Sandeep Wadhwa, MD, MBA State Medicaid Director Colorado Department of Health Care Policy and Financing State Coverage I

1. 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

2. Current Eligibility for Colorado Medicaid and CHP+

3. Eligibility for Colorado Medicaid and CHP+ with HB 09-1293

4. 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

5. 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.

6. 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

7. 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

8. 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

9. 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

10. Regional Accountability for Health, Access and Cost Management

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

12. S Source: BRFSS Prevalence Data, 2007

13. Health: Maternity Profile • 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

14. ER Visits

15. Admission Rate for Acute and Chronic Indicators (2008)

16. Readmissions

17. Regional Care Coordination Organization 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

18. Statewide Data and Certification Organization 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

19. ACC Program Design • 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

20. Our expectations for these initiatives 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

21. For more informationplease visit our Web site: colorado.gov/hcpf