcomes.

For the first time since Colorado opened its health insurance exchange, people will see a drop in coverage prices, according to the Canon City Daily Record. Coverage costs across the state will drop by an average of 20.2 percent. In western Colorado, which has some of the highest health insurance premiums in the U.S., a family of four will save an average of $10,000 per year, according to the Colorado Division of Insurance. The main reason for the price cut is the state’s new reinsurance program, which uses $260 million in state and federal funding to cover some of the most expensive medical costs for those who purchase plans through the marketplace.
 

A new Colorado law will establish a legally protected process for communication with patients and/or their families and a format for resolution after an adverse healthcare incident, according to the National Law Review. Participation by healthcare facilities and providers is voluntary and the process must be initiatied by the healthcare provider involved in the adverse incident or by another provider jointly with the health facility involved. If the process is initiated by the patient or their family/representative, the discussion will not be protected. If followed correctly, this complicated process can significantly benefit nursing homes and assisted living facilities in investigating, communicating and resolving compensation issues related to adverse resident outcomes. 

Health systems and physician groups have dominated the Denver healthcare market in recent years, but employers and health plans are poised to disrupt that dynamic, reports HealthLeaders. Four major health systems accounted for 85 percent of patient admissions in 2017, according to a report by Catalyst for Payment Reform and the Colorado Business Group on Health, which may be enough to stifle price competition. Indeed, the study revealed that Coloradans face 13 percent higher prices compared to the national average and 5 percent higher utilization rates. Authors of the report indicate that a statewide purchaser cooperative may be an effective method to change the market dynamics in Denver. 

Though high prices at specific Colorado hospitals may correlate with higher quality for some services, price does not appear to predict or even reflect quality on balance, according to an analysis by the Colorado Business Group on Health and the Colorado Consumer Health Initiative. The report notes that hospital quality varies nearly as much within hospitals as it does across hospitals. Furthermore, hospital prices for routine healthcare procedures in Denver varied by more than 800 percent in 2017. The hope is that “Hospital Value Reports” such as this one will incentivize value by examining price and quality measures in concert. 

Data from Colorado’s all-payer claims database show wide variation in the facility fees charged by hospitals and freestanding emergency departments, according to Modern Healthcare. For example, the Center for Improving Value in Health Care reports that for the highest severity level, the facility fees commonly ranged from $1,990 (25th percentile) to $4,700 (75th percentile), but can go as high as almost $48,000.

Rural and mountain region emergency medical services are trying just about anything to keep their money-losing ambulances running across Colorado’s rugged or remote terrain, according to The Colorado Sun. High costs, low reimbursement rates and scarce job applicants are forcing ambulance services to consolidate with fire responders, take on new tasks between emergency runs, and outsource fast-growing transport runs to bigger metro hospitals. Rural counties tend to have higher percentages of low-reimbursement insurance such as Medicare, Health First Colorado (Medicaid) or veterans care, making every ambulance run a money loser for the local hospital or emergency services district.

Colorado state officials will purchase six vans from New York-based Medical Coaches to expand the treatment of people with substance abuse issues, according to mHealthIntelligence. The vans will be equipped with connected health tools that allow healthcare providers to deliver Medication Assisted Treatment (MAT) therapy. Healthcare providers are increasingly turning to MAT therapy as a means of treating people with substance abuse disorder – Colorado is using a $30 million State Opioid Response (SOR) grant from the Substance Abuse and Mental Health Services Administration (SAMHSA).

Both Medicaid members and commercially insured Coloradans have relatively good access to healthcare, according to a new analysis by the Colorado Health Institute (CHI). CHI’s Access to Care Index scores 25 measures of access on a scale of one to 10, with 10 being the best. Overall, Medicaid members scored 7.4 and commercially insured Coloradans scored 8.2. However, the index suggests that access to care for Medicaid members has room for improvement: those with commercial insurance have a better chance of finding a provider; the logistics of getting to the doctor are harder for Medicaid members; and that regardless of payer, obtaining preventive care remains hardest.

Using 2017 claims data available through the Colorado All-Payer Claims Database, an interactive map from the Center for Improving Value in Health Care (CIVHC) illustrates regional variation for 11 common services, according to AboutHealthTransparency.org. Though no one region had consistently high or low prices, some regions stand out. For example, the West region is the highest with respect to prices for five procedures – breast biopsy, C-section, hip replacement, knee arthroscopy and tonsillectomy. 

