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COLORADO HEALTH REFORM IMPLEMENTATION

COLORADO HEALTH REFORM IMPLEMENTATION. October 2012. HEALTH IN COLORADO. 22% of adults obese; 14.2% kids 18.3% working age adults uninsured; 9.3% kids 20.7% of women receive initial prenatal care later than the first trimester or not at all

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COLORADO HEALTH REFORM IMPLEMENTATION

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  1. COLORADO HEALTH REFORM IMPLEMENTATION October 2012

  2. HEALTH IN COLORADO • 22% of adults obese; 14.2% kids • 18.3% working age adults uninsured; 9.3% kids • 20.7% of women receive initial prenatal care later than the first trimester or not at all • 28.7%of preschool-age children do not receive all recommended doses of six key vaccines. • 14.8% of adults reported having poor mental health Improve health care access and outcomes for the people we serve while demonstrating sound stewardship of financial resources.

  3. Insurance reforms Insurance Accountability Improve health care access and outcomes for the people we serve while demonstrating sound stewardship of financial resources.

  4. COVERAGE Coverage • Medicaid expansions up to 133% of poverty • Premium tax credits available up to 400% of poverty on exchange • Cost sharing subsidies up to 250% of poverty (limits out of pocket spending) • Investments in workforce Improve health care access and outcomes for the people we serve while demonstrating sound stewardship of financial resources.

  5. MEDICAID AND SUPREME COURT • Will Colorado Expand Medicaid to 133%? • How much will it cost? • Bottom Line: All states are waiting for further guidance from the Health and Human Services Administration and the Centers for Medicare and Medicaid Services before accurate cost estimates can be performed. Improve health care access and outcomes for the people we serve while demonstrating sound stewardship of financial resources. 3

  6. Department of Health Care Policy and Financing WHAT IS A HEALTH BENEFIT EXCHANGE? An online marketplace for individuals and small employers to: Compareinformation regarding cost and quality Shopfeatures of plans containing the same base benefits Determineeligibility for tax credits (premium relief) Call or sit down with someone for help Enrollin a plan Improve health care access and outcomes for the people we serve while demonstrating sound stewardship of financial resources.

  7. SB11-200: CO HEALTH BENEFIT EXCHANGE ACT OF 2011 • Passed in May 2011 • SB200 establishes the framework for the state Exchange • Not to duplicate the functions of the DOI • Governed by a Board of Directors • Legislative Implementation Review Committee • Mission is toincrease access, affordability, and choice for individuals and small employers purchasing health insurance in Colorado. Improve health care access and outcomes for the people we serve while demonstrating sound stewardship of financial resources.

  8. Bending the cost curve Cost Containment Coordinated Care Models in Colorado • Patient-Centered Medical Homes • Accountable Care Collaboratives (Medicaid) • Accountable Care Organizations (Medicare) Transitions of Care • Reducing preventable readmissions after hospitalization Preventing and Managing Chronic Disease Improve health care access and outcomes for the people we serve while demonstrating sound stewardship of financial resources.

  9. Accountable Care Collaborative GOAL: Improve clients’ health and contain health care costs Improve health care access and outcomes for the people we serve while demonstrating sound stewardship of financial resources. 8

  10. Room for Experimentation: HB 1281 • HB 12-1281 • Calls for payment reform pilot projects • Away from fee-for-service, toward global payment • Built on existing ACC framework • Pilots evaluated after 2-3 years Courtesy: Colorado Health Institute Improve health care access and outcomes for the people we serve while demonstrating sound stewardship of financial resources.

  11. Long Term Services and Support • Redesign long term care payment • Structure, data systems, and delivery systems to transform long term care to support a more efficient, person-centered, continuum of care • Components: • Colorado Choice Transitions (Money-Follows-the-Person Grant) • Integrated Care for Dual Eligible Population • HCBS Waiver Modernization • Green House and other culture change initiatives • Overall delivery system redesign Improve health care access and outcomes for the people we serve while demonstrating sound stewardship of financial resources.

  12. FOCUS ON BUSINESS • Tax credits for small businesses providing coverage • http://www.getcoveredco.org/Resources/Small-Businesses • Potentially 90,000 eligible small businesses in Colorado • Fewer than 25 FTEs • FTEs average less than $50,000 • Exchange will serve small businesses starting in 2013 • Encouraging small businesses to engage in workplace wellness programs – provides grants • Eliminates “job lock” due to need of health insurance • Medical Loss Ratio (MLR) requires insurance companies to spend at least 80% of small employer premium dollars on medical costs Improve health care access and outcomes for the people we serve while demonstrating sound stewardship of financial resources.

  13. EMPLOYER FLOW CHART Improve health care access and outcomes for the people we serve while demonstrating sound stewardship of financial resources.

  14. QUESTIONS & ANSWERS Sue Birch Executive Director Health Care Policy and Financing Sue.Birch@state.co.us colorado.gov/healthreform

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