Improve value in health care service delivery

Why is this important to Colorado?

Value in health care service delivery means that the funding spent on health care is leading to healthy outcomes, not unnecessary expenses or procedures.  We know that:

  • Choice and competition for patients encourage continuous improvement of care.
  • Measuring the actual costs of patient care and associated health outcomes is critical for improving value and patient experience.

How do we measure success?

  • Maintain average annual per capita total cost of care for Medicaid under $6,140, despite anticipated rise in healthcare costs.  In 2016, the average annual per capita total cost of care was $6,092.
  • Reduce the number of physically unhealthy days per month from 7.4 in 2014 to 5 by 2020. This represents the average number of unhealthy days per month reported by Medicaid clients on surveys for the State’s Behavioral Risk Factor Surveillance System. In 2017, this number was 6.0 days.
Status Outcome Measure

Outcome Baseline

(June 2015)

Actual

(June 2016)

Actual

(June 2017)

Outcome Target Target Date

Per capita total cost of care $6,140 $6,092 TBD - Nov 2017 $6,140 2018

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Unhealthy days per month 6.3 7.0 6.0 5.0 2020

Source: HCPF, CDPHE, ACC annual report

What actions are we taking?

  • Colorado Department of Health Care Policy and Financing is adding value by integrating what have traditionally been separate delivery systems for primary care and behavioral health services. When care for behavioral health and substance use disorders are excluded from the physical health system, substandard care and increased costs result.
  • Colorado Department of Health Care Policy and Financing (HCPF) is focused on purchasing that provides better health outcomes for the lowest practicable cost. The Department is working with stakeholders to create sustainable value-based payment models for primary care. These models are designed to increase provider flexibility, reward performance, and align with other state and national payment reform initiatives while holding providers accountable for quality and success.
  • Colorado Department of Health Care Policy and Financing (HCPF) efforts to enhance primary care services include incentivizing providers to offer evening and weekend hours, offering on-site behavioral health, and consultations via telephone and secure e-mail.
  • Increase patient engagement and remove barriers to access for patients. Colorado Department of Health Care Policy and Financing supports efforts to engage members in their health and health care decision in order to promote wise use of services and improve health and wellbeing.  The Department is doing this by using tool and programs like the Member Portal, the Peak Health mobile app, and Healthy Communities.
  • The Accountable Care Collaborative: Rocky Mountain Health Plans Prime program has exceeded its goal of increasing utilization of the Patient Activation Measure, a tool that providers can use to match interventions and health care strategies to clients based on their level of health knowledge and readiness to change.
  • To increase social inclusion and connectedness to the community among those receiving long-term services and supports (LTSS), the Colorado Department of Health Care Policy and Financing continues to make progress on a large-scale effort to transform its delivery system for LTSS. Efforts focus on increasing ease of access, simplifying processes, expanding services, and reducing administrative burden. Programs supporting this strategy focus on simplifying Colorado Medicaid home and community-based service waivers for older Coloradans and persons with disabilities, and developing infrastructure to transition members from long-term care facilities to community-based settings. As of August 2017, we transitioned a total of 273 individuals since inception of the Colorado Choice Transitions program. In addition, we are implementing conflict-free case management to introduce more choice for individuals, and launched regional pilot programs to understand how a No Wrong Door system makes it easier for older adults and people with disabilities to learn about – and access – the services they need.