In April of this year, Colorado took a major step forward in increasing access to healthcare for underserved Coloradans when Governor Ritter signed the Colorado Healthcare Affordability Act.
This landmark collaboration involving the current administration, our legislators and the Colorado Hospital Association will use a hospital provider fee to secure matching federal funds to provide insurance through the Child Health Plan Plus (CHP+) and Medicaid to cover more than 100,000 Coloradans in need of basic healthcare.
Ironically, on the same day and five blocks away from where the Governor signed the legislation, a crowd of Medicaid and CHP+ recipients gathered to raise concerns about the State’s plan to cut Medicaid provider reimbursement rates to balance the budget. Currently, Medicaid payment rates for pediatric services do not cover overhead expenses.
These two events raise a fundamental question: Will Colorado find providers to care for the increasing numbers of publicly insured people? The answer to this question begins with a remarkable success story in our own State during the last three years.
In 2005, Colorado ranked 50th in the nation in the numbers of children in poverty who were uninsured. Citing low Medicaid reimbursement rates that failed to cover overhead costs and adverse administrative policies, 80 percent of Colorado physicians in private practice were reluctant to accept new patients with public insurance
At the same time, health outcome surveys from 1999-2005 documented poor vaccination and primary care visit rates for Colorado Medicaid children, especially those without a designated provider.
Compared to those with private insurance, children in Colorado with public or no insurance experienced significantly higher estimated rates of hospital admission, higher death rates and higher severity of illness, resulting in potential excess charges of nearly $128 million to Colorado’s public health care system in 2005.
Thanks to the leadership of the Ritter administration, a coalition of community groups and concerned legislators, these policies began to change in 2007.
The Colorado General Assembly established the standards and measures of the medical home model with the goal that every child enrolled in a public health plan would have a primary care provider responsible for delivering timely and appropriate care.
Working with many community groups, the administration implemented this legislation and began to increase provider reimbursement and improve other essential administrative services. By February of 2009, more than 90 percent of Colorado pediatricians were accepting Medicaid and CHP+ patients, and, most significantly, an estimated 50,000 more children have a medical home.
Earlier this year, the Department of Healthcare Policy and Financing reported their preliminary results to the Governor and Legislature indicating that, in collaboration with the Colorado Children’s Healthcare Accbess Program (CCHAP), children enrolled in a medical home had: “increased incidence of low-cost preventive care .emergency department utilization was reduced and less expensive for children .. fewer children were admitted to the hospital with a lower cost per admission (and) the enrollment for medical homes for children continues to increase at a steady pace as practices request to join either through the Department or the CCHAP programs.”
The Colorado medical home model is now being successfully replicated in Michigan and is being considered by other states. While ongoing analysis is necessary to distinguish the relative importance of the services provided and the health-seeking behaviors of the families who choose them, its early success in improving access to quality healthcare for Colorado’s children deserves continued support.
The Colorado Healthcare Affordability Act provides an opportunity to use the same approach to improve the quality of health care and decrease unnecessary costs for additional Coloradans.
With the progress that has been made in the last three years, Colorado should be expanding its medical home programs and seek to replicate this model in the program expansions laid out in the Health Care Affordability Act.
James K. Todd, MD, is the Jules Amer Chair of Community Pediatrics at The Children’s Hospital. EDITOR’S NOTE: This is an online-only column and has not been edited.
