A Presentation of the Colorado Health Institute Health Trends Impacting the Colorado Landscape September 7, 2011 AHEC/CHI Conversations Series

Today’s Topics A brief introduction to CHI The Colorado Context: 6 Trends Upcoming Legislative Session 2

A Brief Introduction CHI is a trusted and leading source of credible health information for Colorado leaders. Our insight is used to: – Inform policy – Contribute to effective implementation – Support state efforts to improve health 3 AccessQualityValuePrevention

Our Focus: Stakeholder Communities Legislators and Policy makers: Reform Opportunities in Policy Foundations: Measuring Impact Prioritizing grants Coordinating efforts Leading Health Organizations: Informed policy Collaborative approach 4

THE COLORADO CONTEXT 5

Colorado Trends But will it play in Pueblo? Affordability and individual responsibility. I want my PCP! Who will we provide additional care? Medical homes: Heroes or hassles? Colorado constraints: Current market and politics Building Out and Wiring Up: Our big investments to reshape health HEAL Thyself! 6

ACA: Incenting New Behaviors Individuals Purchasing Insurance Integration of Care Alignment of payment and incentives 7

#1: But will affordability play in Pueblo? 8 Source: CHI analysis of COHS

Affordability: What CHI is Watching New regulations Market behavior 9 One in three Coloradans are uninsured or underinsured. Adequately insuredUnder- insured Uninsured Insured, with uninsured family member Coloradans by insurance status, Source: The Colorado Trust (2010). The magnitude of underinsurance in Colorado.

800, ,000153,000175, , Who will still be uninsured in CO?

Individual Responsibility and Employer Implications What about the role of patients? – Individual mandate – Value based design and purchasing – Readmissions and patient safety 11

#2: I want my PCP! Colorado’s workforce faces two major challenges: 12 Today, we face a distribution problem. Tomorrow, we will face a distribution problem AND a shortage problem. Providers choosing specialty care over primary care (Mal)distribution of providers

Our primary care workforce Percent of CO providers working in primary care – 39% of Physicians – 43% of Physician Assistants (PAs) – 65% of Advanced Practice Nurses (APNs) < 20% of medical students choose primary care 13

Scope of Practice MAs, CNAs LPNsRNs PAs APNs MDsSpecialists Sub- specialists Market dynamics push to lowest cost provider Training costs and societal investment

#3: Medical Homes: Heroes or Hassles? Reduce costs Improved care quality Reduced medical errors Higher patient satisfaction Fewer health disparities 15

The Promise Deferred It won’t be today or tomorrow – Medical homes require transformation – Workforce as members of “care teams” – Technology is not “plug and play” – Health care neighborhoods – Payment reform 16

What CHI is watching The Colorado Multi-Payer, Multi-State Patient- centered Medical Home Pilot ACCs and Medicaid – Political appetite to invest? 17

#4: Colorado Constraints Our market today – New administration – Divided houses – Fiscal crisis – The shadow of ACA 18

#4: The Colorado Flavor of Reform 19 Healthier Communities HB : Physical activity required in elementary schools HB11-40: requires youth coaches to complete training on concussions Public Insurance HB : Directs state to identify barriers to providing integrated care for people who need both physical and mental health care SB11-008: Streamlines Medicaid eligibility for children between 100% and 133% of FPL Private Insurance SB11-200: Colorado Health Benefits Exchange SB11-01: Requires insurers to offer child- only health insurance plans SB permits small employers to reimburse employees for costs of health insurance premiums Scope of Practice HB : Adds licensed acupuncturists to the list health care providers for reimbursement. HB : Expands loan repayment for nurse faculty and other providers

Doing more with less (and less) 20 $100 million budget reductions for FY , including… $2.7 million Safety net clinics $2.7 million Safety net clinics $3 million Health disparities grants $3 million Health disparities grants $10.3 million Early detection and treatment funds $10.3 million Early detection and treatment funds $1.6 million Women’s Wellness Connection program $1.6 million Women’s Wellness Connection program $17.7 million Tobacco education programs $17.7 million Tobacco education programs $11.7 million Medicaid Provider Fee reduction $11.7 million Medicaid Provider Fee reduction $2.5 million Medicaid children’s oral health services $2.5 million Medicaid children’s oral health services

#5: Building Out and Wiring Up Physical infrastructure – The ACA allocates $11 billion to FQHCs 3 Major Initiatives in Colorado – COHRIO, QHN and EMR – APCD – State Insurance Exchange 21

The Colorado Health Insurance Exchange 2 A health insurance exchange is an organized marketplace for customers to shop for health insurance based on price and quality. #COHIEX

Healthy Living LiveWell Colorado Colorado Children’s Health Foundation School-based Health Centers Family Resource Centers Health Coverage Colorado Benefits Management System Assessment Colorado Healthcare Affordability Act Simplify the enrollment process for Medicaid and CHP+ Health Care Center for Improving Value in Health Care Health TeamWorks CORHIO Prometheus Colorado Health Service Corps Federally Qualified Health Centers #6: HEAL Thyself!

Implications for Employers Grants for small employers – Efforts to maximize employee engagement – Initiatives to change unhealthy behaviors and lifestyle choices – Supportive environment efforts 24

COLORADO LEGISLATIVE SESSION: 2011 AND

What to Expect 2012 Health reform alignment Individual responsibility arguments Workforce supply issues Cost savings – Public insurance and structural deficits – Private insurance: cost to employers 26

Contact Information Michele Lueck President and CEO Colorado Health Institute Colorado Northwest Community College Nursing Graduates, 1965