by Kim Bimestefer, Executive Director, Colorado Department of Health Care Policy and Financing

It is my privilege to lead the Department of Health Care Policy and Financing (HCPF). We are the state’s largest health plan serving about 22% of the population through Health First Colorado (Colorado’s Medicaid program), the Children’s Health Plan Plus (CHP+), and other safety net programs. Our focus has been working with providers and other key partners on improving the health outcomes and quality of care; improving health plan operations and service to providers and members; identifying opportunities to control Medicaid claim trends; and driving health care affordability to employers and consumers served in the private insurance arena.

Over the last year, we collaborated with health care thought leaders to craft and roll out Colorado’s Health Care Affordability Roadmap to respond to one of the state’s and the nation’s most complex and pressing challenges - controlling health care costs. We’ve engaged employers and their representatives; consumer advocates and union leaders; providers and their representatives (including the Colorado Medical Society leaders); innovators and their associations; Regional Accountable Entities; commercial payers and more. The Roadmap is designed to be customized by geographic communities across the state under the philosophy that all health care is local.

Given Medicaid’s size and budget ($10B, 25% of the State’s General Fund), the Roadmap informs Medicaid cost control strategy, and Medicaid learnings inform the Roadmap. The Roadmap’s ability to drive efficiencies across the continuum of Medicaid spend directly impacts the budget dollars available to invest in other key areas of state government such as transportation and education. By providing insights, the Roadmap is also an effective tool to inform health care policy.

The Roadmap’s initial focus areas were chosen because of their impact and consistent relevance to the health care cost equation, as well as our ability to lower health care costs to the benefit of all Coloradans by creating effective strategy in each category. 

  1. Constrain prices, especially hospital and prescription drugs.
  2. Champion alternative payment models.
  3. Align and strengthen data infrastructure.
  4. Improve our population and behavioral health.
  5. Maximize innovation.

We are now implementing a few Roadmap concepts through SB 18-266, Controlling Medicaid Costs. Specifically, this bill provided funding to rollout provider cost and quality tools like Prometheus and the prescriber tool, to launch an inpatient hospital review program that will help us target those who need the most support when transitioning out of a hospital and modernize our claim edits to match commercial payer standards. For those new to it, Prometheus can identify potentially avoidable complications and inform referrals based on quality. The new physician Prescriber Tool offers payer and patient costs for alternative drug therapies while also offering “health improvement programs” available under the patient’s unique medical plan design.  Finally, doctors will have a single tool that aggregates health improvement programs and cost-effective prescription therapy insights, inclusive of all payer reimbursement and program information.  

Governor Polis has asked us to be bold. Thank you for engaging in the affordability conversation, and for being thought leaders. We appreciate your partnership, and we look forward to moving boldly forward together to respond to the voices of the Coloradans we jointly serve.  

Categories: Communications, Colorado Medicine