health care financing the patient-centered medical home: making the investment in primary care...
TRANSCRIPT
Healt
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are Financing the Patient-Centered
Medical Home: Making the
Investment in Primary Care
Sandeep Wadhwa, MD, MBA
Medicaid Director and Chief Medical
Officer
State of Colorado
October 2008
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Colorado Health Care Snapshot
8.8%1.1%
Medicare404
Medicare &Medicaid
49
MedicaidOnly346
Non-Group157
EmployerRetiree
54
EmployerWorkers &
Dependents2,605
TRICARE/Other111
Uninsured785
7.6%
57.1%
1.2%3.5%
2.4%
17.2%
Total Population = 4,564
SCHIP531.1%
8.8%1.1%
Medicare404
Medicare &Medicaid
49
MedicaidOnly346
Non-Group157
EmployerRetiree
54
EmployerWorkers &
Dependents2,605
TRICARE/Other111
Uninsured785
7.6%
57.1%
1.2%3.5%
2.4%
17.2%
Total Population = 4,564
SCHIP531.1%
Source of InsuranceNumbers in Thousands – Source: June 2007 Lewin Report
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Medical Services PremiumsCaseloadFY 07-08
Other5% Elderly and
Disabled24%
Low-Income Adults15%
Low-Income Children
56%
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Medical Services PremiumsPer Capita Cost
FY 07-08
$0.00
$2,000.00
$4,000.00
$6,000.00
$8,000.00
$10,000.00
$12,000.00
$14,000.00
$16,000.00
Elderly andDisabled
Low-IncomeAdults
Children Other
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State’s Role in Primary State’s Role in Primary Care ReformCare Reform
• Legislative/regulatory authority
• Catalyst for encouraging public/private collaboration
• Active participant in the community of payers
• Dominant payer for safety net
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Financing Primary Care Financing Primary Care Reform Medicaid - Reform Medicaid -
Phase 1Phase 1• Repurposed our EPSDT
care coordinators to support Medical Home objectives
• Increased EPSDT payments to further cover Medical Home activities
• Regional ASO with 50% shared savings with primary care physicians
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Financing Primary Care Financing Primary Care Reform Medicaid - Reform Medicaid -
Phase 2Phase 2• Care management PMPM fee
for medical home providers• Care coordinator and health
educator layer - community and office based
• Move from shared savings to shared outcome incentives (ambulatory care sensitive conditions hospitalizations, emergency room visits)
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State Based Primary State Based Primary Care ReformCare Reform
• Participate in multi-payer collaborative
• Created public-private value- based healthcare center to collaboratively address structuring/financing of primary care
