Western Slope practices may be included in new Medicaid program

Colorado is one of four states and three regions selected to participate in a new initiative that aims to make U.S. health care more affordable and more effective.

The Centers for Medicare and Medicaid Innovation selected Colorado, Arkansas, New Jersey, Oregon and metropolitan areas in and around Tulsa, Okla.; Cincinnati, Ohio, and Albany, N.Y., to participate in the Comprehensive Primary Care Initiative.

The initiative pairs Medicare with private insurance companies and Medicaid to provide incentive dollars for primary-care practices statewide. Those practices, which will be selected by the federal government in August, will use the incentive money to provide a host of new services aimed at helping physicians communicate better with patients and the local medical community.

Medicare, Colorado Medicaid and seven private insurers, including Grand Junction-based Rocky Mountain Health Plans, will provide incentives for 75 primary-care practices in Colorado. With incentive dollars, practices could increase access to care for patients, hire a care coordinator who can track a patient’s medical history across different care providers, deliver more preventative care, or create a computer database that can track the progress of all patients in a practice who share a condition, such as diabetes, in order to find which treatments seem to work best with all of them.

All services paid for by incentives have to align with the main goals of the Comprehensive Primary Care Initiative, which are to: improve medical outcomes; help primary-care physicians better track their patients’ care; and preventing illness when possible. The point of meeting those goals is to see if practices can cut down on major illnesses and hospital visits and help lower health care costs for insurance providers. 

Savings and better health outcomes were found in 16 Front Range primary-care practices that participated in a four-year pilot program, funded by the Colorado Health Foundation, that will end on Monday, Dr. Marjie Harbrecht said.

As chief executive officer of Lakewood-based nonprofit organization HealthTeamWorks, Harbrecht helped manage the pilot program and partnered with Denver-based nonprofit Center for Improving Value in Health Care to encourage Colorado insurers to apply to be part of the new initiative. She said the goal of the pilot and the initiative is to encourage physicians who currently are reimbursed by insurance companies for number of procedures to instead focus on what patients need most.

“We want this to go from a pilot to how we do business,” Harbrecht said.

Incentivizing 59 more primary-care offices in Colorado than the number of practices who participated in the pilot to improve outcomes and cut costs for medical offices and insurance providers is one way to spread the practice, Harbrecht said. She said she hopes western Colorado practices will be among those who apply by July 17 to participate in the initiative.

Patrick Gordon, director of government programs for Rocky Mountain Health Plans, said his company has no control over who will be picked to participate in the initiative, but his company will help Western Slope practices apply.

“Our job is to help as many Western Slope providers as possible who are interested in this process qualify,” Gordon said.

HealthTeamWorks and the Center for Improving Value in Health Care plan to continue help with the initiative by facilitating the process to help make sure the program goes smoothly in Colorado, according to Edie Sonn, vice president of strategic initiatives for the Center for Improving Value in Health Care.

“At the end, we can say: Does this result in better care, quality outcomes and cost savings?” she said.


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