1. health and fitness

Cover Sheet
National Governor’s Association Policy Academy
Developing State-Level Capacity to Support Super-Utilizers
Colorado State Team Lead and Administrative Coordinator:
Kathryn Jantz, MSW, MPH
Accountable Care Collaborative Program
Colorado Department of Health Care Policy and Financing
1570 Grant Street
Denver CO 80203-1818
Telephone: 303-866-5972
Fax: 303-866-2803
Kathryn.Jantz@state.co.us
Over the past several years, Colorado Medicaid under the Department of Health Care Policy and
Financing (the Department) has implemented a number of service delivery reforms to reduce
costs and improve quality of care for clients. Central to these efforts is the Accountable Care
Collaborative (ACC) program, which relies upon a multi-layered system of accountability using
regional organizations in collaboration with primary care providers. While this program has
generated positive results in only its first two years of operation, more focused efforts on select
populations will ensure continued improvements and success. The next phase of the ACC
program’s evolution must incorporate targeted strategies that enhance the system’s competencies
and capabilities for better coordinating the health care of high-utilizing clients, known as “superutilizers.”
Beyond the marked increase in health care service consumption, the super-utilizer population is
not homogenous in needs or behaviors. These individuals may have a wide range of physical
and behavioral health needs, and the ability of each user to effectively access the health care
delivery system is highly variable. To align with and best leverage current efforts, Colorado will
specifically focus on interventions for clients who are enrolled in the ACC program and who
meet criteria for the Client Over-Utilization Program (COUP). This subset of super-utilizers is
characterized by ineffective and often inappropriate behaviors related to accessing the health care
delivery system. This group differs from clients who have high medical needs and may be
facing other challenges around access and in-home supports.
The ACC program is designed to leverage regional needs and strengths through one centralized,
accountable organization, known as a Regional Care Collaborative Organization (RCCO), in
each of the seven regions of the state. The RCCO is responsible for the care of clients residing in
the region who are enrolled as members in the program. Because the ACC program is designed
to be outcomes-focused, each RCCO has the flexibility to address local needs through a
community-based approach that leverages community strengths and resources. The model
allows RCCOs to adapt and develop innovative approaches to managing their population’s health
care.
The Client Over-Utilization Program identifies clients who are inappropriately using the health
care system and applies an administrative lock-in mechanism that controls the route by which
care is accessed. The lock-in component ensures that clients receive coordinated care by using
the primary care provider as a singular point of contact for the client’s whole health. The client
may access other providers and specialists via a referral when the primary care provider
determines it medically necessary and appropriate. The COUP program was established several
years ago; however, the administration of the program has recently been transferred from the
Department to its Utilization and Management (UM) vendor. This transition phase offers an
opportunity to revisit program criteria and processes. The Department is committed to ensuring
that the administrative mechanism is adequately accompanied by the robust supports of the ACC
program.
While the ACC program is a congruous environment to test various new interventions for the
COUP eligible population, no corresponding forum exists to review and discuss the efficacy of
these interventions beyond claims-based outcomes. For this purpose, the Department proposes
to create a Policy Academy that would provide the necessary structure for state agency
representatives to convene and learn about RCCO activities targeting super-utilizers while
ensuring relevant coordination with other statewide and local efforts. Using RCCOs as learning
labs will allow the state to compare different interventions, encourage community partnerships,
Colorado – NGA Super-Utilizer Policy Academy
Page | 1
maximize success of the program, and assess the strengths and challenges of the seven different
models.
At the completion of the Policy Academy, Colorado will have:
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Identified concrete ways that the Department of Health Care Policy and Financing, the
Department of Public Health and Environment (CDPHE) and the Department of Human
Services (DHS) can partner in serving the super-utilizer population, and will have identified
designated staff from each agency for continued engagement;
Begun implementing a necessary reimbursement structure for incentivizing providers to
serve clients who meet overutilization criteria;
Identified the necessary data with the means to obtain it, and developed a plan to incorporate
the data into provider workflow;
Completed an assessment of barriers to implementing medical neighborhoods and a
preliminary proposal for how the state can support medical neighborhoods; and
Shared intervention best practices between regions.
Demonstrated Commitment from Relevant Leaders Across State Government:
The core team represents the Governor’s Office, Medicaid, public health, behavioral health
(including substance use disorders), human services, and health IT. Although direct state
representatives from housing and transportation development are not on the core team,
representatives from these areas are engaged and have agreed to participate in the daylong instate workshop and a year-long workgroup.
Effective implementation of a robust strategy for COUP-eligible clients requires a strong and
innovative workforce. In the ACC, the state pays the RCCOs to ensure all clients receive care
coordination and to develop a contracted network of Primary Care Medical Providers (PMCPs)
who are willing accept COUP eligible clients. The RCCOs are reimbursed through per member
per month (PMPM) payments, providing significant flexibility. The RCCOs can reimburse
health coaches, peer navigators, or a host of other service providers.
Kathryn Jantz, ACC Program Lead, will be the team lead for this initiative and will champion
this aspect of workforce development. The framework of the Academy will enable the Medicaid
agency to develop relationships with the state Human Services and Public Health agencies,
which up to now have only been peripherally involved in the ACC program. Kathryn is
committed to engaging core team members in 1:1 meetings to discuss various aspects of the
project and ensure full participation in the Academy activities.
