Cover Sheet National Governor’s Association Policy Academy
Cover Sheet National Governor’s Association Policy Academy Developing State-Level Capacity to Support Super-Utilizers Colorado State Team Lead and Administrative Coordinator: Kathryn Jantz, MSW, MPH Accountable Care Collaborative Program Colorado Department of Health Care Policy and Financing 1570 Grant Street Denver CO 80203-1818 Telephone: 303-866-5972 Fax: 303-866-2803 [email protected] Over the past several years, Colorado Medicaid under the Department of Health Care Policy and Financing (the Department) has implemented a number of service delivery reforms to reduce costs and improve quality of care for clients. Central to these efforts is the Accountable Care Collaborative (ACC) program, which relies upon a multi-layered system of accountability using regional organizations in collaboration with primary care providers. While this program has generated positive results in only its first two years of operation, more focused efforts on select populations will ensure continued improvements and success. The next phase of the ACC program’s evolution must incorporate targeted strategies that enhance the system’s competencies and capabilities for better coordinating the health care of high-utilizing clients, known as “superutilizers.” Beyond the marked increase in health care service consumption, the super-utilizer population is not homogenous in needs or behaviors. These individuals may have a wide range of physical and behavioral health needs, and the ability of each user to effectively access the health care delivery system is highly variable. To align with and best leverage current efforts, Colorado will specifically focus on interventions for clients who are enrolled in the ACC program and who meet criteria for the Client Over-Utilization Program (COUP). This subset of super-utilizers is characterized by ineffective and often inappropriate behaviors related to accessing the health care delivery system. This group differs from clients who have high medical needs and may be facing other challenges around access and in-home supports. The ACC program is designed to leverage regional needs and strengths through one centralized, accountable organization, known as a Regional Care Collaborative Organization (RCCO), in each of the seven regions of the state. The RCCO is responsible for the care of clients residing in the region who are enrolled as members in the program. Because the ACC program is designed to be outcomes-focused, each RCCO has the flexibility to address local needs through a community-based approach that leverages community strengths and resources. The model allows RCCOs to adapt and develop innovative approaches to managing their population’s health care. The Client Over-Utilization Program identifies clients who are inappropriately using the health care system and applies an administrative lock-in mechanism that controls the route by which care is accessed. The lock-in component ensures that clients receive coordinated care by using the primary care provider as a singular point of contact for the client’s whole health. The client may access other providers and specialists via a referral when the primary care provider determines it medically necessary and appropriate. The COUP program was established several years ago; however, the administration of the program has recently been transferred from the Department to its Utilization and Management (UM) vendor. This transition phase offers an opportunity to revisit program criteria and processes. The Department is committed to ensuring that the administrative mechanism is adequately accompanied by the robust supports of the ACC program. While the ACC program is a congruous environment to test various new interventions for the COUP eligible population, no corresponding forum exists to review and discuss the efficacy of these interventions beyond claims-based outcomes. For this purpose, the Department proposes to create a Policy Academy that would provide the necessary structure for state agency representatives to convene and learn about RCCO activities targeting super-utilizers while ensuring relevant coordination with other statewide and local efforts. Using RCCOs as learning labs will allow the state to compare different interventions, encourage community partnerships, Colorado – NGA Super-Utilizer Policy Academy Page | 1 maximize success of the program, and assess the strengths and challenges of the seven different models. At the completion of the Policy Academy, Colorado will have: Identified concrete ways that the Department of Health Care Policy and Financing, the Department of Public Health and Environment (CDPHE) and the Department of Human Services (DHS) can partner in serving the super-utilizer population, and will have identified designated staff from each agency for continued engagement; Begun implementing a necessary reimbursement structure for incentivizing providers to serve clients who meet overutilization criteria; Identified the necessary data with the means to obtain it, and developed a plan to incorporate the data into provider workflow; Completed an assessment of barriers to implementing medical neighborhoods and a preliminary proposal for how the state can support medical neighborhoods; and Shared intervention best practices between regions. Demonstrated Commitment from Relevant Leaders Across State Government: The core team represents the