Date: 10/14/2009

Commission Discussion -- Health Care


Votes: View--> Action Taken:

09:18 AM -- Commission Discussion - Health Care

Joan Henneberry, Executive Director of the Department of Health Care Policy and Financing (HCPF) provided an overview of the department. Joining the director was John Bartholomew, Chief Financial Officer, and Dr. Sandeep Wadhwa, the State Medicaid Director. Representatives of the department provided the commission the following:

- Attachment A: A PowerPoint of the department's presentation;


- Attachment B: A list of mandatory and optional services provided under Medicaid;


- Attachment C: Governor Ritter's 2008 Report titled, "Leading Colorado to a Healthier Future;" and


- Attachment D: HCPF 2008 Annual Report.


Director Henneberry discussed the recent history of health reform and its importance to Governor Ritter and the department. She summarized some of the problems with the current system: costs are perceived as too high; access is too low; and too many state residents are uninsured. These conditions have both policy and financial implications for the health-care system. Director Hennebery acknowledged that there is too much inefficiency, fraud, abuse, and waste in the current system, and that there are misaligned incentives in the system. As designed, the system provides incentives for specialty services and procedures, rather than focusing on primary care. Proper incentives would front-load the system and place the emphasis on primary, preventative care. Under an ideal system, health-care providers would be paid to keep individuals healthy, rather than creating payment incentives to wait until the patient needed specialty procedures. Director Hennebery labeled our current system a "transaction based" system.

Director Hennebery testified that the leadership at HCPF wants to change the way the department and the public think of health care. This change is from a transaction based system to a "pay-for-value" system that works with health-care providers to ensure they are supplying quality and value to Medicaid recipients and to hold providers more accountable. Many of the recent changes at the department are supported by recommendations made by the Colorado Blue Ribbon Commission for Health Care Reform (the 208 commission). Some of the immediate actions the department took in 2006 include enrolling more eligible children and adults. The department has embraced a managed care model that aims to integrate health care between numerous providers, using a centralized approach. For children, this included instituting a medical home model to coordinate care between the primary provider and all other sources of health care. Further, the department increased efforts to improve the care of the program's most chronically sick and expensive clients.

The 208 commission made other recommendations that the department has implemented such as creating the Center for Improving Value in Health Care, and funding the statewide information system for sharing health care data. The department also helped pass the hospital provider fee bill that will allow additional coverage to uninsured Coloradoans without a General Fund impact.

Director Henneberry testified that, in the next phase of reforms, the department will implement and integrate federal requirements into our state system.