The Colorado legislature passed numerous bills in the healthcare space that primarily focused on reducing the cost of care for consumers and improving accountability for quality care, according to the National Law Review. Some of these laws include HB 19-1174, which requires insurance carriers, providers and facilities to begin providing patients with information on the potential impact of receiving services from an out-of-network provider, prohibits “balance billing” patients who receive covered services from out-of-network providers at an in-network facility or emergency services from out-of-network providers or facilities, and establishes the reimbursement amount insurance carriers must pay to out-of-network providers that provide health care services to covered persons at an in-network facility or out-of-network providers for emergency services. HB 19-1131 requires that manufacturers and their representatives provide information about the wholesale acquisition cost of a prescription drug when providing information to a health care provider licensed to prescribe controlled substances or prescription drugs, and that when providing wholesale prescription drug price information, the manufacturer and representatives must also provide a list of at least three generic prescription drugs from the same therapeutic class and their wholesale acquisition costs. HB 19-1320 requires certain hospitals to complete an annual community health needs assessment and annual community benefit implementation plan.

Colorado Governor Jared Polis signed legislation that caps insurance co-payments on insulin at $100 a month, no matter the type of insulin. According to The Denver Post, the measure goes into effect in January and insurers are expected to pay the difference in price. The cost of insulin has continued to increase in the U.S., with prices doubling since 2012. 

A new Colorado law protects patients from surprise medical billing by prohibiting healthcare providers from sending consumers a bill when they’ve unknowingly received out-of-network care. According to High Plains Public Radio, the law also sets a reimbursement rate that insurers pay to out-of-network hospitals and doctors. Researchers with the Center on Health Insurance Reforms at Georgetown University have found Colorado is more protective of consumers with respect to surprise medical billing, than other states in the region.

A collective in Summit County, home to 30,000 people in Colorado, is implementing a novel strategy to address high healthcare costs, according to Modern Healthcare. A knee replacement in the county costs 89 percent more, on average, than in the Denver metro area, while a craniotomy can cost a patient 163 percent more, on average. Peak Health Alliance, a collective of small and large businesses and individuals, representing roughly 6,000 people, has launched a unique model to negotiate discounted rates for medical services directly with the county’s main health system and only hospital provider, Centura Health. Following this negotiation process, Peak sends those contracted rates to health insurers to see who can craft the best plans. The effort was strengthened by a wealth of claims data that revealed that the county’s providers collected more than 500 percent of Medicare rates for outpatient hospital services in 2015 and 2016, driving many residents out of the county for care. Some of Peak’s success will depend on how well the selected insurer is able to manage the small population of members that drive 50 percent of the spending.

A new survey conducted by the Healthcare Value Hub discovered that more than half (58%) of Coloradans were burdened by healthcare costs, according to the Durango Herald. Healthcare continues to be an important topic of conversation for Coloradans, especially those outside the Denver metro area, where nearly two-thirds of those surveyed indicated they were burdened by these high healthcare costs. The survey found that the majority of Coloradans (82%) agreed that the healthcare system needed to change to better meet the needs of the consumers. Coloradans should not have to delay or forgo healthcare due to cost: more than 40 percent delayed going to a doctor or having a procedure done, 38 percent avoided going altogether, 21 percent did not fill a prescription and 19 percent cut pills in half or skipped doses to save money.

The 2019 legislative session is about to start in Colorado, and healthcare, especially funding healthcare will be one of the most actively debated, according to the Colorado Sun. One particular point of tension is the rising costs of insurance, which has risen over 50 percent over the last decade for individuals who had coverage through an employer. Another area of high costs for individuals are health plan deductibles whose costs are rising even faster than premiums; over 65 percent between 2010 and 2017 (more than five times the rate of inflation). Colorado's out-of-pocket costs for healthcare are among the highest in the nation, according to a recent analysis from the Colorado Health Institute. These charts show that the rising costs of healthcare are complicated and connected, involving many different players in the system. 

In 2014, Colorado Center on Law and Policy (CCLP) joined with consumer groups to address the high cost of specialty drugs in Colorado to open a dialogue with the state's Division of Insurance (DOI) and health insurers to address the unmanageable out-of-pocket costs, according to Health Affairs. Many plans charged coinsurance of up to 50 percent of the cost of drugs of the highest tier is discriminatory against people with disabilities and chronic conditions, in violation of the Affordable Care Act. Colorado's DOI enacted a regulation effective June 1, 2018, prohibiting plans from putting more than  Most recently, Colorado’s DOI took decisive action by promulgating a regulation, effective June 1, 2018, prohibiting plans from putting more than half of drugs for a particular condition on the highest cost tier. Though it is difficult to assess whether enforcement of the rule will affect premiums, increases for 2019 individual plans are modest—an average of just 5.6 percent. Plan specifics for 2019 plans are now publicly available, and a review of formulary tiering for HIV drugs reveals some significant improvements from 2018.  If carriers do not comply with the regulations of the ACA, the DOI should exercise its authority to assure that Coloradans have full access to the health care benefits and services they need.

