Alfred Gilchrist

Alfred Gilchrist, Chief Executive Officer
Colorado Medical Society

In mid-April the Senate Health and Human Services Committee held the first hearing and favorably reported on a 5-to-2 bipartisan vote for legislation to create a Commission on Health Care Costs in Colorado. The bill subsequently passed the full Senate and as of this printing is awaiting action in the House. In the Final Word column in this issue, the Senate authors outline the compelling public policy motives for a commission. They understand what a growing consensus of legislators and policy advocates have been warning. Expanding coverage will accelerate the cost spiral if the delivery system doesn’t produce consistently greater value.

This is not an abstract concern that plagues other states. Here in our backyard Coloradans were surprised when a national analysis recently ranked our mountain resort counties as the highest priced health insurance exchange products in the United States. As I reported in my last column, the Colorado Department of Insurance, initiated by Governor Hickenlooper, has already appointed a study group directly tied to a public backlash over the cost of health insurance sold on the Exchange in the resort region of Summit, Garfield, Eagle and Pitkin counties, and at least one county has threatened to sue the state.

In our testimony to the Senate committee, we emphasized what members of the 69th Colorado General Assembly already know: Health care spending trends point to anticipated cost increases that will risk compromising health care spending and investment, and crowd out funding for highways, education and clean water, among other vital infrastructure needs. We also commended the methodical, empirical approach proposed by the authors. Good data analytics are vital to producing sustainable, functional state policies for managing health care costs without compromising optimal patient outcomes.

When the massive Medicare physician payment dump recently hit the media fan, we witnessed a raft of predictable media reports, some fair and some sensational. We can be reasonably certain that the cost commission as contemplated under the current legislation won’t indulge in similar tactics. Unlike other states, Colorado thought-leaders and influencers had already come together through the 208 Commission to create the Center for Improving Value in Health Care and the All Payer Claims Database, one of only a handful in the country. Because the authors’ predecessors showed patience and foresight, we have the expertise on the ground that can convert unfiltered payer data into useful information for consumers and physicians alike.

The Health Care Cost Commission legislation, like the 208 Commission before it, is not without controversy. It has reignited the perennial debate over market-based versus public sector approaches. Comparisons to the federal reforms in the Affordable Care Act have already surfaced. These approaches are not mutually exclusive, and the methodology in the legislation to establish the commission points to market-based approaches.

We expressed strong support for a commission model. When legislators and advocates fail to approach complex policy challenges methodically and collaboratively, you tend to get faith-based positions – laws based on beliefs rather than empirical evidence, making leaps of faith that often seek to fix the problem by declaring the symptoms illegal. Fee freezes, eligibility, coverage caps and other barriers to care are a couple of time-honored responses that come to mind.

Colorado has a long history of consensus building through interim work groups and blue ribbon commissions. Interim studies minimize the risk of end-of-session fire drills because they bring diverse views and expertise together to fix problems rather than blame and to lay the groundwork for legislators on a solid foundation of what works, and what should be avoided.


Categories: Communications, Colorado Medicine, Practice Evolution, Payment Reform