On a panel led by the newly appointed Colorado Medicaid Director Adela Flores-Brennan during the 2022 Colorado State of Reform Health Policy Conference, officials from the Colorado Department of Health Care Policy and Financing (HCPF) spoke to the state’s continuing efforts to improve Medicaid.
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HCPF panelists outlined some of the many plans it’s developing for implementation in the coming months. According to Health Disparities & Equity, Diversity, and Inclusion Officer Aaron Green, HCPF has been examining the current health disparities impacting its members across the state.
Citing the department’s Health Equity Plan, Green laid out its 4 focus areas for reducing health disparities: vaccination, maternity and perinatal care, behavioral health, and disease prevention. He acknowledged the challenges that exist in equitably serving 1.67 million Coloradans.
“When we’re looking at equity, it’s so important that it doesn’t matter who walks in the door to get that service, that they get it how they need it, when they need it, and in the best quality and timeliness as possible,” Green said.
“We know historically that marginalized and underserved folks of color, LGBTQ [individuals], people with disabilities, people who don’t speak English as their first language, people [who] have different zip codes, rural communities, that we all have access at different points. [For] people who have marginalized identities, we recognize that healthcare and access to quality of care has been uneven, or they have been denied or delayed access to care.”
Current Colorado law mandates that the Health Equity Plan be built into the health system’s infrastructure. HCPF has been working closely with its providers and advocates to this end, hosting a series of listening sessions over the past year with its members to understand equity gaps in Colorado.
The department has been stratifying its data collection to ensure equitable decisions can be made when working with partners to target and close those health gaps. But Green said providers need to promote workforce diversity to adequately represent, serve, and culturally respond to its members.
When it passed, the American Rescue Plan Act (ARPA) provided $530 million in one-time funding to strengthen and enhance Colorado’s Medicaid Home and Community-Based Services (HCBS). HCPF’s Office of Community Living (OCL) is responsible for administering and overseeing the HCBS programs that support nearly 80,000 Coloradans with disabilities.
Bonnie Silva, Director of OCL, said half of that money went to direct care workers by increasing base wages from $12 to more than $15 per hour. There are plans to create a public awareness campaign about employment opportunities in long-term care.
“I contend that if people really understood that this career was an opportunity, we would have lots of people knocking on our door,” Silva said. “But because people with disabilities continue to be marginalized and not fully integrated into our society, so are their workers. How do we elevate this field similar to emergency services, or nurses and help people see this is one avenue where you can start your career, continue your career and really accomplish great things?”
To utilize the ARPA funds within the 3-year spending window, her commission came up with 63 projects that target simplifying access to long-term care, strengthening the provider base, improving quality of care, and addressing direct care workforce retention.
Silva highlighted some of the projects, including the creation of standardized training for case management, streamlining access to the eligibility process, and working with providers on streamlining the administrative processes for its members.
The panel highlighted the state’s adoption of an Alternative Payment Model (APM) that raised fee-for-service rates by 4% to providers who, in exchange, are required to meet and report on the state’s quality and structural measures.
Peter Walsh, MD, Chief Medical Officer of HCPF, spoke to some of the APM’s pilot programs that focus on improving health outcomes for Medicaid.
“[One voluntary program] incorporates an opportunity for providers to get some of their costs reimbursed via a partial capitation model, which allows them to take whatever percentage [as] partial capitation and use those lump sums to apply to implement actual interventions in their practice and improve care to patients,” Walsh said.
“Things that they wouldn’t necessarily be able to make if they were getting reimbursed on an actual care delivery model, but it’s helpful to get an upfront amount as well.”
Walsh said that while the state’s APM continues to evolve, it centers on the quality of medical care by encouraging providers to focus on chronic conditions when appropriate.
“So it’s likely that model, as it evolves, will have a client-positioned focus to it with protocol metrics overlaid, as well as access and quality metrics.”
HCPF has received authorization and funding to begin the next phase of Medicaid contract procurement. Once contracts have been issued, the department will work with stakeholders on developing a future APM model. In those conversations, Walsh said the department is very mindful about alignment with CMS core measures.
During the panel’s Q&A session, several community health advocates from the audience expressed their frustrations with the lack of engagement to address concerns ranging from provider oversight, access to care, and administrative hurdles.
One audience member, an official from Salud Family Medical Center in Aurora, said there were 40,000 Medicaid eligible people in her region who still do not have access to providers. She asked the panel what was being done to address rising health disparities for women of color in Aurora.
In response, Green invited her and all interested stakeholders to the Statewide Health Equity Task Force’s next information sharing session.
The panel assured the audience that HCPF would make more concerted efforts on community engagement that move beyond conducting surveys.
“One of the things that I would really like to do as Medicaid Director is trying to figure out how we get into the community more,” Flores-Brennan said. “We have an opportunity coming up with the implementation of some new legislation [and] the advocates were really good about putting some very specific measures in place in that legislation [that’s] really holding us accountable to that level of outreach and community engagement.
But even without that, it’s something that we know we need to do and that we can always do a better job. And things in a program this big are going to get sideways. I’m learning that, and the other thing that I’ve learned is that we’re all really mission-driven to this program. I came to HCPF because I want to do this work. And so we are committed to fixing it and making it work for everybody.”