Cost of Care is Down Says State Medicaid Director

An Interview with Catherine Strode, Advocacy Denver. Over one million Coloradans are now receiving their medical care through enrollment in the Medicaid program. That figure represents 20 per cent of the state’s population. In an interview with Catherine Strode, the Director of Medicaid, Gretchen Hammer, explains how the cost of care is being contained with the rising enrollment rates.

How is the Medicaid expansion impacting enrollment and costs?

“With the expansion, we created the opportunity for more Adults Without Dependent Children to become eligible through income determination alone. Previously, AWDC could be eligible through having a disability. The changes that were supported by both the Hospital Provider Fee and, further, by the Affordable Care Act, allowed us to expand for parents and AWDC. We’ve seen growth in both of those populations. We’ve seen additional enrollment for populations who have previously been eligible but were not enrolled. We have seen continued growth in our child enrollment as well. As we look at changes in enrollment in Medicaid, there are pressures on the state budget that are part of that. That’s part of what we continue to want to strive for: cost containment within Medicaid and making sure we’re getting the highest value for dollar spent because we recognize the impact on both the state and the federal budget.”

How is the Regional Care Collaborative impacting cost savings?

“The Annual Report from last year estimated 29 to 33 million dollars in net savings from the RCCO (Regional Care Collaborative Organization) program and that’s from our Year Three Accountable Care Collaborative Report. Over 800,000 of our Medicaid enrollees are now participating in our Accountable Care Collaborative which is providing additional services and supports for those enrollees to navigate the health care system and get their health care needs met. We’re seeing that there is an ongoing improvement in the utilization of services and in health improvement as people stay enrolled in the Accountable Care Collaborative. Total cost of care is down, by about 4.5 per cent below the statewide target. Hospital readmissions are also 10.6 per cent below and high cost imaging is 6. 8 per cent below. Those are areas where we know we’re doing well in terms of quality of care, in addition to reducing services.”

How is the workforce meeting the expansion demands?

“One of the things that is most important to remember whenever we talk about workforce is that there are issues of raw numbers and there are issues of misdistribution. That’s one of the things that’s really complicated about workforce. It’s often where are people practicing, in addition to how many of those practitioners do we need, and do we have. We also know where on the county map of Colorado we have Medicaid enrollees. We can tell in big buckets. We have a number of counties across the state of Colorado that have less than 6,000 Medicaid enrollees; and we have a couple of counties that have more than 80,000 enrollees. That also helps us prioritizes our work force recruitment efforts and understand where those that we serve are residing and how we need to be trying to make sure that the delivery system in those communities is able to meet the needs of those that are enrolled. Since we expanded Medicaid to a population that we had traditionally not served, AWDC, we to some extent, are learning about what their health care needs are so we can appropriately target our provider outreach efforts. This is not a population we had any claims history on. We have benefits managers that are now looking back at our first year of expansion and really trying to understand what would have been the service needs of those that we are now newly serving.”

How is waiver simplification and the person-centered care movement impacting the state’s Medicaid program?

“The Department is embracing that movement. We have a person-centered care initiative we just launched that goes across the Department and is not just related to work at the Office of Community Living. We have recruited champions from across the Department. We seated an external stakeholder advisory council to help consumers who are served by Medicaid; and we’ve got leadership work going on so we can infuse the person-centeredness work into our Department performance plan. We have already merged the Elderly, Blind and Disabled Waiver with the Persons Living with AIDS waiver and are expanding service availability and consumer directed approaches for those on the Persons Living with Aids Waiver. We’re trying to drive toward the Community Living Advisory Group recommendations through that waiver simplification. We’ve got a task group that is working on self-directed services, a person-centered approach, and new and expanded benefits. There’s a variety of things were working on: residential supports, employment supports, transition services, wellness supports, behavioral health services. That will continue to be part of figuring out how do we simplify the waivers and how do we continue to continuously improve our service delivery.”