$4.5M grant to help 
boost medical results

An effort to knit together medical and human-service organizations on the Western Slope to provide seamless — and lower-cost — medical outcomes is getting a boost from the federal government.

Rocky Mountain Health Plans will coordinate distribution of $4.5 million over the next five years from the Centers for Medicare and Medicaid Services to draw physicians, social services caseworkers and others closer together to provide better, and ultimately, less expensive care.

There are plenty of services available to people whose conditions, such as diabetes, depression, obesity and other chronic conditions, can lead to expensive hospitalization, or worse, said Patrick Gordon, associate vice president of Grand Junction-based Rocky Mountain Health Plans.

The problem is that many of those people don’t know about the services and if they do, are unable or unwilling to contact them.

So, “Instead of expecting people to find services, we’ll bring the services to them,” said Gordon, who is heading up Rocky Mountain Health Plan’s coordination of the grant, which the insurer will distribute to participants such as social services agencies and health care providers, including behavioral health specialists.

Rocky Mountain Health Plans first drew national attention as a nonprofit organization that sought to hold down costs for its Medicaid patients with a “Transitions” program that reduced health care costs by helping patients take care of themselves after being released from hospitals.

By reducing readmissions, the plan helped hold down costs and improved the outcomes for those patients, many of whom were on Medicaid or Medicare and in doing so, drew the attention of federal policymakers.

Medicaid provides coverage for about 30 percent of Mesa County residents.

In addition to bringing more services to bear for patients, the approach also gives physicians leeway to work more closely with physicians, who are otherwise tethered to methods that require them to see as many patients as possible in a given day.

By freeing them from the “perverse incentives” of volume-based schedules, physicians have more time to pursue better treatment for individual patients, resulting in better outcomes and less expense, said Steve ErkenBrack, president and chief executive officer of Rocky Mountain Health Plans, which is now owned by a for-profit company, United HealthCare.

Patients whose care is coordinated under the program “might not even know they’re receiving a different model of care,” Gordon said.

The Accountable Health Communities Model — the program under which the grant was awarded — “aims to reduce unnecessary health care utilization in order to drive down spending, while also improving outcomes and quality of care for patients,” according to the program website.

CMS is giving up to $120 million to 32 organizations in the program.

Over five years, the groups will serve as test hubs helping Medicare and Medicaid beneficiaries with health-related social needs including housing instability, food insecurity, domestic violence and transportation.

Rocky Mountain Health Plan’s participation, Gordon said, “is a community-directed effort, not a corporate effort.”

It will rely on participation from a variety of agencies and providers, each of which knows a given patient from one perspective.

For instance, if a physician is unaware of a patient’s difficulty in getting transportation to medical appointments, other agencies that deal with the patient might be aware of the problem and can help with solutions.

“It’s a no-wrong-doors process” in which an entire network can respond to an issue that only one agency or practice might otherwise be aware of, Gordon said.

“Navigators,” or case managers who deal with individual patients also can help guide them through agencies and across county lines, if necessary, Gordon said.

Those navigators will be an entirely new workforce dedicated to aiding individual patients, he said.

The program will kick into gear on May 1 and will have to meet a series of standards, including showing cost reductions, Gordon said.

The program, ErkenBrack said, “is not a medical solution, this is a health care solution.”


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