BACKGROUND: The Colombian High-Cost Disease Fund (CHCDF) is a non-governmental technical organization created by the Ministry of Treasury and the Ministry of Health. All the insurers are required to report information on patients diagnosed with cancer, HIV, hemophilia, RA, CKD, hypertension, and diabetes mellitus. Through the SISCAC platform, CHCDF obtains such information and reports standardized metrics that allow stakeholders to improve the quality of health care and the delivery of health services.

OBJECTIVES: Record the selection and adoption of high-cost disease metrics by insurers and health service providers in Colombia.

METHODS: A development group was convened, consisting of two members of the CHCDF and two physician specialists; and a panel of independent experts, consisting of five sectors of the healthcare Colombian system. The search criteria were established to perform a systematic review of the literature and the preliminary indicators were selected by the development group.

RESULTS: Between 2012 and 2019, a total of 13 evidence-based consensuses were held in which 267 metrics were established. In the last consensus, representativeness from the five sectors was obtained. The percentage of controlled diabetic patients increased from 33.0% in 2015 to 52.4% in 2018; 46.2% of hemophilic arthropathy patients received prophylaxis in 2015 and 60.2% in 2019; the percentage of maternal-infant transmission studies conducted on children under 6 months exposed to HIV increased from 23.5% in 2012 to 73.0% in 2018; the average waiting time for confirmation of the diagnosis in stomach cancer decreased from 42 days in 2016 to 29 days in 2018, and the percentage of patients with rheumatoid arthritis with acute phase reactants in the diagnostic process increased from 36.1% in 2016 to 93.4% in 2018.

CONCLUSIONS: The assessment of high-cost disease metrics showed improvements in the quality of care. Measuring compliance with best practices is a good strategy for directing efforts towards achieving goals.