Governor’s Office, Medicaid, public health, behavioral health (including substance use disorders), human services, and health IT. Although direct state representatives from housing and transportation development are not on the core team, representatives from these areas are engaged and have agreed to participate in the daylong instate workshop and a year-long workgroup. Effective implementation of a robust strategy for COUP-eligible clients requires a strong and innovative workforce. In the ACC, the state pays the RCCOs to ensure all clients receive care coordination and to develop a contracted network of Primary Care Medical Providers (PMCPs) who are willing accept COUP eligible clients. The RCCOs are reimbursed through per member per month (PMPM) payments, providing significant flexibility. The RCCOs can reimburse health coaches, peer navigators, or a host of other service providers. Kathryn Jantz, ACC Program Lead, will be the team lead for this initiative and will champion this aspect of workforce development. The framework of the Academy will enable the Medicaid agency to develop relationships with the state Human Services and Public Health agencies, which up to now have only been peripherally involved in the ACC program. Kathryn is committed to engaging core team members in 1:1 meetings to discuss various aspects of the project and ensure full participation in the Academy activities. Health Information Technology/Data Analytics Capability: In the ACC program, the Department’s Statewide Data Analytics Contractor (SDAC), Treo Solutions, is responsible for providing secure electronic access to actionable data via a Web portal. The Web portal can be accessed by the Department, RCCOs and Primary Care Medical Providers (PCMPs). In addition to the interactive Web portal, the SDAC provides each RCCO with a complete file of paid claims so that they can conduct their own internal analysis, should they choose to do so. The SDAC Web portal is based on a data repository of Medicaid paid claims data and Behavioral Health Organization (BHO) managed care encounter data. ACC enrollees are assigned clinical risk group (CRG) identifiers and predictive risk scores. The SDAC conducts analysis to Colorado – NGA Super-Utilizer Policy Academy Page | 2 determine which claims were potentially preventable, possibly providing insights into which “super-utilizer” clients are ideal for intervention. Although the Department has put significant effort into educating providers about the SDAC web portal, limited research has been done into how this data is being incorporated into the workflow of direct care coordination. This initiative will provide insight into how that data is currently impacting direct care coordination, and determine what additional data is necessary as it relates to COUP eligible clients. The SDAC data has a number of limitations: Paid claims data illustrates health events that occurred months ago; Claims do not provide a complete picture of client health or quality outcomes; and Medicaid clients often move on and off of Medicaid, leaving gaps in the claims history. Colorado is engaged in three efforts to address those limitations. First, the Department is exploring methodologies to obtain real or close to real-time data on Emergency Department visits for Medicaid clients. Second, Colorado is well on its way to developing a statewide Health Information Exchange System. Third, Colorado is developing an All Payer Claims Database that will include historical claims data from the largest commercial payers’ individual and large- and small group plans, and Medicaid, representing over two million Coloradans. In addition to these statewide efforts, many of the RCCOs have developed their own IT infrastructure that may include both claims data and data from hospitals or other sources. Creating a forum where RCCOs share with one another how they are utilizing already available data may lead some RCCOs to enhance or alter their internal IT infrastructure. Each of these initiatives does or will provide access to the information necessary to allow for client identification and stratification, effective interventions and measuring progress. However, access to the necessary data is not synonymous with effective use of the data. In the Policy Academy, the state hopes to consider how to most effectively use the current data available (paid Medicaid claims) and gain a deeper understanding for how the other data sources can be integrated as they become available over the next several years. Specifically, the state wants to re-examine the definition of super-utilizers and how to measure success with this complex population. Comprehensive Stakeholder Engagement Plan: The ACC has a robust stakeholder process. The ACC Program Improvement Advisory Committee meets every two months, and is comprised of a diverse set of stakeholders engaged in the health care delivery system including consumers, health care providers and behavioral health providers. The Policy Academy presents an opportunity to incorporate representatives of nonmedical entities into the ACC Advisory Committee. This would transition the advisory committee from a focus on purely the health care system to the social determinants of health. For the purpose of this initiative, the team leader would request that the ACC Program Improvement Advisory Committee form a temporary workgroup. This workgroup would include members of the core team and additional