Better primary care saves Colorado $20 million

By Katie Kerwin McCrimmon

An experiment to ensure that complex Medicaid patients have a regular doctor and care coordinators who can help them stay healthy has saved Colorado an estimated $20 million in its first year, according to a new report from Colorados Medicaid managers.

Were very happy that its moving in the right direction, said Laurel Karabatsos, director of health programs for the Colorado Department of Health Care Policy and Financing (HCPF).

So far, about 20 percent of Colorados more than 600,000 Medicaid clients are enrolled in the program called the Accountable Care Collaborative (ACC).

Our goal over the next year is to enroll more and more of our population to make this our dominant program, Karabatsos said. Weve been really focused on primary care and getting our patients into a primary home this first year. We hope to expand to behavioral health, social services and building a virtual network of specialists and ancillary providers. We anticipate more savings as we integrate.

The results of the ACC could drive critical health policy decisions following next weeks elections when Colorados governor and lawmakers must decide whether to expand Medicaid under the Affordable Care Act (ACA). If Mitt Romney wins the presidency, he has vowed to dismantle the ACA. Furthermore, the U.S. Supreme Court this summer told states they did not have to expand Medicaid, which covers care for children, poor people, the disabled and the elderly in nursing homes.

If President Obama wins and Democrats retain control of the U.S. Senate, implementation of the ACA likely will move forward. That means Gov. John Hickenlooper and Colorados legislature will need to decide whether to proceed with plans to expand Medicaid.

Already funding for health and human services in Colorado consumes about one-third of the state budget, with programs at HCPF costing about $5 billion a year. Hickenlooper did not include funds for Medicaid expansion in the proposed budget he released this week, but once the election results are clear, the governor could ask for additional funds to expand Medicaid.

As Colorados economy sputtered, the states Medicaid population ballooned to 620,000 last year and is projected to climb to more than 700,000 next year. Even without further expansion, cost savings are critical. But policymakers hope that continued savings will help Colorados bottom line while at the same time giving patients better care.

The ACC marked the end of its first year in June. Along with reaching targeted savings of about $20 million, a robust data analysis of the program has found the following additional results:

  • Emergency room use stayed relatively steady. Among the Medicaid population as a whole, ER use increased by about 1.5 percent. For ACC members, ER use increased by .2 percent. Some individual patients are doing far better. One regional ACC manager reported that a patient who had visited an ER 32 times during the previous year had gone just once since enrolling in the ACC.
  • Hospital readmissions declined among ACC members by nearly 9 percent compared to other Medicaid patients.
  • High-cost imaging services decreased by 3 percent among the group that received more health coaching.
  • Health improved among people with chronic diseases such as asthma and diabetes. Studies have shown that people with one or more chronic diseases cost health systems the most and lead to early death and disability.
  • Prescriptions increased to help people manage hypertension. Early treatment of high blood pressure helps cut risk of heart attacks, strokes and other illnesses.

Karabatsos said that lawmakers signed on to the program with the promise that it would at least pay for itself and would potentially generate savings. The next step will be to work with Medicare managers to add people who are on both Medicaid and Medicare, so-called dual eligibles, to the system.

Gretchen Hammer, executive director for the Colorado Coalition for the Medically Underserved and chair of the board for the Colorado Health Benefit Exchange said a better Medicaid program will be good for patients and Colorado taxpayers.

The reality is nobody likes to be hospitalized. It is disruptive in a persons life. It can be avoided if you can get the care you need. With good chronic disease management, we can keep people from having to spend time in a hospital, from having too many high-cost imaging tests being done and using the emergency department inappropriately. Those are all good things for the medically underserved, Hammer said.

So far, more than 132,000 Medicaid clients are now enrolled in the system. That includes nearly 50,000 children and about 84,000 adults. Overall, more than two-thirds of Medicaid recipients are children, so ACC managers plan increased outreach efforts to enroll more of them.