Promoting Health for Colorados Vulnerable Populations

1

• Promoting Health for Colorados Vulnerable
  Populations
• Sandeep Wadhwa, MD, MBAState Medicaid
  DirectorColorado Department of Health Care
  Policy and FinancingClinicNet ConferenceMarch
  6, 2009

2
Medicaids Origin

• Enacted in 1965 as companion legislation to
  Medicare (Title XIX)
• Established as means-tested program where
  eligibility is determined by income
• Provided federal matching grants to states to
  finance care
• Focused on single parents with dependent
  children, elderly, blind, disabled
• Included mandatory services and options for
  broader coverage
• Source Rowland D, Kaiser Commission on Medicaid
  and the Uninsured,
• Medicaid Basics, May 2005.

3
Overview of Programs

• Department administers Medicaid, Child Health
  Plan Plus (CHP) and other medical programs for
  low income, elderly and persons with disabilities
• Colorado receives Federal match (50 Medicaid,
  65 CHP)
• Source of insurance for nearly 10 of Coloradans
• Provides comprehensive, low-cost health coverage
  for low-income families
• Acute and long-term care coverage for elderly and
  persons with disabilities

4
Eligibility for Colorado Medicaid and CHP
5
Colorado State Operating Budget, 18.6 Billion
FY 2008-09
20.2 Health Care Policy and Financing
6
Colorado Health Care Snapshot
Source of InsuranceNumbers in Thousands
Source June 2007 Lewin Report
7
Medicaid Caseload
Medicaid Expansions
FY 2008-09 and FY 2009-10 projections from the
Departments November 3, 2008 Budget Request.
8
Child Health Plan Plus Caseload
CHP Expansions
Includes children and prenatal. FY 2008-09
and FY 2009-10 projections from the Departments
November 3, 2008 Budget Request.
9
Medical Services PremiumsCaseloadFY 2007-08
10
Medical Services PremiumsExpenditure (in
Millions)FY 2007-08
11
Medicaid Enrollees and Expenditures by Enrollment
Group, FY 2007-08
12
Percent of Colorado Primary Care Providers
Enrolled in Medicaid
13
Department Goals

• Enroll more children in public insurance programs
• Improve health outcomes
• Develop strategies for reforming the long-term
  care system

14
Colorado Health Ranking

• 2008 OVERALL RANK 19th (drop of 3 positions in
  one year)
• Strengths
• Low prevalence of obesity
• Low levels of air pollution
• Low rate of preventable hospitalizations
• Low rates of cancer deaths and cardiovascular
  deaths
• Challenges
• High geographic mortality disparity within the
  state
• High rate of uninsured population
• Significant Changes
• In the past year, the violent crime rate
  decreased by 11
• In the past year, per capita public health
  funding increased by 34
• In the past five years, immunization coverage
  increased by 25
• Since 1990, the percentage of children in poverty
  declined by 42
• Source Americas Health Rankings 2008,
  www.americashealthrankings.org

15
Colorado Health Ranking

• Overall and Dimension Ranking 22
• Access 35
• -Adults and children insured
• Quality 30
• -Recommended screenings and preventive care for
  adults and children
• -Usual source of care for adults and children
• -Appropriate care
• -Patient satisfaction
• Source Commonwealth Fund State Scorecard on
  Health System Performance, 2007

• Avoidable Hospital Use and Costs 15
• -Hospital admissions and ER visits for pediatric
  asthma
• -Hospital readmissions
• Equity 43
• -Differences in performance associated with
  patients income level, type of insurance, or
  race or ethnicity
• Healthy Lives 2
• -Mortality
• -Infant mortality
• -Breast and colorectal cancer
• -Limited activities

16
Health Outcomes

• Thinnest state in country but low income
  children have 3 times the obesity rate as higher
  income children
• Smoking rates double state average for adults
  with Medicaid
• Nursing home bed days trending down and less
  expensive community services trending up
• Medicaid inpatient hospital costs stable, but ER
  and outpatient trending up

17
(No Transcript)
18
S

Source BRFSS Prevalence Data, 2007
19
Internal Performance Improvement Initiatives

• Balanced scorecards for all offices with key
  performance metrics for health, cost,
  satisfaction, access
• Internal audit function
• Contract management improvement
• Financial management system
• Project management tracking tool
• Legislative implementation status