external members including a representative from the following organizations: Care Solutions, LLC Colorado Coalition for the Homeless Colorado Community Health Alliance Colorado – NGA Super-Utilizer Policy Academy Colorado Community Health Network Colorado Coalition for the Medically Underserved Page | 3 Colorado Department of Human Services Colorado Department of Public Health and Environment Colorado Hospital Association Colorado Health Institute Community Health Partnerships Center for Improving Value in Health Care Colorado Health Partnerships Colorado Access Denver Health and Hospital Authority City and County of Denver, Crime Preventions and Control Commission Colorado Regional Health Information Organization Colorado Department of Human Services Department of Local Affairs, Division of Housing Integrated Community Health Partners Jefferson Center for Mental Health Physician Health Partners Quality Health Network Anticipated Outcomes and Challenges: The Policy Academy will result in cross-agency partnerships, a clear plan for financing care for this population, a vision for how to ensure an adequate network of care, and the identification and sharing of intervention best practices. We anticipate improved partnerships between the Department, CDPHE and DHS. Success in this arena will result in identification of concrete ways that each agency can collaborate to better serve this population. In addition, the Policy Academy will result in identification of staff at each agency who will maintain this partnership. The requirement to work closely with a superutilizer program, in this case the RCCOs, and to follow a number of clients over the course of the year, will provide all three agencies with a depth of knowledge of the program in action that they could not have gained through current forums. Although the ACC program emphasizes community partnerships, the Department has generally left relationship development to the RCCOs in their local communities. Participation in this Policy Academy would develop state level relationships, ensuring that connections are occurring statewide. This outcome, although seemingly modest, is one of the most important outcomes of the state’s participation. Starting the conversation of how to partner is often the hardest step. The risk is that staff turnover could jeopardize the longevity of those relationships or competing demands could mean that those relationships are not maintained beyond the super-utilizer workshop. At the conclusion of the Policy Academy, Colorado would like to have clear plans for how to incentivize care and support the necessary infrastructure for this population through the various ACC payment structures. Ideally, implementation of these payment structures would begin prior to the conclusion of the Academy year. The Department is currently considering whether to pay an additional PMPM payment specifically for COUP clients, or to incorporate a higher PMPM for this population into a variable rate structure within the ACC. In addition, the Department is exploring how to incentivize effective care for this population through Key Performance Indicators (KPIs) and Shared Savings. These changes would likely require CMS approval and could potentially require a State Plan Amendment. The greatest risk to achieving this outcome is that the solutions identified will not be operationally feasible. We also welcome the chance provided by this Policy Academy to explore options implemented in other states. In addition, we would like to formulate a vision for how to develop a Medical Neighborhood that is able to support these complex clients. The state has heard from providers that many of these clients engage in behaviors that make it challenging to connect them with specialty care. The state would like to explore the possibility of facilitating this type of care through telehealth Colorado – NGA Super-Utilizer Policy Academy Page | 4 programs. An enhanced telehealth program would likely require additional funding. Further, gaining the support of various members of the health care system in order to develop a robust Medical Neighborhood could require the leadership of the Governor’s office, and will need to compete for limited state resources to reach completion. Through the one-day workshop, the Policy Academy will provide an opportunity for the RCCOs to share their intervention models (or one of their models) with each other, and with the other workgroup members. This should generate discussion that will help the RCCOs develop a more comprehensive system of care and will allow RCCOs to consider best practices in other regions. Work Plan Team leader will meet 1:1 with each Core Workgroup Member. Workgroup will meet and be provided with options related to the program. Will decide frequency and structure of meetings. Team leader will partner each Core Team Member with a RCCO and have them do a “ride along” for care coordination. Identify super-utilizer clients to follow for the year-long initiative and work with RCCO’s to gain permission from clients. Develop a plan for tracking the clients’ experience. Meet with other state staff to brainstorm ways to collaborate. Develop several options to bring back to each agency. Identify key members of the team that will work together on a regular basis (meeting at least quarterly) for the foreseeable future to determine how to partner on serving this population. Day-long workshop. RCCOs share their intervention