The big changes coming in health care
CHI was founded in 2002 to address a gap in sound health policy data and analysis, particularly independent and impartial information. Today, the need for reliable data and research has never been greater as leaders in the public, private and non-profit sectors work to transform Colorado’s health care system — an ever-more costly system that isn’t working as well as it should for nearly anybody.
This is a time of extraordinary change in health care. Most people are familiar with the revisions in the Affordable Care Act. But many may not realize the level of innovation that is underway in Colorado regardless of changes in the law, particularly collaborative efforts that would have been unthinkable even a decade ago.
Most of these projects are working toward three common goals — improving how patients experience the health care system, increasing the health of all Coloradans and reducing the per-capita cost of health care by making it more efficient and effective. Meanwhile, there’s widespread recognition that stronger preventive health for individuals and better overall health for our communities will be important components of successful change.
With that in mind, here are CHI’s top five Colorado health care trends heading into 2013:
• More public-private partnerships: Dozens of health care collaborations are being tested in Colorado, with private insurance payers, health care organizations and clinicians, among others, joining with public programs such as Medicare and Medicaid to try new ideas. The bottom line of these collaborations is a sharing of the risks and the rewards. One unique initiative to keep an eye on: The Colorado Comprehensive Primary Care Initiative is bringing public and private insurers together to expand comprehensive primary care and the medical home model in 73 primary care practices across Colorado.
• Integrating all aspects of patient care: Moving from a scattered, fragmented system to one that integrates every part of a patient’s care, including primary care, specialty care, oral health and behavioral health, is a top priority. The Colorado Department of Health Care Policy and Financing is conducting a pilot program that has the potential to be a transformative model of health care. The Accountable Care Collaborative divides the state into seven regions and challenges regional coordinators to enroll Medicaid clients in “medical homes” that oversee and integrate their care. Nearly 150,000 Coloradans are in the ACC project, with an anticipated 200,000 set to be signed up in the near future. Early results looking at whether the program can lower expensive emergency room visits and hospital stays are encouraging. Meanwhile, Colorado has tapped leaders across the state to help draft an application for a competitive State Innovation Models grant that would further support these ground-breaking efforts.
• A Colorado flavor of payment reform: State lawmakers approved a bill in the 2012 session that sets the stage to experiment with different payment models in the Medicaid pilot program, allowing for a move away from the traditional fee-for-service payment system to variations of a global payment system that would reward caregivers for providing more efficient, integrated care. This was a bipartisan effort that continues the creative and forward-looking work by Colorado’s legislators related to health reform.
• Big questions for small employers: Beginning in 2014, employers must provide coverage for all employees working 30 hours or more each week. In Colorado, most of these businesses are in the retail and hospitality industry. Looking at significant new expenses, CHI anticipates that many of these businesses will look to curtail worker hours.
• A steep learning curve: purchasing insurance: There will be many options for purchasing coverage — brokers, the Small-Employer (SHOP) Exchange, the Individual Exchange, private exchanges, the broker market. There will be myriad choices as well – basic health plans, gold plans, silver plans, bronze plans. The good news is that there should be more transparency, making comparisons easier. But it will be a new frontier, and CHI expects that there will be confusion and anxiety as change kicks in.
Michele Lueck is president and CEO of the Colorado Health Institute.
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