BROWSE CASE STUDIES Case Studies > Health Plan Rate Analysis

Health Plan Rate Analysis

August 2014


Insurance Department, Health Reform


Cost, Health, Commercial


Center for Improving Value in Health Care

Background: The Colorado Network was working with one of its network members to avoid paying higher costs to a health plan, which would force that member to increase fees.

Goal: Analyze high cost/high utilization DRGs by payer to determine appropriate rates with health plans.

Data Analyzed: Average charged, average allowed, average plan paid, average member liability for selected DRGs by Payer for Rural Hospitals and The Colorado Network member.

Results: In progress.