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Summary of the Commission's Recommendations

This package of recommendations draws upon baseline analysis of current health care costs and coverage in Colorado, the modeling results of all five proposals, input received at community meetings and feedback from the Commission's Advisory Task Forces.

It is important to note the unprecedented nature of this accomplishment. The fact that such a diverse group--representing a broad array of backgrounds, ideologies and interests--was able to come to agreement on these recommendations signals that real reform is, indeed, possible.

(Three of the 27 commissions dissent from these recommendations and have prepared two minority reports.)

In developing its recommendations, the Commission made careful choices about how to balance competing priorities in order to best accomplish its charge of expanding access and reducing costs.

The Commission's 32 recommendations reflect certain philosophical imperatives:

  • Everyone--individuals, employers, providers, insurers and the government--has a role to play in addressing Colorado's health care needs. All have a share in the responsibility; all will share in the benefits.
  •   "One size fits all" doesn't work in health care. People have differing income levels and health care needs, and health status can change in an instant. Communities' needs vary greatly, depending on geographic location, demographic makeup and numerous other factors. We need a range of interventions that respond to a variety of individual and community situations.
  • Some people simply cannot afford private insurance coverage. Those people should have access to public coverage or subsidies for basic health care needs.
  • Safety net providers such as community clinics and hospitals play an essential role in caring for those on public programs and those without any health coverage. If we expand public programs to include more people, and as we recognize that noncitizens will continue to need care even if they do not have coverage, we must preserve and enhance safety net providers' ability to serve these populations.
  • We recognize that vulnerable populations must be protected in any reform of the system.  We cannot jeopardize their safety or reduce or compromise current levels of services as reform moves forward.
  • Individuals should have meaningful choices and options that give them control over their own care and coverage decisions.
  • Government, employers and insurers should promote and encourage healthy lifestyles and preventive care. Individuals, however, have responsibility for their own health and wellness.
  • Because most Coloradans have insurance, we should build on the strengths of the current system, keeping and broadening what works to minimize dislocation for those who already have good coverage, while making important changes to better meet the needs of those who currently lack affordable health coverage.
  • In order to accomplish our goals, we must maximize the federal funding available to Colorado--for example, through public program expansions that will enable us to draw down the maximum federal match, and through applications for federal waivers that will enable us to try new approaches to better meet the needs of Colorado's vulnerable populations.

 

Key features

  • Require all legal residents of Colorado to have minimum insurance coverage ("individual mandate"). Make the mandate feasible by:
    • Expanding eligibility for  public programs
    • Providing sliding-scale subsidies for low-income workers to purchase private coverage
    • Reforming the individual insurance market by making coverage more readily available and affordable for people with chronic illnesses and high-cost conditions
    • Enforce the mandate through the income tax system.
  • Require employers to offer pre-tax premium-only plans to facilitate employee purchase of health cove rage.
  • Create a "Connector" to assist individuals and small employers to understand and choose among insurance options.
  • Restructure, combine and expand eligibility for Medicaid and the Child Health Plan Plus.
  • Reduce administrative costs by streamlining processes and combining functions.
  • Promote consumer choice and direction and encourage cost-consciousness by improving access to cost and quality information.
  • Implement measures to enhance quality and improve coordination of care.
  • Encourage individual responsibility for health, wellness and preventive behavior.
  • Improve delivery of services to vulnerable and underserved populations through program expansions, reimbursement for telemedicine and other mechanisms.
  • Fund safety net providers and public health delivery systems appropriately.

 

Important Considerations

What follows is not merely a laundry list of recommendations. It is a comprehensive, integrated package that will only succeed in achieving the goal of expanding coverage and containing costs if viewed as a whole and implemented in the appropriate stages.

For example, before requiring all Coloradans to have insurance, we must first make coverage accessible and affordable. Before we expand public programs we must first improve efficiencies and increase provider participation. Where flexibility exists, strategies that 1) serve vulnerable and poorest populations and 2) fix elements of the health care system that are ineffective, should be pursued before other health care reform strategies.

 

Cost containment is crucial. The Commission has identified ways to reduce administrative costs, and believes that minimizing the cost shift from uncompensated care will help stabilize costs. But many other factors drive costs. The multi-stakeholder "Improving Value in Health Care Authority" proposed here is a vehicle to address these issues on a coordinated, ongoing basis.

Taken together, our package of recommendations offers a bold yet realistic approach to providing high quality, affordable health care to all Coloradans.