models (or one of their models) and their data use methodologies with each other and the other workgroup members. Community partners share their role in caring for this population. Explore options from other states. Meet with Academy faculty to brainstorm options to bring to workgroup. Present options to workgroup. Gain internal approval. Assess whether or not CMS approval is necessary. Assess whether or not any contract changes are necessary. Week 07/08/13 07/22/13 08/12/13 08/26/13 09/02/13 TBD TBD TBD TBD 02/03/14 02/17/14 03/03/14 03/17/14 04/07/13 04/21/13 Implementation Prospects: The State of Colorado is highly committed to serving this population. As the infrastructure for both the ACC and the COUP program are in place and the goal of Colorado’s participation in this Policy Academy is high quality comprehensive care, the state is very likely to be successful in making measureable change over the course of the year. The Policy Academy complements other activities in which Colorado is already engaged, including the Comprehensive Primary Care initiative (CPC) and the State Innovation Models Initiative (SIM), both administered by the Center for Medicare and Medicaid Services (CMS) Innovation Center. Colorado is one of seven states chosen to participate in CPC, a multi-payer initiative (public and private) with the goal of strengthening primary care. To be selected to participate, Colorado primary care practices had to demonstrate their commitment to coordinating care for their patients. Participating practices are given a bonus payment for each of their clients. In order to receive the PMPM payment for Medicaid patients, the practices must contract with the ACC. Colorado – NGA Super-Utilizer Policy Academy Page | 5 This contingency ensures that the state’s long-term health care reform program aligns with shortterm initiatives. The state’s participation in CPC guarantees that lessons learned around care coordination across the system can be shared and disseminated to a multi-payer audience. In addition, small private practices that may not have experience working with complex Medicaid clients with significant health utilization needs may be more comfortable accepting these clients if there is a strong system of non-medical care to complement the medical services. Colorado has received SIM Pre-testing funding to further develop our State Health Care Innovation Plan, with a focus on behavioral health integration. One aspect of integration is an assessment of what would be required operationally for implementing Health Homes in 2015. The SIM pre-testing period includes a robust stakeholder process, and one of the concerns we have heard from providers is that PCPs may not be the appropriate primary point of care for some super-utilizers. Health Homes will provide an opportunity to rethink who can be the primary point of care. This Policy Academy aligns with SIM activities in both timing and focus. The SIM Pre-testing funds period ends September 31, and CMS has not released anticipated dates for awarding the next round of SIM Testing funds. The Policy Academy would provide structure for the state to continue conversations with some of the same participants in SIM over the course of the year and pilot some intervention models with this smaller population. Participation in this Policy Academy will further the efforts in the NGA sponsored Prescription Drug Abuse Reduction Policy Academy by focusing narrowly on a population and a program that has not received much attention within that Academy. In addition to state administered interventions, there are a multitude of localized interventions taking place in Colorado, many of which are in collaboration with their local RCCO. For example, the Colorado Springs Fire Department has partnered with community medical and safety-net organizations, including their local RCCO, to implement a pilot program that uses the Fire Department’s resources and medical expertise to address “frequent fliers” in their community. The Policy Academy will give the state the opportunity to share these ideas between regions and assess scalability. Description of the Super-Utilizer Population that will be Served: For the purposes of this project, the state will focus on clients who meet the eligibility criteria for COUP and are enrolled in the ACC. Clients enrolled in COUP are not able to see multiple providers, ensuring continuity of care and heightening the potential for developing an effective intervention. COUP clients have documented evidence of abuse or over-utilization of allowable medical benefits. Clients become COUP eligible if they exceed any one of the following parameters during a three-month period: Use of sixteen or more prescriptions; Use of three or more pharmacies; Use of three or more drugs in the same therapeutic category, i.e., Oxycodone, Oxycontin, Hydrocodone; Has excessive ER and physician visits; OR A referral or analysis indicates possible overutilization. The ACC program is designed to be iterative; the state is committed to making significant ongoing changes. The Policy Academy will give state staff and stakeholders a chance to thoughtfully improve how the program serves this super-utilizer population. Colorado – NGA Super-Utilizer Policy Academy Page | 6 STATE OF COLORADO OFFICE OF THE GOVERNOR 136 State Capitol Denver, CO 80203 - 1792 Phone (303) 866-2471 Josette Gbemudu Senior Policy Analyst National Governor’s Association 444 