Highlights from the 2019 State of Colorado Quality Strategy Report

The Department of Health Care Policy and Financing released their 2019 Quality Strategy Report this month. The report explains how the Department will improve their Medicaid system. They do so by detailing what CMS requires of them, and then highlighting what they are doing to meet those requirements.


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These are some of the stand-out Departmental objectives:

The report details a list of goals and objectives for the state’s managed care program moving forward. Stating alignment with the governor’s health care priorities, the Department sets the following goals:

  • Decreasing health care costs and increasing affordability for individuals, families, employers and government
  • Enhancing delivery system innovation to include:
    • Increasing and monitoring members’ access to care and provider network adequacy
    • Increasing and strengthening partnerships to improve population health by supporting proven interventions to address behavioral determinants of health, in addition to delivering higher quality care
    • Protecting and improving the health of communities by preventing disease and injury, reducing health hazards, preparing for disasters, and promoting healthy lifestyles
    • Implementing Pay for Performance to providers for meeting pre-established health status efficiency and/or quality benchmarks for a panel of patients  
  • Improving patient safety
    • Ensure members are connected to the right care, at the right time, every time
    • Promote effective prevention and treatment of chronic disease
  • Improving health outcomes, member experience and patient safety through clinical analytics, evidence-based practices and adoption

The Department seeks to decrease a series of performance for the programs listed below by ten percent.

The report details a set of quality measures on which the Department is focused. The first is the quality and appropriateness of care administered. As growth continues and new programs are added to its jurisdiction, the Department will work closely with the Center for Evidence-based Policy to provide reports for policy-makers to use in the future, and to inform changes to current programs.

Other measures used to determine quality and appropriateness of care include:

  • Review of key indicators through an analysis of administrative data and comparison to performance measure benchmarks (including network adequacy review, client complaints and resolutions/responsiveness)
  • Utilization review to identify over- and under-utilization
  • Review of quality assurance reports from managed care
  • Internal assessments of contract deliverables
  • External Quality Review Organization (EQRO) evaluations
  • Customer satisfaction analysis
  • A review of the RAEs’ and the Dental ASO’s own findings

The Department seeks to increase access to care through the creation and implementation of new programs. The Non-Emergent Medical Transportation program will allow transportation to Health First Colorado medical locations for patients who cannot travel easily, for example. Other programs with an aim to increase access include the Nurse Advice Line, telemedicine services, and eConsult services.

The report also highlights a series of state standards to meet. These standards include expanding geographic reach, creating new payment methods, increasing coordination with out-of-network providers, consolidating data, and improving provider relations to contract with a culturally diverse network. According to the report, having a strong provider network strategy is critical for Medicaid expansion and is a key focus for the department.  

Similarly, the department will implement clinical risk stratification to better help identify the best entry point of care for Health First Colorado patients. In other words, the department will create a tool that helps to assess which patients have increased risk and prioritize the management of their care. Multiple state agencies will be involved in the implementation in order to provide a series of services.

The state is also collaborating with other agencies to address the following issues:

  • Opioid substance abuse disorder, and misuse,
  • High rate of opioid prescribing,
  • The high cost of hospitals,
  • Patient transfer from long-term care facilities,
  • Reporting strategies,
  • Making telehealth and Health IT more user friendly and accessible, and
  • Overall cost control.

The Department will also be implementing a series of alternative payment and delivery methods:

  • Colorado Choice Transitions’ primary goal of this eight-year grant program is to facilitate the transition of Medicaid members from nursing or other Long-Term Care facilities to the community using HCBS, according to the report.
  • Community First Choice, allows states to offer Medicaid attendant care services on a statewide basis to eligible participants. Participants in Community First Choice would have the option to direct their attendant care services or to receive services through an agency.
  • Substance Use Disorder Waiver (SUD), following the passage of HB19 1287, allows the Department to implement the SUD inpatient and residential treatment benefits, including withdrawal management. Adding this benefit would complete the continuum of SUD services available to Health First Colorado members. CMS guidance will be utilized here.
  • Maternal Opioid Misuse Model (MOM), addresses fragmentation in the care of pregnant and postpartum Medicaid beneficiaries with opioid use disorder through state-driven transformation of the delivery system surrounding this vulnerable population.

Going forward, additional strategies to improve Health First Colorado patient care include investments in local public health and attempts to reduce the mental health stigma, reducing costs, and using data in meaningful ways.. The entire report, and some additional Departmental goals, is available here.