Lisa French received a $229,112 lawsuit from St. Anthony North Health Campus hospital in Westminster for a spinal-fusion surgery she had nearly three years prior, according to The Denver Post. French had an ERISA employer-sponsored health plan and signed a contract before surgery agreeing to be financially responsible for all hospital charges not paid by her health insurance or other payer. But, before the surgery, hospital officials told her that she would only owe $1,336. The material for her surgery cost the hospital around $30,000, and the hospital charged French around $200,000--a nearly 500% markup. French’s bill was one of over 700,000 billing disputes being sent to court. A growing number of employers are refusing to pay full amount of hospital bills of their workers due to this alleged price gouging by the hospitals. The law firm representing French explained they are are trying to prevent patients from being subjected to predatory pricing.

According to Healthcare Informatics, for much of the rural areas of Colorado, mental health clinics aren’t usually connected to primary care physician offices, and mental health specialists tend to have minimal interaction with hospitals until an inpatient encounter, which often occurs long after the best opportunity for productive intervention. A $65 million grant from the Center for Medicare and Medicaid Innovation (CMMI) will enable Colorado to be one of the few states in the country to connect primary care and behavioral healthcare together in one system through telehealth technology.

A new report released this week reveals that the cost of health insurance for employers in Colorado is increasing faster than the national average — and that employers are often pushing that added cost onto their workers, according to an article in The Denver Post. People who get health insurance through their work generally haven’t had to deal with the extreme price increases that have impacted people who buy insurance themselves. But the new reports show they are still being squeezed — just more slowly. Employers have increasingly pushed higher premiums and deductibles onto workers, encouraged greater use of telemedicine and switched to limited networks of doctors, or, in some cases, switched insurance companies altogether.

In 2010 Colorado appointed the Center for Improving Value in Health Care (CIVHC) to be the administrator for the state's all-payer claims database (CO APCD) that continues to grow and currently collects data on more than five million people, the majority of insured individuals in Colorado. CIVHC recently released it's 2017 Annual Report analyzing data from the APCD. The report highlights geographic variations in quality of care. For example, women in rural counties have a lower percentage of breast cancer screening than women in urban counties, children between the ages of 5-11 with private insurance have a lower percentage of receiving appropriate asthma medication compared to Medicaid. The report also analyzed healthcare spending, suggesting that it is impossible to draw general conclusions about healthcare prices based on geography or volume of services performed. The CO APCD allows Coloradans to identify reasons behind the high healthcare spending and begin to understand the variation in healthcare costs, and to identify trends and generate benchmarks to allow comparisons across regions. 

Colorado's total cost for healthcare is significantly higher than some other states, according to an article in The Daily Sentinel. A five-state study, led by the Network for Regional Healthcare Improvement and funded by the Robert Wood Johnson Foundation, revealed that Colorado's healthcare costs across all services are 17 percent above the average of the other states. According to the study, Colorado's rates are driven by a higher use of services—11 percent more than the other states—and higher costs—6 percent more than the other states. Extra spending experienced by Colorado varied by service: costs are 30 percent above the average for outpatient services, 24 percent above average for pharmacy costs and 16 percent above average for inpatient care. 

According to an article in the Denver Business Journal, hospitals in Colorado must begin posting self-pay prices for the most common procedures and treatments they offer—a potential first step in bringing more cost transparency to a sector whose pricing ambiguity has frustrated consumers and public officials alike. The move is mandated by Colorado Senate Bill 65, a 2017 measure aimed at requiring healthcare providers to be able to tell people who are paying bills without the help of insurance what a procedure will cost before they get those services. Medical pricing transparency demands are gaining traction on both state and local levels. Under the new law, healthcare facilities such as hospitals must post the self-pay prices for the 50 most used diagnosis-related group codes—the most common reasons for hospitalizations—and the 25 most-used current procedural technology billing codes. 

The quality measures used to reimburse Medicare providers for high-quality, cost-efficient care do not necessarily translate to a pediatric population. With collaboration in mind, the Pediatric Care Network, a clinically integrated network of over 1,400 providers and the Children’s Hospital Colorado was established, according to a news article in RevCycle Intelligence. The network aimed to define value-based care in the pediatric space. To start the collaborative journey to value-based pediatrics, the network focused on increasing data sharing to gain a comprehensive view into the pediatric care continuum. The Pediatric Care Network intends to break down the data siloes between private practices, hospitals, and other pediatric care centers.

