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

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

3. 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

4. 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

5. THE COLORADO CONTEXT 5

6. 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

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

8. #1: But will affordability play in Pueblo? 8 Source: CHI analysis of 2008-09 COHS

9. 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, 2008-09 Source: The Colorado Trust (2010). The magnitude of underinsurance in Colorado.

10. 800,000 214,000153,000175,000 258,000 10 Who will still be uninsured in CO?

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

12. #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

13. 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

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

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

16. 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

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

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

19. #4: The Colorado Flavor of Reform 19 Healthier Communities HB11-1069: Physical activity required in elementary schools HB11-40: requires youth coaches to complete training on concussions Public Insurance HB11-1242: 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 SB11-1289 permits small employers to reimburse employees for costs of health insurance premiums Scope of Practice HB11-1186: Adds licensed acupuncturists to the list health care providers for reimbursement. HB11-1281: Expands loan repayment for nurse faculty and other providers

20. Doing more with less (and less) 20 $100 million budget reductions for FY 2011-12, 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

21. #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

22. 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

23. 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!

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

25. COLORADO LEGISLATIVE SESSION: 2011 AND 2012 25

26. 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

27. Contact Information Michele Lueck President and CEO Colorado Health Institute lueckm@coloradohealthinstitute.org 720.382.7073 Colorado Northwest Community College Nursing Graduates, 1965