Health Care Financing the Patient-Centered Medical Home: Making the Investment in Primary Care Sandeep Wadhwa, MD, MBA Medicaid Director and Chief Medical Officer State of Colorado October 2008

Health Care Colorado Health Care Snapshot Source of Insurance Numbers in Thousands – Source: June 2007 Lewin Report

Health Care Medical Services Premiums Caseload FY 07-08

Health Care Medical Services Premiums Per Capita Cost FY 07-08

Health Care State’s Role in Primary Care Reform Legislative/regulatory authority Catalyst for encouraging public/private collaboration Active participant in the community of payers Dominant payer for safety net

Health Care Financing Primary Care Reform Medicaid - Phase 1 Repurposed our EPSDT care coordinators to support Medical Home objectives Increased EPSDT payments to further cover Medical Home activities Regional ASO with 50% shared savings with primary care physicians

Health Care Financing Primary Care Reform Medicaid - Phase 2 Care management PMPM fee for medical home providers Care coordinator and health educator layer - community and office based Move from shared savings to shared outcome incentives (ambulatory care sensitive conditions hospitalizations, emergency room visits)

Health Care State Based Primary Care Reform Participate in multi-payer collaborative Created public-private value- based healthcare center to collaboratively address structuring/financing of primary care

Health Care Thank you Sandeep Wadhwa, MD