Plan Watch

Colorado Consortium Combines Data from Insurers & Doctors’ Offices

Seven health plans and 74 physician practices unite under a CMS program to bolster primary care

Frank Diamond

In this period of health reform, physicians are being asked to take on more risk, but many worry that they may not be capable of doing so. To help with that, initiators of a program in Colorado hope to supply physicians with both electronic health record and claim information that can be easily obtained, even when patients switch plans.

Mark Crockett, MD

“The clear effort here is to measure cost and quality so as to make risk-based contracts manageable,” says Mark Crockett, MD, of Rise Health.

“Physicians are trying to take on risk by tiptoeing into it for a small number of patients, but with multiple payers, that becomes unmanageable,” says Mark Crockett, MD, the CEO of Rise Health, which sells the software. (Rise Health was purchased by Best Doctors late last year.)

Cooperation crucial

Rise Health’s software is being used in a program developed under the Comprehensive Primary Care Initiative (CPCI), a public-private endeavor run by the Centers for Medicare & Medicaid Services that seeks to strengthen primary care (http://tinyurl.com/CPCI-facts). Colorado is one of seven regions in which physician groups will be rewarded for improved outcomes. Cooperation by health plans is a crucial element.

Rise Health software, including the Ascend Enterprise Data Aggregation Platform and the Stratus Predictive Healthcare Analytics Application, assembles the data needed to build registries, says Crockett. It can also enhance care coordination with analytic capabilities based on payer and patient panels, he says.

The goal, says Crockett, is to streamline the work of providers so that they don’t need to wrestle with different sets of metrics used by seven different payers. “It can be ferociously difficult to organize your staff around all these different types of metrics,” says Crockett.

He says his company’s software reduces that difficulty by gathering information and metrics from the payers into one program and standardizing the interface.

Instead of several different yardsticks, Crockett envisions his company software giving providers one source of information about their cost and quality scores.

The agreement with the seven plans (see box, below) was struck after a lot of give-and-take, according to Crockett. What won over the insurers and 74 group practices involved in the program was the oversight of CPCI, he says. It is an organization that can “get that type of multipayer, multiprovider buy-in, and then have all of the providers essentially sign off that they are comfortable with the information.”

Who’s in

The seven insurers participating in Colorado’s Comprehensive Primary Care Initiative are:

  1. Anthem BlueCross BlueShield in Colorado
  2. Cigna
  3. Colorado Access
  4. Colorado Choice Health Plans
  5. Colorado Department of Healthcare Policy and Financing (Medicaid)
  6. Rocky Mountain Health Plans
  7. UnitedHealthcare

Each insurer is financially committed to the program, though Crockett says those numbers have not yet been finalized.

Portability

One of the key advantages of Rise Health’s software is that information is not lost when someone switches from one health plan to another. Claim data for an Aetna member, for instance, will be on hand if that member switches to BlueCross BlueShield in Colorado. If you stay in Colorado and you are a member of one of the participating plans, your data will travel with you, Crockett says.