Best Practices in Medicaid - Colorado

The Center for Health Transformation is inviting leaders from all 50 states to share their transforming solutions for the Medicaid program. In order that key decision-makers and industry leaders from around the country may learn from others’ successes, it is our intention to provide this interactive resource for showcasing the most innovative practices in the country. Please note that the following contributions have not been edited by CHT staff and will remain open indefinitely to future updates.

View Colorado's Official Medicaid website >>

Consumer-directed care demonstrations Include number of beneficiaries served now and in any expansion plans)

Blue Ribbon Commission

In 2007, $30 billion was spent on health care in Colorado.  This amount represents a 77% increase from 2000. In 2006, Colorado’s General Assembly established the Blue Ribbon Commission on Health Care Reform to develop recommendations for expanding access and reducing health care costs.

The Blue Ribbon Commission presented health care reform recommendations to the legislature on January 31, 2008. In February 2008, Governor Bill Ritter, Jr. presented the Building Blocks to Health Care Reform agenda, calling for $63 million for phased implementation of health care reform. Governor Ritter’s plan closely followed the recommendations of the Commission.  

Center for Improving Value in Health Care

The Center for Improving Value in Health Care was established by Executive Order D 005 08 signed by Governor Ritter on February 13, 2008, as a part of the Governor’s Building Blocks to Health Care Reform plan.

A steering committee led by Joan Henneberry, executive director of the Colorado Department of Health Care Policy and Financing, is bringing consumers, businesses, health care providers, insurance companies, and state agencies together to develop recommendations for strategies to identify, implement, and evaluate quality improvement strategies to ensure a better value for the health care received in Colorado. These recommendations will be presented to Governor Ritter in December 2008 and will inform the state’s efforts in defining the governance structure, funding and scope of the Center.

AcademyHealth and The Commonwealth Fund selected Colorado as one of eight states, to participate in the State Quality Improvement Institute - an intensive, competitively-selected effort to help states plan and implement concrete action plans to improve performance across targeted quality indicators. Participation in this program will provide the state with even more tools, resources and knowledge as Colorado works toward improving the quality of health care across the state.

The Center for Improving Value in Health Care is the vehicle for accomplishing these goals.  The steering committee has embraced the Triple Aim goals as developed by the Institute for Healthcare Improvement of maximizing population health, optimizing consumer experience, and delivering cost effective care as its goals.

Medical Homes

The medical home model is an approach to health care that ensures that all providers of a child’s care operate as a team; that families are vital members of that team; and that all team members understand the importance of quality, coordinated medical, mental and oral health care.  

In 2007, the Colorado Generally Assembly recognized a state goal of increasing the number of children who receive care consistent with the Medical Home approach. The Colorado Medical Home Initiative, a joint effort of Colorado’s Department of Public Health and Environment, Department of Health Care Policy and Financing and community stakeholder advocates is currently working to meet that goal by ensuring that:

• All providers understand the components of the Medical Home approach and implement them in their practices;
• Families understand the components of a Medical Home and advocate for them;
• Provider incentives, resources and needs are effectively aligned to meet state goals;
• Outcomes are evaluated and systems are monitored to assure quality; and
• Research and outcomes

Current Medical Home activities have centered on establishing a pediatric medical home; the state anticipates expanding to support adult medical homes for its Medicaid and SCHIP population.  

Increasing Enrollment

Major efforts are underway to increase enrollment of eligible but not enrolled children and families into Medicaid and the Colorado’s SCHIP program:

• The Colorado Department of Health Care Policy and Financing’s FY 2008-2009 budget included $1.4 million to reach to families who may be eligible for programs;
• The SCHIP program (Child Health Plan Plus) financial eligibility criterion was increased from 205 percent to 225 percent of the Federal Poverty Level; and
• Presumptive Eligibility for Medicaid and Child Health Plan Plus for children was implemented July 1, 2008.

Provider recruitment and retention has been addressed during the Ritter administration by increasing reimbursement rates for primary and preventive care to 90 percent of Medicare and dental care to 52 percent of commercial sites.  

Health Agenda

Colorado’s Medicaid program is embarking on a major initiative to emphasize improved health outcomes and value purchasing in public health insurance programs. This effort will drive transparency and accountability for the Department, contractors and providers to demonstrate quantifiable improvements in health status, functioning, and self-sufficiency. A balanced scorecard approach will be employed measuring health outcomes, access to care, satisfaction, and efficiency.

Disease Management

Colorado is one of several states participating in a national collaborative sponsored by the Center for Health Care Strategies. The Colorado Regional Integrated Care Collaborative (CRICC) is a partnership between the Department and the Center for Health Care Strategies, local health plans and providers, consumer organizations, community foundations and other stakeholders.  The goal is to improve the quality of care received by Colorado Medicaid’s highest-need, highest-cost clients by better coordinating the currently fragmented physical health, mental health and substance abuse services.  

Delivering high-quality, coordinated, long-term care for the disabled and/or the infirm

Long-Term Care

Colorado’s Long-term Care (LTC) Partnership is an alliance between the private insurance industry and the state government to help Colorado residents plan for future long-term needs without depleting all of their assets to pay for care. It is designed to encourage and reward Colorado residents for planning ahead for future LTC needs. 

Colorado has two primary goals with its Partnership:  1) To assist the citizens of Colorado in planning for their future LTC needs by offering quality LTC insurance products, (2) Offer an option so that citizens will not need to deplete all of their resources to pay for LTC. 

Future plans

Colorado intends to:

• Ensure that all children and adults in Medicaid and the Child Health Plan Plus have a medical home,
• Streamline the eligibility and enrollment administrative processes for families;
• Implement enhanced Medicaid fraud and abuse policies including the use of advanced software technology:
• Increase dental care benefits for low-income adults; and

Strengthen and expand accountable care delivery systems and enroll the majority of Medicaid clients into accountable care organizations by