20
Health and Healthcare Initiatives

• Upcoming activities to
• Reduce readmission rates
• Reduce emergency room rates
• Reduce preventable hospitalizations
• Anticipate activities related to achieving
• Lower child and adolescent obesity
• Lower adult tobacco use
• Fewer suicide attempts

21
Healthcare Effectiveness Data and Information Set
(HEDIS)
22
Healthcare Effectiveness Data and Information Set
(HEDIS)
23
Healthcare Effectiveness Data and Information Set
(HEDIS)
24
Current Programs/Initiatives

• Provide a Medical Home to all Medicaid and CHP
  kids
• Make it easier for families to enroll in public
  programs by modernizing eligibility
  determinations
• Increased Medicaid reimbursement for primary
  care, oral care and hospitals (07-08)
• Improve mental health benefits in CHP

25
Reform Vision
Stakeholder Collaboration
Supportive Payment System
Health Outcome Evaluation
Appropriately Defined Benefits
Accountable Care Coordination
Enhanced Enrollment Structure
Transformed Public Insurance Programs
Optimal Client Health and Function
26
Future Directions

• Improved Eligibility and Enrollment Processing
• Colorado Accountable Care Collaborative
• Pharmacy Technical and Pricing Efficiencies
• Medicaid Program Efficiencies
• -Medicaid Benefit Package Reform
• -Health Outcomes Measurement Survey
• -Fluoride Varnish
• -Hospital Back Up Program Enhancements
• -Oxygen DME Administrator
• -Serious Reportable Events

27
Future Directions

• CO Healthcare Affordability ActHospital fee
  based on patient days that will generate revenue
  to
• - Increase hospital reimbursement rates under
  Medicaid and Colorado Indigent Care Program,
  which will help reduce uncompensated care and
  cost shifting
• -Cover the uninsured by increasing eligibility
  for Medicaid and CHP
• Long-Term Care Presumptive Eligibility
• -Allow self-declaration of income for those
  applying for LTC-Ease administrative burden for
  clients and families
• -Requires federal waiver

28
Benefits Collaborative

• Ensure benefit coverage policies promote optimal
  health and functioning of Medicaid clients
• Define amount, scope and duration of Medicaid
  benefits
• Base benefit coverage decisions on Colorado
  customization of best practices from other states
  and review of clinical standards
• Benefit coverage determinations are made in a
  manner that is transparent to, and inclusive of,
  all stakeholders

29
Colorado Accountable Care Collaborative

• Regionally procure services from Accountable Care
  Organizations to provide enhanced primary care
  case management for Medicaid clients
• Client-centered model focused on health and
  prevention
• Requires quality care coordination across
  providers
• Financial accountability and incentives for good
  outcomes

30
Colorado Accountable Care Collaborative
small group
Regional Care Coordination Organization
large group
small group
Regional Care Coordination Organization
large group
small group
Statewide Data and Certification Organization
Regional Care Coordination Organization
large group
small group
Regional Care Coordination Organization
large group
small group
Regional Care Coordination Organization
large group
31
CIVHC

• Center for Improving Value in Health Care
  (CIVHC)- Executive Order
• Inter-disciplinary, multi-stakeholder center
• Identify and pursue strategies to improve quality
  and contain costs
• Long-term approaches to realign our health care
  system
• Led by Dori Biester, interim director
• Recommended structure and next steps reported to
  governor December 2008
• Governor will appoint steering committee members,
  currently accepting nominations
• Work groups comprised of non-appointed members
• Updates on Department Web site

32
Reform Timetable

• Role of new federal administration TBD (waiting
  for transitions in CMS, HHS, etc.)
• Obamas health proposal outlined expanded
  eligibility (higher FPL, childless adults) for
  Medicaid/CHP
• Department is moving forward with state Medicaid
  reform efforts (Balanced Scorecard, Benefits
  Collaborative, Accountable Care Collaborative,
  etc.)
• Increase in caseload and current budget shortfall
  leads to challenging decisions (finding
  efficiencies vs. reducing provider rates)

33
For more informationplease visit our Web site

• colorado.gov/hcpf
• sandeep.wadhwa_at_state.co.us