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Sandeep Wadhwa, MD, MBA State Medicaid Director Colorado Department of Health Care Policy and Financing State Coverage Initiatives Annual Meeting July 30, 2009. Care Coordination and Medical Homes. Current Eligibility for Colorado Medicaid and CHP+.

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Sandeep Wadhwa, MD, MBAState Medicaid DirectorColorado Department of Health Care Policy and FinancingState Coverage Initiatives

Annual Meeting

July 30, 2009

Care Coordination and Medical Homes



Eligibility for colorado medicaid and chp with hb 09 1293
Eligibility for Colorado Medicaid and CHP+ with HB 09-1293


Care coordination
Care Coordination

  • Currently ~85% clients in FFS

  • Multiple initiatives to move more clients into outcomes-focused, coordinated system of care

  • CRICC, Family-Centered Medical Home, Multi-Payer Medical Home, Safety-Net Medical Home, Accountable Care Collaborative


Colorado regional integrated care collaborative cricc
Colorado Regional Integrated Care Collaborative (CRICC)

Department, CHCS, and local health plans are partnering to create an opportunity to evaluate and improve enhanced care management for some of the most complex members enrolled in Medicaid

Colorado Access and Kaiser are participating health plans

Disabled and Elderly. All members will be adults 21-64.

Target Denver metro counties in 2009 and expand to rural areas.


Colorado family centered medical home
Colorado Family Centered Medical Home

  • Colorado has been involved in Medical Home work since 2002

  • Family Centered Medical Home involves family and community in program design

  • Certified practices receive Medical Home incentive payment

  • Free support services offered to participating practices

  • Initial observation and evaluation suggest increased incidence of lower-cost preventive care, reduced ED utilization, and fewer hospital admissions


Colorado multi stakeholder multi payer medical home pilot
Colorado Multi-Stakeholder, Multi-Payer Medical Home Pilot

Colorado Medicaid is partnering with 5 commercial insurers: Aetna, Anthem-Wellpoint, CIGNA, Humana, United Healthcare as well as employer based ASOs

Adult population already associated with these practices

Denver-metro area, approx. 25,000 lives, ~250 are Medicaid

16 PCP practices

3-tiered payment model; anticipate the PMPM will be used to hire a care-coordinator

NCQA-based PCMH model with practice transformation support to maximize credentials of all skilled staff & aid in care coordination

2-year pilot started in May 2009


Colorado safety net medical home pilot
Colorado Safety-net Medical Home Pilot

The Colorado safety-net, including FQHCs, philanthropically funded clinics and rural health centers were awarded a grant from the Commonwealth Fund to implement PCMH in a safety-net setting

The safety-net cares for approximately 1/3 of Medicaid and CHP+ clients

Statewide pilot involving 68 health clinics and covering 125,000 lives (approx 40K – 45K are Medicaid or CHP+)

NCQA-based PCMH model with practice transformation support to maximize credentials of all skilled staff and aid in care coordination

Expanded office hours, many clinics have integrated services

4-year pilot, in planning stages


Accountable care collaborative
Accountable Care Collaborative

  • Regional system of care accountable for health, access and cost goals

  • Facilitate creation of statewide HIT platform

  • Reduce variability in cost and quality

  • Create a delivery system that is client-centered

  • Incentivize Medical Home standards

  • Healthcare optimization with providers, clients and explicitly share accountability for health and healthcare



Preventable causes of death
Preventable Causes of Death Management

Danaei, The Preventable Causes of Death in the United States …, PLoS Med 6(4), 2009.


S Management

Source: BRFSS Prevalence Data, 2007


Health maternity profile
Health: Maternity Profile Management

  • Exceed Commercial or HP2010

    -No Alcohol Use During Pregnancy

    -Cesarean Section Rate

    -Breastfeeding in Early Postpartum Period

    -Infant Had Well-Baby Check-Up-Baby Placed on Back to Sleep

  • Not at HP2010; tied with commercial

    -Adequate Maternal Weight Gain

    -Low Birth Weight Babies

    -NICU Admission Rate

  • Significantly worse than HP2010 and Commercial

  • -Unintended Pregnancy

  • -Timeliness of Prenatal Care

  • -Tobacco Use During Pregnancy

  • -Multivitamin Use During Pregnancy

  • -Stress During Pregnancy

  • -Postpartum Depression Symptoms


Er visits
ER Visits Management



Readmissions
Readmissions Management


Regional care coordination organization
Regional Care Coordination Organization Management

Functions:

Outcomes Management

Accountable for health and healthcare optimization for region

Provider Support

Billing, MMIS, clinical decision support

Care Coordination and Care Transitions

Coordination among care providers, between programs, and between phases in life

Medical Home Practice Redesign

Increase efficiencies within the practice with special attention

to the unique issues and needs of Medicaid clients


Statewide data and certification organization
Statewide Data and Certification Organization Management

Functions:

  • Create a Web-based provider health information system

  • Provide care management software support

  • Extraction and analysis of statewide data to identify data-driven opportunities to improve care quality

  • Offer provider IT support


Acc program design
ACC Program Design Management

  • Pilot program starting in July 2010

  • Enrollment = 60,000 for the pilot

    • 40,000 adults and 20,000 children

  • Formal program evaluation

  • Prove revenue neutral or savings before additional expansion

  • Clients assigned to provider through passive enrollment

    • Attribution enrollment

  • $20 PMPM to be shared between RCCO and providers

  • Substantial gainshare with RCCO and the

    • providers


Our expectations for these initiatives
Our expectations for these initiatives Management

Healthier communities

Comprehensive, continuous patient-centered care

Strengthened provider partnerships

Integrated delivery system

Cost-effective care coordination with focus on outcomes and health status

Greater opportunity for partnership and statewide policy development

20


For more information please visit our web site

For more information Managementplease visit our Web site:

colorado.gov/hcpf


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