N. Capitol St., Suite 267 Washington, DC 20001-1512 via email to [email protected] May 31, 2013 ____________________ John W. Hickenlooper Governor Dear Ms. Gbemudu, We are pleased to submit this application for Colorado’s participation in the National Governors Association Policy Academcy for Developing State-Level Capacity to Support SuperUtilizers. Colorado’s goal is to become the healthiest state in the nation by achieving the best care and producing the best health outcomes with the best value. As such, we would like to use this opportunity to promote inter-agency and multi-sector collaboration in order to meet the needs of individuals who have unnecessarily high utilization rates in our healthcare system. In particular, we will use this Policy Academy to focus on interventions for super-utilizer Medicaid clients enrolled in the Accountable Care Collaborative (ACC) program, Colorado’s preeminent payment and delivery system reform initiative. The Colorado Department of Health Care Policy and Financing (HCPF), Colorado’s single Medicaid state agency, will be the lead agency for this effort, and our designated team includes: Kathryn Jantz, MSW, MPH, ACC Program Lead, Health Programs Office, HCPF (Team Lead and Administrative Coordinator) Laurel Karabatsos, Deputy Medicaid Director, HCPF Joel Dalzell, Section Manager, Health Data Strategy Section, HCPF Gabriel Kaplan, PhD, MPA, Director, Prevention Health Policy, Systems and Analytics Branch, Colo. Dept. of Public Health & Environment Lisa Clements, PhD, Director, Office of Behavioral Health, Colo. Dept. of Human Services Katherine Blair, Senior Policy Advisor for Health, Governor’s Office We intend to use this opportunity to actively engage many other experts and stakeholders in Colorado, including Regional Care Collaborative Organizations within the ACC, medical and behavioral healthcare providers, patient advocates, county departments, federally qualified health centers, and health data organizations. Thank you for your time and consideration, John W. Hickenlooper May 28, 2013 Marilyn S. Gaipa, LCSW, CAC III Care Solutions, LLC working with Jean East, PhD - Associate Dean of Academic Affairs Graduate School of Social Work University of Denver 2148 S High St Denver, CO 80208 Dear National Governors Association: On behalf of the Graduate School of Social Work, University of Denver and Care Solutions, LLC, it is my pleasure to submit this letter of support for Colorado’s application for the National Governors Association Policy Academy – Developing State-level Capacity to Support Super-Utilizers. As an organization that provides academic preparation for social workers in all aspects of health care delivery, we believe strongly in the importance of a statewide plan that focuses on care coordination for super-utilizers who are enrolled in Medicaid. We are committed to the Governor’s vision of making Colorado the healthiest state in the nation and believe that this opportunity will improve service delivery to this population. The Graduate School of Social Work is committed to developing social work health care professionals that function at the highest level in health care services, including all levels of care coordination, integrated physical and behavioral health care, medical social work/discharge planning, prevention/early intervention and wellness activities. The Graduate program at GSSW is developing a health/wellness concentration year curriculum, along with a continuing education program, to train effective and efficient social workers to deliver these needed services. Our organization will continue to share our perspective with the State and work collaboratively to design a state action plan to better address the needs of super-utilizers in Colorado. Sincerely, Marilyn Gaipa, LCSW, CAC III Care Solutions, LLC Principal/Founder working with Jean East, PhD –Associate Dean of Academic Affairs Graduate School of Social Work University of Denver May 28, 2013 Marilyn S. Gaipa, LCSW, CAC III Care Solutions, LLC working with Jean East, PhD - Associate Dean of Academic Affairs Graduate School of Social Work University of Denver 2148 S High St Denver, CO 80208 Dear National Governors Association: On behalf of the Graduate School of Social Work, University of Denver and Care Solutions, LLC, it is my pleasure to submit this letter of support for Colorado’s application for the National Governors Association Policy Academy – Developing State-level Capacity to Support Super-Utilizers. As an organization that provides academic preparation for social workers in all aspects of health care delivery, we believe strongly in the importance of a statewide plan that focuses on care coordination for super-utilizers who are enrolled in Medicaid. We are committed to the Governor’s vision of making Colorado the healthiest state in the nation and believe that this opportunity will improve service delivery to this population. The Graduate School of Social Work is committed to developing social work health care professionals that function at the highest level in health care services, including all levels of care coordination, integrated physical and behavioral health care, medical social work/discharge planning, prevention/early intervention and wellness activities. The Graduate program at GSSW is developing a health/wellness concentration year curriculum, along with a continuing education program, to train effective and efficient social workers to deliver