Case Studies

Resource	Category	Carriers	Purpose
Combining Electronic Medical Records with Claims Data to Identify Opportunities for Improving Outcomes for Medicaid Patients The vision for this network is that it will support a broad array of data uses including development of improved quality metrics using both clinical… State: Colorado	Health Reform, Medicaid, Population Health, Researchers	Medicaid	Cost, Quality
Bundled Payments for Palliative Care in Colorado Background: The purpose of this project is to gather information about the impact of a bundled palliative care service on patient medical and… State: Colorado	Medicaid		Cost
Determine Insurance and Provider Composition Across Colorado Data Analyzed: Total charges, allowed, plan paid, and member liability for all claims in the APCD database by county and payer. In addition, Lockton… State: Colorado
Bundled Payment Development for Orthopedic Care Goal: This healthcare provider wanted to be able to analyze de-identified medical claims data for total knee and hip replacements and spinal fusion… State: Colorado
Assist Family Planning Centers with Setting Rates Background: The majority of family planning service clinics are publicly funded and serve a very high-need population. Having good data to help them… State: Colorado	Insurance Department, Population Health	Commercial, Medicaid	Cost, Utilization
Hospital Bundled Payment Opportunity Analysis This bundled payment analysis seeks to conduct bundled payment analysis to identify where Colorado hospitals may have opportunities to reduce… State: Colorado
Analyze loss data by geographic area to determine appropriate geographic rating areas for Colorado Background: The purpose of the project is to analyze loss experience for the 2014 geographic rating areas, and determine if revised geographic rating… State: Colorado	Insurance Department
Impact Study of Project Angel Heart’s Home-Delivered Meals Through this study, Project Angel Heart hopes to examine the cost patterns of clients prior to service, during service, and post- service, as well as… State: Colorado	Population Health, Researchers	Commercial, Medicaid	Cost
Identify care outcome improvement opportunities by combining medical claims with EMR data for approximately 100,000 Medicaid patients over a four year period. The Scalable Architecture for Federated Translational Inquiries Network (SAFTINet) is a multi-state consortium of stakeholders dedicated to… State: Colorado
Bundled Payment Analysis for Health Plans This health plan is part of a bundled payment learning collaborative aiming to analyze and understand bundled payment opportunities. Claims data in… State: Colorado
Testing Bundled Care Analytics to Improve Care and Lower Costs Goals: Test the applicability of certain costs of care metrics such as total severity-adjusted patient costs, episode-level severity-adjusted costs,… State: Colorado
Evaluation of Availability and Cost for Optometrist Services to Enhance Access for Medicaid Patients. Goal: Determine financial impact that an increase in reimbursement would have on the overall Medicaid budget and the number of Optometrists and… State: Colorado	Medicaid, Providers	Medicaid
Prior Coverage Analysis Goal: Evaluate prior coverage analysis, de-identified and aggregated by payer, which depicts measures of data quantity (number of members, number of… State: Colorado	Consumers, Health Reform, Population Health, Providers, Researchers	Commercial, Medicaid	Utilization
Cost Transparency in Colorado Hospitals Data from this project will provide a baseline for these consumers to evaluate whether they are being charged appropriately. More broadly, this… State: Colorado			Cost
Inform Rate Setting and Provide Network Development As a result of the data, Colorado HealthOP was able to get a better understanding of patterns of care in rural/western slope areas, and the… State: Colorado	Insurance Department
Assessing the Impact of Cost-Sharing Policy Changes on the Use of Preventive Services One of the first provisions of the federal Affordable Care Act to be implemented was the requirement that Medicare and all private insurance plans… State: Colorado			Cost
Develop Innovative 21st Century Ambulatory Health Care Model Historic claims file for a list of Medicaid patients. This healthcare provider was awarded a cooperative agreement from CMS and Medicaid Innovations… State: Colorado			Cost
Identify Opportunities to Reduce Use of Potentially Harmful Medications During and Post Surgery This research entity will define patterns of opioid analgesia and prolonged opioid use in a large cohort study of patients that underwent major… State: Colorado	Consumers, Population Health, Providers, Researchers		Utilization
New Long-Term Opioid Prescription-Filling Behavior Arising in the 15 Months After Orthopaedic Surgery in Virginia This study determined the rates of long-term opioid prescription-filling behavior after common orthopaedic surgical procedures in patients who were… State: Virginia	Consumers, Population Health, Researchers	Commercial	Utilization
Small-Area Variation in the Care of Low-Risk Neonates in Massachusetts and Texas A research study that measures special care days (SCDs) (intermediate or intensive), length of stay, and readmission rates among low-risk neonates… State: Massachusetts, Texas	Providers, Researchers	Commercial	Quality, Utilization

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