CMS Board of Directors votes to support draft proposal, with comments provided

by Kate Alfano, CMS Communications Coordinator

After months of stakeholder meetings over the summer and fall, the Colorado Division of Insurance (DOI) and the Department of Health Care Policy and Financing (HCPF) issued a draft report in early October outlining a state option for health insurance coverage. CMS has been actively involved in the stakeholder process by providing testimony and other comments, advocating for CMS’s goal to support a public option plan that increases competition in health insurance markets, reduces insurance premiums, facilitates quality improvement and administrative simplification, and inspires physician network participation. Further, CMS and allies believe the public option should harness innovative strategies to reduce costs by incentivizing the delivery of efficient care, delivery of high-value services, avoidance of low-value services, streamlined administration and healthy behaviors.

Following months of member engagement and comments to the state, and in addition to a full analysis of the draft proposal, the CMS Work Group on Health Care Costs and Quality recommended that CMS should support the proposal, while recognizing some legitimate questions. After further deliberation the CMS Board of Directors agreed.

The proposal is a result of HB19-1004, passed by the 2019 Colorado legislature, which directed the two agencies to create a plan for a state option that would increase the affordability and availability  of coverage, increase coverage and ensure quality. Under the plan, state option insurance coverage would be administered by insurance companies and sold on Connect for Health Colorado, the state’s health insurance exchange. The plans will initially only be available to those who buy insurance on the individual market, roughly 7 percent of the state population. State leadership has expressed interest in scaling a successful option to the small group market in the future.

The DOI estimates that those who buy coverage on the individual market will see a reduction in premiums of between 9 and 18 percent once coverage starts in January 2022.

The plan aims to achieve those reductions by setting hospital rates at 175 to 225 percent of Medicare; physician rates are not set in the current plan.

HCPF Executive Director Kim Bimestefer said at the official release on Oct. 8, “we spent some time yesterday with...the Colorado Medical Society and we challenged them to step up and [to] bring the things to the table that [physicians] can do to be part of the solution, especially in the area of empowering physicians to be able to better control cost and quality.”

Both Insurance Commissioner Mike Conway and Executive Director Bimestefer thanked CMS for our active engagement on this initiative and encouraged our continued collaboration.

In the comments CMS submitted on October 25, CMS President David Markenson, MD, MBA, relayed the society’s support and goals for the state option, recognized some important issues that need further work, and presented additional ideas. “It is more important than ever to ensure that physician clinical autonomy and quality patient care is protected,” he wrote.

Markenson put forth the following ideas, committing to collaborate actively with the state to achieve them:

  • Use evidence-based benefit design to construct health benefits that drive the provision and use of high-value care.
  • Drive the use of common, evidence-based performance measures and administrative processes across payers to reduce or eliminate administrative burdens on physician practices.
  • Get actionable data into physicians’ hands with user-friendly tools to empower physicians and their patients in their decision-making: digitize referrals, scale the advance directive registry, and provide practice-level reports to build out value-based payment models, to name a few.
  • Accelerate the use of value-based payment models using input from key stakeholders, including physicians.
  • Target social determinants of health to improve individual and population health, and reduce overall health care spending.

In closing, Markenson expressed CMS’s commitment to remain actively engaged and the society’s hope to continue to support the proposal as it works its way through the Colorado legislature.

Categories: Communications, Colorado Medicine, ASAP, Resources, Practice Evolution, Payment Reform, Interacting With Payers