What are some of the gaps that you see in the service delivery system as it is currently?
“Access to specialists for sure. There are some gaps there. There not a lot of specialists that actually take Medicaid clients. We’re also seeing that there are fewer and fewer providers that accept Medicare as well. So were seeing some general access to care issues.”
How is Colorado’s approach different from other states in coordinating care under the dual eligible program? How do you think it will differ?
“Colorado is on the forefront in terms of implementing an accountable care organization –that we call the ACC, the accountable care collaborative. And many states are coming to us to understand. what we are doing with our ACC program and how is it structured. So that is very different than other states. The other thing we’re looking at is how do we make sure that we’re connecting some different systems of care. So we have a very good PACE program in Colorado that is designed for individuals that meet nursing home level of care. We want to make sure we keep that and that we build on it. We also have Medicare special needs plans as well that do some coordination for dual eligibles, but there’s a large number of dual eligibles out there that are in the fee for service unmanaged network. We want to make sure that when we design the accountable care collaborative to meet the needs of the duals that it connects to the PACE continuum of care as well as to Medicare SNIPS. We’re working that out. So that to me is what’s kind of unique. We want to leverage what’s strong in the state and then build on that and make sure we’re keeping the connections.”
I know a lot has been said about the savings projected in the dual eligible redesign. Where would the savings come from and why do you think it would create savings for the state?
“Now we haven’t actually measured the savings but we believe the savings will come from reduced avoidable hospitalizations and reduced ER usage and reduced need for specialty care as well. So ideally, I view it I view it as the life cycle of an individual and how do you keep them healthier longer so they need less acute care? So the idea is if you’re really staying on top of what a patient needs and helping them to manage their chronic conditions like diabetes, high blood pressure, COPD, congestive heart failure, if you’re helping them to manage those conditions they’re going to need less acute care over time. So it will take time for the savings to accrue because you actually have to understand what’s happening with your patients, very proactively and then monitoring them over time. So this is not like flipping a switch in terms of cost savings – like okay we’re going to coordinate services for the duals and in six months we’re going to see savings. It’s going to take longer than that.”