The high-desert region encompassing Pueblo in southeastern Colorado was one of only 14 out of 306 regions nationally to improve on a majority of performance measures tracked by the Commonwealth Fund’s Scorecard on Local Health System Performance, 2016 Edition. Socioeconomic challenges and geographic isolation have fostered a sense of interdependence among local health care providers, who have leveraged the state’s Medicaid expansion to enhance access to care while improving coordination. Providers have also joined with public health and social service agencies, businesses, educators, and nonprofits in creating the Pueblo Triple Aim Corporation, an improvement collaborative that uses data to define problems and create shared accountability for solving them. 

Health systems like UCHealth and Denver Health are betting that the future of healthcare involves a mix of professionals sharing responsibility for patients, according to a report in Politico. While focusing on these Colorado-based systems, this article provides a nice overview of national trend towards collaborative care and changing provider roles and new payment models encouraging health systems to deploy their workers more efficiently — while also avoiding unnecessary services and costly errors.  

The Pediatric Care Network, a collaboration among community pediatric providers and specialists at the University of Colorado School of Medicine and Children's Hospital Colorado, aims to enhance the health and well-being of children by delivering higher quality and more efficient care at a lower cost, according to EurekAlert. The Network will establish and adhere to clear standards of care across the network, coordinate care, and use data and analytics to evaluate outcomes. 

In the Denver metropolitan area, a collaborative pilot project is leveraging electronic health record (EHR) data to monitor public health trends and evaluate interventions, and the data service is providing public health officials with data to identify and address health disparities, according to Health Informatics. The Colorado Health Observation Regional Data Service (CHORDS), based in Denver, is a regional partnership between Colorado health providers, public health departments and the University of Colorado Denver to share health data in order to track population health trends and develop effective interventions.

Colorado’s governor is pushing a package of bills to increase transparency and help slow the rise of healthcare spending in the state, according to the Denver Business Journal. But two bills at the heart of the package could impact future insurance competition in the state. The first would allow local governments to provide health benefits to their employees through the group benefit plan offered to state employees. The second would require insurers that bid to provide the state’s group benefit plan to meet several new requirements, including participating in the state health exchange and rural and Medicaid markets.

Medicaid Accountable Care Organizations in Colorado and Oregon both achieved improvements in service utilization, cost and quality of care, according to a new study in JAMA Internal Medicine. Oregon’s ambitious Coordinated Care Organizations were marked by heavy federal investment and a move to global budgets while Colorado’s Accountable Care Collaborative involved a much smaller state investment and retained fee-for-service provider reimbursement. The study showed that smaller investments such as Colorado’s can nonetheless lead to significant improvements.  

In order to combat high healthcare costs in the High Country and throughout the state, Colorado lawmakers are creating a package of proposed bills, according to The Aspen Times. The bills will address four major themes: cost, choice, quality and transparency, with a consumer protection component weaved into each theme.

The Colorado Health Foundation released a report that focuses on rural communities and highlights barriers Coloradans face in their pursuit of health, including poverty, unhealthy food options, and lack of access to healthcare. The report discusses possible solutions emerging from rural communities to overcome these health challenges.

Since implementation in 2012, the APCD has received national recognition for its design and capabilities, according to the Center for Improving Value in Healthcare. In 2016, three impactful Spot Analyses were released identifying health care cost drivers and opportunities to save money. These publications help inform Change Agents, featured in the report, who provide concrete examples of the power and value of the CO APCD to lower healthcare costs, improve care quality and benefit the health of state residents.

The Colorado Health Foundation, in partnership with the Colorado Health Institute, published the 2016 Colorado Health Report Card. It evaluates the current status of population health, healthcare delivery, and health coverage in Colorado and provides a benchmark for measuring progress on some of the most pressing health issues across 38 key health indicators and through five life stages.

Already paying among the highest healthcare costs in the United States, residents of Colorado’s mountain communities are facing another wave of high costs: pharmaceutical drug prices spiraling out of control, according to the Rocky Mountain Post. Mountain residents have historically paid more in almost every category of healthcare, with the exception of prescription drugs. However, the prices of many common prescription drugs, including insulin and EpiPens, have spiked in recent years. Observers say that creates further hardship – and the real risk people will not be able to afford critical and life-saving medications.

According to a recent report by the Colorado Health Institute, a single-payer healthcare proposal on Colorado’s ballot this fall would not raise enough money to cover the program’s costs. ColoradoCare would see a $253 million deficit in the first year, and the deficit would grow as costs outpaced revenue. A ten percent payroll tax is expected to bring in $25 million annually, but this added funding would fall short without additional tax increases. However, the plan would make Colorado the first state to achieve universal coverage.

