Q&A: Lt. Gov. Primavera on expanding access to physical and behavioral health services
Dianne Primavera is the Lieutenant Governor of Colorado and leads the Office of Saving People Money on Health Care and the Office of eHealth Innovation. She was formerly a state legislator and the CEO of Susan G. Komen Colorado.
In this Q&A, Primavera discusses her work in the legislature, future efforts at the Office of Saving People Money on Health Care, and what the impact of the new Behavioral Health Administration (BHA) will be.
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State of Reform: What are the main health policy conversations that are happening right now in the legislature? What are you pushing for in this session?
Lt. Gov. Dianne Primavera: “The governor and I are especially interested in lowering costs [and] making high quality, affordable, equitable health care accessible to every Coloradan. Over the last three years, we’ve all made really significant progress towards reaching that goal. This year’s legislative session is about building on that previous success that we’ve had.
One particular focus is reforming Colorado’s behavioral health system. In 2019, our administration created the Behavioral Health Task Force, which identified areas where change is needed and outlined strategies to address the challenges. One of those was to create the Behavioral Health Administration and we’re hoping that the BHA will be the strategic and visionary leader for behavioral health in Colorado, working with the state agencies and communities to make sure that every Coloradan has access to mental and behavioral health care services that they need.”
SOR: How will your policy priorities address concerns around the social determinants of health?
DP: “The governor and I have always firmly believed that all roads lead to health, and we know that being well goes far beyond physical well-being. That has allowed us to be creative in thinking about what resources Coloradans would need to truly thrive like housing, education, transportation and how we can cover as many people as possible.
One of the things that I’m personally very excited about is our proposed medical financial partnership pilot program. This is to address what we call ‘financial toxicity.’ We know that the high cost of medical care—especially for chronic and long-term conditions—can have toxic effects on all areas of a patient’s life. That includes their ability to manage their mental health and their ability to work and provide for themselves and their families.
So, we’re hoping that this program will combat that trend by embedding a financial service professional from a community based organization—like a ‘financial navigator’ or somebody who knows all the ins and outs of insurance policies of Medicaid and Medicare—directly into the doctor’s office. [This will ensure] that they can meet patients right when they’re diagnosed and help them navigate the resources that are available to them. Nobody should have to choose between getting the care that they need and keeping a roof over their heads.
We’re at a pivotal moment for health care reform, not just in Colorado, but around the country. The governor and I are always hoping to be a leader for the rest of the country in our health care policy and this legislative session is really no different.”
SOR: How has the Office of Saving People Money on Health Care accomplished its goal? What are some of the future plans for the office?
DP: “It’s amazing how fast time flies. I signed the executive order five days into our administration creating the office and [received] the privilege of leading as the director ever since. It’s been the cornerstone of our efforts to reduce the cost of health care for Colorado, and we’ve done exactly that with landmark bills over the last three years. [These bills addressed] reinsurance, skyrocketing cost of insulin, creating the Colorado Option, and the Prescription Drug Affordability Board. In 2022, the reinsurance program alone will save Coloradans an average of 24.1% on their insurance premiums when they have to buy it on their own in their individual market.
The office has also worked really hard to apply an equity lens to all of its work. Equity doesn’t just mean people of color. It also means people with a variety of health conditions and disabilities. We often speak about our vision of a Colorado for all, and to achieve that vision, we have to acknowledge and address historical, systemic disparities to access and affordability. Going forward, we’ll continue to think creatively about how to lower costs, increase access, and make sure people of all communities have the ability to thrive.”
SOR: What have you learned about how COVID has impacted our health system and how it impacted our public health leadership?
DP: “First of all, the thing that gives me the greatest heartache is the impact that the pandemic had on the loss of life in Colorado. At the same time, we’ve seen Colorado step up to the plate to take care of themselves and one another. We’re fortunate to have one of the ten lowest death rates due to COVID in the country.
That said, the pandemic served as a ‘black light’ shining on our health care system. It illuminated many of the cracks that we knew existed and revealed some that we didn’t even know existed. In Colorado, we were really lucky to have dedicated public servants who have run at a dead sprint throughout the past couple years during the pandemic to find fast solutions for some of the challenges.
One of the offices that I’m particularly proud of is the Office of eHealth Innovation. They provided critical support to expanding broadband networks and to support telehealth technology, which was especially important in the early days of the pandemic when people were having to stay at home.
Our pandemic response was covered by collaboration. It was so critical to act quickly, to address new roadblocks, and also solve problems proactively, especially in regards to support for the workforce.
We know that the pandemic took a huge toll on the health care workforce and we’re looking at a handful of different options right now to address that. This includes raising wages for direct workers and creating a health care corps in partnership with AmeriCorps. That will not only bolster the current workforce, but help train the next generation of health care professionals.”
SOR: Behavioral health is a key issue in Colorado, as you know. Will the creation of the BHA solve all of Colorado’s behavioral health issues? How so? And if not, what more needs to be done to best service Coloradans?
DP: “We know that creating the BHA certainly won’t solve all of our problems, but it’s a meaningful and important step towards that. What it will do is serve as the strategic and visionary leader for behavioral health in Colorado, and work with other state agencies and communities around the state to make sure that all Coloradans have access to the mental and behavioral health care services that they need.
I was also proud to serve on the Behavioral Health Transformational Task Force. We spent months meeting with stakeholders and developing recommendations for leveraging the $450 million coming into the state to the American Rescue Plan Act (ARPA). We hope that money will address the structural gaps in our behavioral health continuum and give us a one-time infusion of cash to make some transformational changes.
Our budget this year also directs $32.2 million to expand residential options that can serve youth with acute behavioral health care needs and directs significant investments to the direct care workforce. It doesn’t matter how many buildings you erect if you don’t have the workforce to take care of the people inside the building.”
This interview was edited for clarity and length.