these needed services. Our organization will continue to share our perspective with the State and work collaboratively to design a state action plan to better address the needs of super-utilizers in Colorado. Sincerely, Marilyn Gaipa, LCSW, CAC III Care Solutions, LLC Principal/Founder working with Jean East, PhD –Associate Dean of Academic Affairs Graduate School of Social Work University of Denver May 21, 2013 National Governors Association 444 North Capitol Street Washington, D.C. 20001 Dear National Governors’ Association: On behalf of the Colorado Coalition for the Homeless, it is my pleasure to submit this letter of support for Colorado’s application for the National Governors Association Policy Academy – Developing State-level Capacity to Support Super-Utilizers. As a Federally Qualified Health Center: Healthcare for the Homeless Provider that delivers housing, healthcare and supportive services to more than 12,000 homeless men, women and children each year, we believe strongly in the importance of a statewide plan that focuses on care coordination for super-utilizers who are enrolled in Medicaid. The Coalition is committed to the Governor’s vision of making Colorado the healthiest state in the nation. We believe that this opportunity will help us enhance our ability to deliver an integrated model of care that includes primary care, mental health and substance treatment services, dental, vision, pharmacy, respite care and mobile health services – along with housing and benefits acquisition. Currently, assisting our clients in the enrollment process for Colorado’s Medicaid expansion programs is a top priority. To date we have facilitated the submission of more than 1,500 applications for the Adults without Dependent Children (AwDC) program. For 25 years, the Coalition has been crafting lasting solutions for individuals with extremely complex needs. We believe we are well-positioned to share a meaningful perspective with the State and to continue to collaborate on a state action plan to better address the needs of superutilizers in Colorado. Sincerely, BJ Iacino Bette Iacino Vice President, Public Policy and Communications Colorado Coalition for the Homeless (303) 285-5223 [email protected] May 28, 2013 National Governors Association Hall of the States 444 N. Capitol Street, Suite 267 Washington, DC 20001 Dear sir or madam: On behalf of the Colorado Coalition for the Medically Underserved (CCMU), it is my pleasure to submit this letter of support for Colorado’s application for the National Governors Association Policy Academy – “Developing State-Level Capacity to Support Super-Utilizers.” As an organization that actively works on improving the health care system so it meets the needs of all Coloradans, we believe strongly in the importance of a statewide plan that focuses on care coordination for super-utilizers in Medicaid. We are committed to the governor’s vision of making Colorado the healthiest state in the nation and believe that this opportunity will improve service delivery to this population. The health care system only works if it works well for our most vulnerable populations—and many tend to cost the system the most for various reasons. We at CCMU prioritize these populations in our health system improvement work, and we have been pleased with the success thus far in the Accountable Care Collaborative. As an increasing amount of vulnerable populations are being enrolled in the ACC, we need to enable them to better their health outcomes with appropriate and beneficial use of the system. This is even more critical with the impending enrollment of more low-income adults without dependent children— many of whom have never before received coverage and face significant behavioral and physical health challenges. Colorado has an immense opportunity to capitalize upon with the burgeoning growth and continuing success of the ACC and the impending changes with health reform. We are pleased with the state’s commitment to super-utilizers, and we will commit to working collaboratively with the state to design an action plan and supporting them in their efforts. Sincerely, Aubrey Hill Director of Health Systems Change Colorado Coalition for the Medically Underserved PO Box 18877, Denver, CO 80218 | 720.583.1760 | ccmu.org Gretchen Hammer Executive Director Colorado Coalition for the Medically Underserved Leading change for a healthier Colorado 2013 Members AspenPointe Beth-El Colleg of Nursing UCCS Central CO Area Health Education Center Colorado Springs Fire Department Colorado Springs Health Partners Dream Centers of Colorado Springs El Paso County Public Health El Paso County Medical Society HealthSouth Rehabilitation Hospital Robin Johnson MD Kaiser Permanente Mission Medical Clinic Mountain View Medical Group Open Bible Medical Clinic & TLC Pharmacy Peak View Behavioral Health Peak Vista Community Health Centers Penrose- St. Francis Health Services Pikes Peak Hospice & Palliative Care Doris Ralston Rocky Mountain Health Care Services Select LTC Hospital S.E.T. Family Medical Clinics The Independence Center UC Health/Memorial Hospital Laura Wedemeyer May 24, 2013 National Governors Association Ms. Krista Drobac Health Division Director Dear National Governors Association: On behalf of Community Health Partnership it is my pleasure to submit this letter of support for Colorado’s application for the National Governors Association Policy Academy – Developing State-level Capacity