Dr. Chris Tonozzi is Mountain Family's Director of Data Quality.

Dr. Chris Tonozzi, MD, Director of Data Quality

The high cost of health care in the United States is a significant issue. It is common knowledge that in the U.S. we spend much more on health care than other countries. Despite this significant expense, it’s also common knowledge that indicators for health are not significantly improved in the U.S. (See this report by the Commonwealth Foundation.)



Colorado’s statistics don’t help matters. The Center for Improving Value in Health Care (CIVHC) is a state agency that is the steward of the Colorado All Payer Claims Database (CO APCD). This is a collection of data from most insurers in Colorado that collects data on what we are spending, and where it is being spent. CIVHC has been participating in a project that compares Colorado health care expenses to several other states. Unfortunately, Colorado has some of the highest costs for health care among the states studied. Each of us knows this because of the high prices that we, or our employer, have been paying for our insurance. Here it is graphically (see below) from the CIVHC report. Colorado’s costs are 17% higher than the average of the five states studied.

Other highlights of the report are the following:

  • About one-third of our high cost is related to the price of our health care services. About two- thirds is related to utilization: the fact that we use more health care services than are used in other states.
  • Pharmacy costs are an unusually large proportion of the costs in Colorado. The second biggest driver of cost is outpatient hospital visits (day surgeries, emergency visits, diagnostic studies, procedures).
  • The Western region of Colorado has a very high median cost per patient at $547 per member per month, but it is not the highest in Colorado. Eastern Colorado is higher at $591. The average is $447.

Mountain Family Health Centers is working hard on the total cost of health care, since this has a significant impact on our patients. We have control over only a small aspect of this cost of care (CIVHC estimates that “professional services” which is how our costs are categorized, account for only 5% of the Total Cost of Care). We know that our average per member per month cost for adult Medicaid patients in the PRIME program is $620. We’re working internally and with partners in the community to lower the costs that our patients face not only when they receive care within Mountain Family, but also when they need hospital services or a medication.

If you’ve got ideas on other how we can cut costs, let us know!

Editor’s note: The PRIME program is focused on those individuals at high risk and chronic emergency room use. Mountain Family Health Centers has excelled in reducing emergency services use and improving wellness and self-sustainability in this group. Average Western Slope Medicaid costs per adult member, per month are $306. Mountain Family has have reduced its per adult member, per month cost to $224 per individual. This has been done through moving to value over volume, team based care.