Financing the Patient-Centered Medical Home: Making the Investment in Primary Care

1. Financing the Patient-Centered Medical Home: Making the Investment in Primary Care Sandeep Wadhwa, MD, MBA Medicaid Director and Chief Medical Officer State of Colorado October 2008

2. Colorado Health Care Snapshot Source of InsuranceNumbers in Thousands – Source: June 2007 Lewin Report

3. Medical Services PremiumsCaseloadFY 07-08

4. Medical Services PremiumsPer Capita CostFY 07-08

5. State’s Role in Primary Care Reform Legislative/regulatory authority Catalyst for encouraging public/private collaboration Active participant in the community of payers Dominant payer for safety net

6. Financing Primary Care Reform Medicaid - Phase 1 Repurposed our EPSDT care coordinators to support Medical Home objectives Increased EPSDT payments to further cover Medical Home activities Regional ASO with 50% shared savings with primary care physicians

7. Financing Primary Care Reform Medicaid - Phase 2 Care management PMPM fee for medical home providers Care coordinator and health educator layer - community and office based Move from shared savings to shared outcome incentives (ambulatory care sensitive conditions hospitalizations, emergency room visits)

8. State Based Primary Care Reform Participate in multi-payer collaborative Created public-private value- based healthcare center to collaboratively address structuring/financing of primary care

9. Thank you Sandeep Wadhwa, MD sandeep.wadhwa@state.co.us