to Support Super-Utilizers. CHP is a community coalition formed in 1992 by local health care leaders to foster a coordinated approach to health care issues, and every major health care provider in our region is a member. CHP is also the coordinating body for RCCO Region 7, Colorado’s innovative accountable care model for Medicaid. This ACO is dedicated to providing care coordination and population management for the growing Medicaid population in our region. We believe strongly in the importance of a statewide plan that focuses on care coordination for super-utilizers who are enrolled in Medicaid. We are committed to the Governor’s vision of making Colorado the healthiest state in the nation and believe this opportunity will improve service delivery to this population. RCCO Region 7 currently serves 57,000 Medicaid enrollees. RCCO-level care coordination efforts focus on top emergency department utilizers – individuals who have been in the ED more than ten times in the past twelve months with no in-patient admission. We work collaboratively with primary care providers to ensure case management services for these individual clients. We are piloting innovative interventions to reduce ED utilization, including working with Fire Department paramedics, and ED in-person interventions. Page 2 Letter of Support Sincerely, Debbie Chandler Valerie Herl Chief Executive Officer Colorado Springs Health Partners VP of Business Operations Pikes Peak Hospice & Palliative Care Robin Johnson, MD, FACEP Jill Law Emergency Room Physician Public Health Director El Paso County Public Health Jefferson Martin Pam McManus Executive Director Open Bible Medical Clinic/TLC Pharmacy President Peak Vista Community Health Centers Bruce Minear Kelly Phillips-Henry Chief Executive Officer Mountain View Medical Group Chief Operating Officer AspenPointe Mike Scialdone Nancy Smith Chief Executive Officer UC Health/Memorial Hospital Dean and Professor Beth El College of Nursing & Health Sciences Jameson Smith Richard Spurlock MD Chief Administrative Officer Penrose-St. Francis Health Services Kaiser Permanente May 21, 2013 National Governors Association Hall of the States 444 N. Capitol Street, Suite 267, Washington, DC 20001-1512 Dear National Governors Association: On behalf of the Center for Improving Value in Health Care (CIVHC), it is my pleasure to submit this letter of support for Colorado’s application for the National Governors Association Policy Academy – Developing State-level Capacity to Support Super-Utilizers. CIVHC is dedicated to achieving the Triple Aim in Colorado by expanding access to and use of data, and facilitating the development of new delivery and payment models for both Medicaid and commercial payers. As such, we believe strongly in the importance of a statewide plan that focuses on care coordination for super-utilizers who are enrolled in Medicaid. We are committed to the Governor’s vision of making Colorado the healthiest state in the nation and believe that this opportunity will improve service delivery to this population. Our organization will continue to share our perspective with the State and work collaboratively to design a state action plan to better address the needs of super-utilizers in Colorado. Sincerely, Philip B. Kalin President and CEO May 28, 2013 Gretchen McGinnis Colorado Access RCCO 2, 3 and 4 10065 E Harvard Ave, Suite 600 Denver, CO 80231 Dear National Governors Association: On behalf of Colorado Access, it is my pleasure to submit this letter of support for Colorado’s application for the National Governors Association Policy Academy – Developing State-level Capacity to Support Super-Utilizers. As an organization that holds the Regional Collaborative Care Organization (RCCO) contracts for three of the state’s seven regions as well as functioning as the Behavioral Health Organization in the city and county of Denver and the largest CHP+ HMO in the state, we believe strongly in the importance of a statewide plan that focuses on care coordination. This grant’s project for super-utilizers who are enrolled in Medicaid is a positive step in that direction. We are committed to the Governor’s vision of making Colorado the healthiest state in the nation and believe that this opportunity will improve service delivery to this population. Colorado Access, in our 17 year history, have created and implemented many nationally recognized programs focused on the unique needs of the state’s neediest populations in Medicaid. This opportunity to focus on this important population in a more coordinated and collaborative fashion is exciting and one that we look forward to participating in. Our organization will continue to share our perspective with the State and work collaboratively to design a state action plan to better address the needs of super-utilizers in Colorado. Sincerely, Gretchen McGinnis Sr. Vice President of Public Policy and Performance Improvement _____________________________________________________________________________________________ 10065 East Harvard Avenue Suite 600 Denver, Colorado 80231-5963 Phone: 720.744.5100 Fax: 303.751.9048 STATE OF COLORADO Nation OFFICE OF BEHAVIORAL HEALTH Lisa M. Clements, PhD, Director 3824 W. Princeton Circle Denver, CO 80236 Phone: 303-866-7434 Fax: 303-866-7090 [email protected] John W. Hickenlooper Governor Reggie Bicha Executive Director May 23, 2013 National Governor’s Association Hall of the States 444 N. Capitol St., Suite #267 Washington, DC 20001-1512 Dear National Governors Association: On behalf of the Colorado Department of Human Services, Office of Behavioral Health (OBH), it is my pleasure to submit this letter of support for Colorado’s Developing State-level Capacity to Support Super-Utilizers National Governors Association Policy Academy application. OBH believes strongly in the importance of a statewide plan that focuses on care coordination of superutilizers in Colorado. Through the Accountable Care Collaborative (ACC), the State has made significant strides towards addressing this population of Medicaid clients. This opportunity will allow the State to revisit its approach and further align the activities of the various state agencies for the ACC enrolled population as well as those not enrolled. OBH continues to work with the Colorado Behavioral Health Transformation Council to provide consumers with timely access through multiple points of entry to a full continuum of culturally responsive services, including prevention, early intervention, crisis response, treatment, and recovery. We commit to working collaboratively to implement a plan that will make a positive difference in the care experience and health outcomes for individuals identified as “super-utilizers” in Colorado. Sincerely, Lisa M. Clements, PhD. Director Our Mission is to Design and Deliver Quality Human Services that Improve the Safety and Independence of the People of Colorado May 28,2013 DonnaMills IntegratedCommunityHealth Partners 503N Main St. Ste.202 Pueblo,CO 81003 DearNationalGovernorsAssociation: On behalfof IntegratedCommunityHealthPartners(ICHP),it is my pleasureto submitthis letterof supportfor Colorado'sapplicationfor the NationalGovemorsAssociationPolicy Academy- DevelopingState-levelCapacityto SupportSuper-Utilizers. As a memberof the State'sAccountableCareCollaborative,we believestronglyin the importanceof a statewideplanthat focuseson carecoordinationfor super-utilizers who are enrolledin Medicaid.We arecommittedto the Governor'svision of makingColoradothe healthieststatein the nationandbelievethat this opportunitywill improveservicedeliveryto this population. Our vision for the super-utilizers in the Stateof Coloradois betterquality andquantityof life. A supportsystemthat allowsfor the Triple Aim: populationhealth,experienceof care,andper capitacosts.We believethat healthcareis local anda Statewideapproachwith caveatsallowing for communitydifferencesis inperative. Ow organizarionwill continueto shareour perspectivewith the Stateandwork collaboratively to designa stateactionplanto betteraddressthe needsof super-utilizers in Colorado. DonnaMills Chief ExecutiveOfficer 503 North MainStreet. Suite #300 r Pueblo,Coloradoc 81003 o Phone; 71954$L3M o Fax 71951134069 QualityHealthNetwork.org May 21, 2013 National Governors Association Hall of the States, 444 N. Capitol St., Ste. 267 Washington, D.C. 20001-1512 Dear National Governors Association: This letter is to confirm the support of Quality Health Network (QHN) for Colorado’s application for the National Governors Association Policy Academy – Developing State-level Capacity to Support Super-Utilizers. As a nonprofit community collaborative located in Grand Junction, Colorado, Quality Health Network (QHN) is focused on health information technology adoption, health information exchange (HIE), and the innovative use of information for improved healthcare outcomes in the communities across western Colorado. QHN provides for the secure exchange of health information to optimize the health of the region, improve economic efficiencies, and to bring value to healthcare and community stakeholders. QHN supports and believes strongly in the importance of a statewide plan that focuses on care coordination for superutilizers who are enrolled in Medicaid. We are committed to the Governor’s vision of making Colorado the healthiest state in the nation and believe that this opportunity will improve service delivery and quality of care to this population. As a fully operational HIE, since 2005, QHN has undertaken a significant initiative to deploy innovative data analytics which provide risk stratification and predictive modeling tools to medical providers in the QHN western Colorado network. These tools improve care coordination for chronic disease states and support patient behavior change for all patients; however super-utilizers, our most medically and psychosocially complex patients, are frequently the noteworthy beneficiaries of these practice transformation tools. The maturity of QHN’s data base also supports hot-spotter identification and the potential to deploy healthcare interventions in the primary care setting to help care providers predict needs, prioritize resources and engage in preventative care. The QHN HIE is an integral part of clinical transformation providing data and performance measurement tools across multiple payers as well as providing primary physicians with real time “alerts” when their patients are admitted to emergency or acute care settings. Our organization will continue to share our perspective, knowledge and expertise with the State and work collaboratively to design a state action plan to better address the needs of super-utilizers in Colorado. Sincerely, Dick Thompson Executive Director & CEO Quality Health Network 744 Horizon Drive, Suite #210 • Grand Junction, CO 81506 • 970-248-0033
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