 

 

 

Overview of Recommendations

Reduce Health Care Costs, while Enhancing Quality of Care

  1. Slow the rate of growth of health insurance premiums: cover at least 85% of the uninsured; increase Medicaid provider reimbursement to help minimize cost-shifting.
  2. Reduce employee health premiums: require employers to establish plans allowing employees to purchase health insurance pre-tax; provide sliding-scale subsidies to help low-income workers buy insurance.
  3. Reduce administrative costs: streamline insurance processes; combining administrative functions of public programs; review regulatory requirements with an eye toward minimizing administrative burden.
  4. Increase use of prevention and chronic care management: allow health insurance premiums to be reduced for those who engage in healthy behaviors; eliminate copayments for preventive care, reduce them for chronic care management services; encourage employers to provide workplace wellness programs; encourage individual responsibility for personal health and wellness; increase funding to public health agencies.
  5. Review current Colorado long-term care studies to identify opportunities for improvement.
  6. Improve end-of-life care: foster clinically, ethically, and culturally appropriate end-of-life care, including palliative and hospice care; ask patients to complete advance directives.
  7. Explore ways to minimize barriers to midlevel providers practicing to the fullest extent of their licensure and training.
  8. Provide a medical home for all Coloradans: reimburse providers for care coordination and case management.
  9. Support the adoption of health information technology: support the creation of a statewide health information network and an electronic health record that works across systems for every Coloradan.
  10. Support the provision of evidence-based medicine: adopt population-specific care guidelines and performance measures; develop a statewide data system.
  11. Pay providers based on quality.
  12. Make information on insurer and provider price and quality available to all Coloradans.
  13. Promote consumer choice and direction: give consumers in the individual market a choice of minimum benefit plans; create a "Connector" to facilitate individual and employer insurance purchases; increase price and quality transparency; provide consumers evidence-based information at the point of care.
  14. Build on community efforts that have been proven to enhance quality and lower cost.
  15. Create a multi-stakeholder "Improving Value in Health Care Authority" to implement reform recommendations and assess and report on their effectiveness.

 

Improve Access to Care, with Mechanisms to Provide Choices

  1. Require every legal resident of Colorado to have at least minimum health coverage; enforce through income tax penalties; provide affordability exemptions.
  2. Encourage employees to participate in employer-sponsored coverage: require employers to establish plans that allow employees to purchase health insurance pre-tax; provide subsidies for low-income workers to purchase their employer¿s plan; enforce waiting periods for eligibility for the premium subsidy and public programs.
  3. Create a "Connector" to assist individuals and small businesses and their employees in offering and enrolling in health coverage.
  4. Provide sliding-scale subsidies to low-income workers to maximize access to/enrollment in private coverage for working lower-income Coloradans.
  5. Require all health carriers offering health insurance in Colorado to offer a Minimum Benefit Plan in the individual market.
  6. Guarantee access to affordable coverage for Coloradans with health conditions by making changes to the individual insurance market: provide guaranteed issue and modified community rating for those not eligible for an expanded CoverColorado program; restructure/expand CoverColorado.
  7. Restructure and combine Medicaid and the Child Health Plan Plus (CHP+) into one program for children, parents and childless adults; increase provider reimbursement; require enrollment in managed care where available for non-disabled adults and children.
  8. Improve benefits and case management for the disabled and elderly in Medicaid: provide care coordination; promote consumer-directed care; increase the number of people served by home- and community-based services; explore the potential for further reforms.
  9. Improve delivery of services to vulnerable populations: create a Medicaid buy-in program to enable disabled individuals to receive Medicaid benefits while employed, a Medically Correctable fund to assist with one-time expenses and a Medically Needy program to assist low-income insured people to pay for catastrophic events; increase the number of people receiving home and community-based care; provide mental health parity in the Minimum Benefit Plan.
  10. Expand eligibility in the combined Medicaid/CHP+ program: cover adult legal residents under 205% FPL (approx. $42,000 annual income for a family of four) and children in families earning up to 250% FPL (approx. $51,000 annual income for a family of four); provide premium and copayment assistance to elderly up to 205% FPL (approx. $21,000 annual income for an individual).
  11. Ease barriers to enrollment in public programs: use automatic enrollment strategies and one-year continuous eligibility.
  12. Enhance access to needed medical care, especially in rural Colorado: continue to pay all qualified safety net providers enhanced reimbursement for Medicaid patients; explore ways to minimize barriers to midlevel providers practicing to the full extent of their licensure; promote and build upon the statewide nurse advice line; expand telemedicine benefits for Medicaid and CHP+; continue to explore ways to develop, recruit and retain more providers.
  13. Create an independent, consumer-directed Consumer Advocacy and Ombudsman Program.
  14. Explore the feasibility of giving Coloradans the option to enroll in coverage that will stay with them regardless of life changes, such as the Optional Continuous Coverage Portable Plan that the Commission modeled.
  15. Explore the feasibility of allowing employers to offer 24-hour coverage.

 

Implementation

 

  1. Adopt these recommendations as a comprehensive, integrated package but do so in stages, increasing efficiency and assuring access before expanding coverage.
  2. Dissolve the Commission once its final report is made to the General Assembly January 31, 2008.