A Presentation of the Colorado Health Institute Health Trends Impacting the Colorado Landscape September 7, 2011 AHEC/CHI Conversations Series.

A Presentation of the Colorado Health Institute

Health Trends Impacting the Colorado Landscape

September 7, 2011

AHEC/CHI Conversations Series

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Today’s Topics

• A brief introduction to CHI• The Colorado Context: 6 Trends• Upcoming Legislative Session

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A Brief Introduction

• CHI is a trusted and leading source of credible health information for Colorado leaders. Our insight is used to:– Inform policy– Contribute to effective implementation– Support state efforts to improve health

Access Quality Value Prevention

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Our Focus: Stakeholder Communities

Legislators and Policy makers:• Reform• Opportunities

in Policy

Foundations:• Measuring

Impact• Prioritizing

grants• Coordinating

efforts

Leading Health Organizations:• Informed policy• Collaborative

approach

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THE COLORADO CONTEXT

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Colorado Trends

• But will it play in Pueblo? Affordability and

individual responsibility.

• I want my PCP! Who will we provide additional care?

• Medical homes: Heroes or hassles?

• Colorado constraints: Current market and politics

• Building Out and Wiring Up: Our big investments to

reshape health

• HEAL Thyself!

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ACA: Incenting New Behaviors

Individuals

Purchasing

Insurance

Integration of Care

Alignment of

payment and

incentives

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#1: But will affordability play in Pueblo?

Source: CHI analysis of 2008-09 COHS

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Affordability: What CHI is Watching

• New regulations• Market behavior

One in three Coloradans are uninsured or

underinsured.

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

61% 13% 19% 6%

Adequately insured Under-insured

Uninsured Insured, with uninsured family member

Coloradans by insurance status, 2008-09

Source: The Colorado Trust (2010). The magnitude of underinsurance in Colorado.

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UNINSURED BEFORE HR IMPLEMENTATION 800,00

0

214,000

153,000 175,000

UNINSURED AFTER HR IMPLEMENTATION258,000

Who will still be uninsured in CO?

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Individual Responsibility and Employer Implications

• What about the role of patients?– Individual mandate– Value based design and purchasing– Readmissions and patient safety

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#2: I want my PCP!

Colorado’s workforce faces two major challenges:

Today, we face a distribution problem.

Tomorrow, we will face a distribution

problem AND a shortage problem.

Providers choosing specialty care over

primary care

(Mal)distribution of providers

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Our primary care workforce

• Percent of CO providers working in primary care– 39% of Physicians– 43% of Physician Assistants (PAs)– 65% of Advanced Practice Nurses (APNs)

• < 20% of medical students choose primary care

Scope of Practice

MAs,CNAs

LPNs RNsPAs

APNsMDs Specialists

Sub-specialists

Market dynamics push to lowest cost provider

Training costs and societal investment

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#3: Medical Homes: Heroes or Hassles?

• Reduce costs• Improved care quality• Reduced medical errors• Higher patient satisfaction• Fewer health disparities

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The Promise Deferred

• It won’t be today or tomorrow – Medical homes require transformation– Workforce as members of “care teams”– Technology is not “plug and play”– Health care neighborhoods– Payment reform

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What CHI is watching

• The Colorado Multi-Payer, Multi-State Patient-centered Medical Home Pilot

• ACCs and Medicaid– Political appetite to

invest?

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#4: Colorado Constraints

• Our market today– New administration– Divided houses– Fiscal crisis– The shadow of ACA

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#4: The Colorado Flavor of Reform

Healthier Communities

• HB11-1069: Physical activity required in elementary schools

• HB11-40: requires youth coaches to complete training on concussions

Public Insurance

• HB11-1242: Directs state to identify barriers to providing integrated care for people who need both physical and mental health care

• SB11-008: Streamlines Medicaid eligibility for children between 100% and 133% of FPL

Private Insurance

• SB11-200: Colorado Health Benefits Exchange

• SB11-01: Requires insurers to offer child-only health insurance plans

• SB11-1289 permits small employers to reimburse employees for costs of health insurance premiums

Scope of Practice

• HB11-1186: Adds licensed acupuncturists to the list health care providers for reimbursement.

• HB11-1281: Expands loan repayment for nurse faculty and other providers

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Doing more with less (and less)$100 million budget reductions for FY 2011-12,

including…

$2.7 millionSafety net

clinics

$3 millionHealth

disparities grants

$10.3 millionEarly detection and

treatment funds

$1.6 million

Women’s Wellness

Connection program

$17.7 millionTobacco

education programs

$11.7 millionMedicaid Provider Fee

reduction

$2.5 millionMedicaid

children’s oral health services

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#5: Building Out and Wiring Up

• Physical infrastructure– The ACA allocates $11 billion to FQHCs

• 3 Major Initiatives in Colorado– COHRIO, QHN and EMR– APCD– State Insurance Exchange

The Colorado Health Insurance Exchange

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A health insurance exchange is an organized marketplace for customers to shop for health insurance based on price

and quality.

#COHIEX

Healthy Living•LiveWell Colorado•Colorado Children’s Health Foundation•School-based Health Centers•Family Resource Centers

Health Coverage• Colorado Benefits Management System

Assessment• Colorado Healthcare Affordability Act• Simplify the enrollment process for

Medicaid and CHP+

Health Care• Center for Improving

Value in Health Care• Health TeamWorks• CORHIO• Prometheus• Colorado Health

Service Corps• Federally Qualified

Health Centers

#6: HEAL Thyself!

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Implications for Employers

• Grants for small employers– Efforts to maximize employee

engagement– Initiatives to change unhealthy

behaviors and lifestyle choices– Supportive environment efforts

• www.hhs.gov

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COLORADO LEGISLATIVE SESSION: 2011 AND 2012

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What to Expect 2012

• Health reform alignment• Individual responsibility arguments• Workforce supply issues• Cost savings

– Public insurance and structural deficits– Private insurance: cost to employers

Contact Information

Michele Lueck President and CEOColorado Health [email protected]

720.382.7073

Colorado Northwest Community CollegeNursing Graduates, 1965