A report by the Colorado Division of Insurance evaluated the total cost of healthcare for commercially fully insured Coloradans in nine geographic rating areas currently in effect for ACA health plans. The report found that regional costs vary significantly for inpatient, outpatient, professional services, and pharmacy, with cost differentials of up to 36 percent. The report also confirms that health insurance for Colorado’s western and rural communities are the highest in Colorado.

An independent analysis of Colorado's proposed universal health care system by the Colorado Health Institute estimates it would cover 83 percent of residents and create a massive new entity that would dwarf most U.S. corporations.

The Colorado Division of Insurance is using its authority to issue guidance in the form of bulletins to enact new consumer protections for network adequacy and provider directories. The finalized bulletin includes standards for appointment wait times, travel distance, and provider-to-enrollee ratios by specialty or service type. The directory standards bulletin will soon be finalized.

Denver Business Journal: Legislators in Colorado agree that greater transparency would help consumers understand what they are paying to hospitals, physicians and drug companies and, in turn, to try to bend the upward cost curve of care. However, they send a  seemingly conflicting message and voted down a bill that would allow such transparency.

Denver Business Journal: There is a strong correlation between social factors and health outcomes through the state and country, said Janna West Kowalski, a Colorado-based community coach with the County Health Rankings and Roadmaps program. Those factors help to explain why some metro-area counties rank with Pitkin and Eagle counties as the healthiest in the state, while others such as Adams and Denver counties rank in the bottom half of Colorado areas.

A bipartisan coalition of prominent Colorado leaders kicked off a campaign Thursday to defeat a ballot measure to create a publicly-financed, comprehensive, Medicare-like health system, according to Colorado Public Radio. The measure is opposed by current Gov. John Hickenlooper and former Gov. Bill Ritter, both Democrats. 

The Colorado Health Foundation, in partnership with the Colorado Health Institute, published a Colorado Health Report Card. It evaluates the current status of population health, healthcare delivery, and health coverage in Colorado and provides a benchmark for measuring progress on some of the most pressing health issues across 38 key health indicators and through five life stages.

The Colorado Commission on Affordable Health Care recently released a report that studies the challenges Colorado faces on health care spending and the primary drivers of rising health care costs. The analysis shows that Colorado’s personal health expenditures increased 327 percent over the past two decades, compared to 216 percent in the US. Spending in Colorado also more than doubled from 2000 although cumulative inflation was only 33.3 percent since 2000.

Reducing emergency department (ED) visits for issues that could be treated in a doctor’s office or similar setting could result in over $800 million in annual cost savings for Colorado, according to a report from the Center for Improving Value in Health Care. The report highlights the primary reasons given for non-emergent ED visits, including the available appointment at a doctor was too far out, after hours care was necessary, patients were directed to an ED by a physician, and the ED was more convenient.

Health policy discussions in Colorado and across the nation are increasingly turning to the subject of network adequacy—the narrower networks that are one result of price-based competition in the insurance market.

The Colorado Health Institute has published a new report titled Narrow Networks in Colorado: Balancing Access and Affordability. It is the first in a series of reports planned on the subject of network adequacy.

Matthew Valenta of the Colorado Consumer Health Initiative calls for more scrutiny of proposed rates by insurance companies and points to several market wide factors that the state's Division of Insurance should consider when evaluating insurer rate requests.

A New York Times analysis finds big swings in Colorado Marketplace premiums. While all states show some pricing volatility, Colorado singled out for having the most.

The Colorado Health Foundation announced its support of a ten-year commitment to a community-level collaborative approach to address healthcare costs through delivery system and payment reform. The delivery system and payment reform initiative will focus on accelerating the “Triple Aim” of healthcare: better health for our population, better care for individuals and lower costs for all.

Denver Post: The Colorado Commission on Affordable Healthcare began its work last Friday, Aug. 22. The commission, which was created by Senate Bill 187, is tasked with looking at the growing healthcare costs in Colorado for the next three years. Through its analysis of a wide variety of healthcare costs, the commission must make recommendations to the legislature. Follow @cchipolicy and #COCostComm on Twitter for updates.

A report from the Colorado Center on Law & Policy examines hospital charges and costs and found that Colorado hospitals charge (on average) four times more than what Medicare pays to treat a given diagnosis. The report also highlights the discrepancy between what hospitals charge and Medicare pays. Finally, the report demonstrates that the variation in charges between hospitals cannot be explained by the frequently-cited hospital cost drivers (e.g., regional labor costs, teaching status, and high volumes of low-income patients).

Colorado voted the second happiest state in the U.S., after Hawaii. Read more >