Experts discussed efforts to improve care coordination and connect patients to needed services at the 2023 Colorado State of Reform Health Policy Conference last month.
Every Health First Colorado (Medicaid) member belongs to a Regional Accountable Entity (RAE), which is responsible for coordinating their care and expanding their access to primary care and behavioral health services. Several RAE representatives discussed their work during the conference.
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Todd Lessley, vice president of clinical services at Rocky Mountain Health Plans, said integrated care coordination is a key component of the organization’s RAE model.
“And (it) is present in every single program that we deliver,” Lessley said. “We have a number of provider and community care organization contracts that allow us to continue to extend care coordination throughout the 22 counties we serve. A key piece of what integration means to us is integrating systems, integrating teams of care coordinators, and integrating disciplines.”
Rocky Mountain recently conducted an analysis of its member population with complex needs who were receiving extended care coordination, Lessley said. The analysis examined emergency department (ED) utilization and inpatient hospital stays.
“We discovered that members enrolled in extended care coordination experienced a 33 percent decrease in ED utilization and a 31 percent decrease in inpatient utilization,” Lessley said. “It underscored that an intensive level of care coordination can be very effective. This is important as we look at what care coordination looks like in the future. And what are the interventions that can drive costs and overall health outcomes?”
Krista Newton, director of care coordination at the Colorado Community Health Alliance, discussed the alliance’s RAE.
“One of the things I love about our RAE model is that it is the helper for the helpers. That is our job. We really see ourselves as the golden thread of what brings all these different entities together. One of our goals is [improving] access to care. Access isn’t just picking up the phone and making an appointment. It could mean finding a provider that talks like (the member). It’s great to give referrals, but what about services?”— Newton
Over 78 percent of its members informed the alliance that they feel more activated, that they’ve improved their own self-management of their healthcare, and that they feel like they can do it on their own, Newton said.
“And 92 percent of our members who say, ‘I need help,’ not only received a referral, but we ensured that they are connected to services,” Newton said. “If we say we really care about whole-person care, we need to support payment around whole-person care, such as expanding benefits so people can go to the pharmacy, the grocery store, (and) the (Special Supplemental Nutrition Program for Women, Infants, and Children) office to support people getting to the places they need to be.”
Lessley gave an example of the type of situation a RAE can provide assistance for. He said a Rocky Mountain single-point entry team recently helped a man with a longstanding history of alcohol abuse, aggressive behavior, and homelessness. He needed housing placement assistance, but couldn’t get help because of his aggressive behavior.
“We were able to negotiate with him, communicate with other providers, and get him connected with a six-week residential substance use disorder treatment program with a community health center. It was a great connection, and (he) had a favorable outcome. He did get sober during that six-week period. And, as a result, was then eligible to go into an assisted living facility where he resides today. Integrated systems, teams, (and) disciplines in the care coordination space really have a meaningful impact on people’s lives, on cost, and on utilization.”— Lessley
Panelists were asked what RAEs are in need of to better assist with health outcomes. Emily Storozuk Parmely, director of consumer and community success at findhelp, said lawmakers can help.
“We need comprehensive legislation leveraging models that support healthcare coordination,” Storozuk Parmely said. “When we’re talking about social needs, this is not going to cut it.”
Dr. Mark Wallace, chief clinical officer at the Northeast Health Partners, said more funding is needed.
“I want longer-term, non-siloed, population-based, community-organized and driven funding,” Wallace said. “We’re on too short of a time window with too much siloed funding. And we’re not going to get at the underpinning social determinants. We spend a lot of time on clinical care and that is not where we’re going to make the long-term changes we need in thriving families and communities.”
Lessley cited reimbursement concerns.
“We need to stop paying providers of all types fee-for-service, and start paying for value and outcomes,” Lessley said.