By Katie Kerwin McCrimmon
Elderly people and disabled Coloradans should be able to receive better care in their homes, according to new recommendations from TBD Colorado, a nonprofit advisory board that Gov. John Hickenlooper created to survey Coloradans over the past year to develop a bipartisan policy agenda.
The recommendations also call for more focus on children’s health — including healthier food and more physical education classes in schools — along with integrated physical and behavioral health care for Medicaid patients.
Health recommendations comprise just a portion of the proposed policy fixes. Overarching reforms would attempt to turn around Colorado’s underfunded schools, resolve transportation dilemmas and address conflicting amendments in Colorado’s constitution that create unsustainable demands on the state budget.
While there are much harder problems to tackle, potential legislation to keep needy people out of nursing homes proved to be the most popular agenda item to surface after meetings with more than 1,200 Coloradans in 100 communities. Easier access to home- and community-based services for elderly and disabled Medicaid patients garnered support from nearly 91 percent of respondents. That support rose to more than 98 percent when people found that it could save Colorado $2.4 million a year.
Hickenlooper attended the Wednesday unveiling of the policy recommendations at the Denver Botanic Gardens and said he was surprised by the broad support for home-based care. Some recommendations, like that one, could prove to be no-brainers to implement if they save money. But far more complicated are costly improvements to education spending and overall health care costs.
“We can’t do everything,” Hickenlooper said. “The bucket list is too long.”
Still he said the TBD recommendations provide a launching pad for Colorado policy makers and lawmakers to set budget priorities.
“How do we compare the competing needs of these different issues?” Hickenlooper said.
Among other health recommendations, TBD participants wanted more managed care and integrated services to improve outcomes and control costs in Medicaid.
Broad, bipartisan support emerged for changing the way providers are paid and better integrating behavioral health services with physical care. For instance, the summary of findings reported that Colorado Access’ Depression in Primary Care Project has shown a 12.9 percent reduction in costs among high-risk patients. Colorado has been testing managed care programs within Medicaid through the Accountable Care Collaboratives with good results and savings of nearly $20 million a year so far. (Read more: Better primary care saves Colorado $20 million)
TBD participants also want better access to healthy food and more PE programs in schools. But support for those programs declined sharply when people surveyed found out how much they would cost. Based on estimates from state agencies and other sources that TBD staffers collected, access to healthy food would cost the state about $60.2 million a year. Support for healthier school lunches shrank to 50 percent, down from 78 percent, after those surveyed considered that price tag.
Some nutrition experts think that providing healthy food to children is not as expensive as it first appears, but government subsidies often make unhealthy options seem cheap by comparison.
Requiring physical education in schools was also popular, with 74 percent of respondents supporting it. That support shrank to 61 percent when people had to decide if it was worth a cost of $95 million a year.
Despite those reservations, TBD leaders said opportunities for youth physical activity should be encouraged including PE in schools, extracurricular and after-school activities, community programs and outdoor recreation.
“Providing opportunities for physical activity is a shared responsibility with families,” the policy statement said.
The clear win-win among all the policy objectives, however, was home-based care.
“That’s the No. 1 most highly-supported option among all TBD (options),” said Chris Adams, of Engaged Public, which led TBD’s outreach efforts. “This is one people are very much in favor of. There’s some concern about fraud and mistreatment of elders, but people said, ‘work through those problems.’ ”