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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+.
July 30, 2009
Care Coordination and Medical Homes
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 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
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
Danaei, The Preventable Causes of Death in the United States …, PLoS Med 6(4), 2009.
Source: BRFSS Prevalence Data, 2007
-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
-Adequate Maternal Weight Gain
-Low Birth Weight Babies
-NICU Admission Rate
Accountable for health and healthcare optimization for region
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
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