Project Summary: Inform Rate Setting and Provide Network Development
Category: Health Insurance Rate Setting
Background: Colorado HealthOP is a nonprofit, consumer-directed health plan formed under provisions of the Affordable Care Act. Their 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.
Objective: To understand cost breakdowns by type of service and patient demographics across the different regions in Colorado so as to inform provider contracting and rate development.
Data Analyzed: A custom report with Commercial and Medicaid data segmented by insurer, geography, facility, provider type, pharmacy, DRG, specialty (especially primary care), drug class, age and gender.
Results: By using APCD data, Colorado HealthOP was able to better understand patterns of care in rural/Western Slope areas, plus the percentage of care types that stay local vs. traveling to other areas. “Deeper dive” geographic analysis was influential in development of health plans to serve the underserved and uninsured in the high-cost rural resort/Western slope regions.