Health Information Technology/Data Analytics Capability:
In the ACC program, the Department’s Statewide Data Analytics Contractor (SDAC), Treo
Solutions, is responsible for providing secure electronic access to actionable data via a Web
portal. The Web portal can be accessed by the Department, RCCOs and Primary Care Medical
Providers (PCMPs). In addition to the interactive Web portal, the SDAC provides each RCCO
with a complete file of paid claims so that they can conduct their own internal analysis, should
they choose to do so.
The SDAC Web portal is based on a data repository of Medicaid paid claims data and Behavioral
Health Organization (BHO) managed care encounter data. ACC enrollees are assigned clinical
risk group (CRG) identifiers and predictive risk scores. The SDAC conducts analysis to
Colorado – NGA Super-Utilizer Policy Academy
Page | 2
determine which claims were potentially preventable, possibly providing insights into which
“super-utilizer” clients are ideal for intervention.
Although the Department has put significant effort into educating providers about the SDAC
web portal, limited research has been done into how this data is being incorporated into the
workflow of direct care coordination. This initiative will provide insight into how that data is
currently impacting direct care coordination, and determine what additional data is necessary as
it relates to COUP eligible clients.
The SDAC data has a number of limitations:
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Paid claims data illustrates health events that occurred months ago;
Claims do not provide a complete picture of client health or quality outcomes; and
Medicaid clients often move on and off of Medicaid, leaving gaps in the claims history.
Colorado is engaged in three efforts to address those limitations. First, the Department is
exploring methodologies to obtain real or close to real-time data on Emergency Department
visits for Medicaid clients. Second, Colorado is well on its way to developing a statewide Health
Information Exchange System. Third, Colorado is developing an All Payer Claims Database that
will include historical claims data from the largest commercial payers’ individual and large- and
small group plans, and Medicaid, representing over two million Coloradans.
In addition to these statewide efforts, many of the RCCOs have developed their own IT
infrastructure that may include both claims data and data from hospitals or other sources.
Creating a forum where RCCOs share with one another how they are utilizing already available
data may lead some RCCOs to enhance or alter their internal IT infrastructure.
Each of these initiatives does or will provide access to the information necessary to allow for
client identification and stratification, effective interventions and measuring progress. However,
access to the necessary data is not synonymous with effective use of the data. In the Policy
Academy, the state hopes to consider how to most effectively use the current data available (paid
Medicaid claims) and gain a deeper understanding for how the other data sources can be
integrated as they become available over the next several years. Specifically, the state wants to
re-examine the definition of super-utilizers and how to measure success with this complex
population.
Comprehensive Stakeholder Engagement Plan:
The ACC has a robust stakeholder process. The ACC Program Improvement Advisory
Committee meets every two months, and is comprised of a diverse set of stakeholders engaged in
the health care delivery system including consumers, health care providers and behavioral health
providers. The Policy Academy presents an opportunity to incorporate representatives of nonmedical entities into the ACC Advisory Committee. This would transition the advisory
committee from a focus on purely the health care system to the social determinants of health.
For the purpose of this initiative, the team leader would request that the ACC Program
Improvement Advisory Committee form a temporary workgroup. This workgroup would
include members of the core team and additional external members including a representative
from the following organizations:
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Care Solutions, LLC
Colorado Coalition for the Homeless
Colorado Community Health Alliance
Colorado – NGA Super-Utilizer Policy Academy
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Colorado Community Health Network
Colorado Coalition for the Medically
Underserved
Page | 3
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Colorado Department of Human Services
Colorado Department of Public Health
and Environment
Colorado Hospital Association
Colorado Health Institute
Community Health Partnerships
Center for Improving Value in Health
Care
Colorado Health Partnerships
Colorado Access
Denver Health and Hospital Authority
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City and County of Denver, Crime
Preventions and Control Commission
Colorado Regional Health Information
Organization
Colorado Department of Human Services
Department of Local Affairs, Division of
Housing
Integrated Community Health Partners
Jefferson Center for Mental Health
Physician Health Partners
Quality Health Network
Anticipated Outcomes and Challenges:
The Policy Academy will result in cross-agency partnerships, a clear plan for financing care for
this population, a vision for how to ensure an adequate network of care, and the identification
and sharing of intervention best practices.
We anticipate improved partnerships between the Department, CDPHE and DHS. Success in
this arena will result in identification of concrete ways that each agency can collaborate to better
serve this population. In addition, the Policy Academy will result in identification of staff at
each agency who will maintain this partnership. The requirement to work closely with a superutilizer program, in this case the RCCOs, and to follow a number of clients over the course of the
year, will provide all three agencies with a depth of knowledge of the program in action that they
could not have gained through current forums. Although the ACC program emphasizes
community partnerships, the Department has generally left relationship development to the
RCCOs in their local communities. Participation in this Policy Academy would develop state
level relationships, ensuring that connections are occurring statewide. This outcome, although
seemingly modest, is one of the most important outcomes of the state’s participation. Starting
the conversation of how to partner is often the hardest step. The risk is that staff turnover could
jeopardize the longevity of those relationships or competing demands could mean that those
relationships are not maintained beyond the super-utilizer workshop.
At the conclusion of the Policy Academy, Colorado would like to have clear plans for how to
incentivize care and support the necessary infrastructure for this population through the various
ACC payment structures. Ideally, implementation of these payment structures would begin prior
to the conclusion of the Academy year. The Department is currently considering whether to pay
an additional PMPM payment specifically for COUP clients, or to incorporate a higher PMPM
for this population into a variable rate structure within the ACC. In addition, the Department is
exploring how to incentivize effective care for this population through Key Performance
Indicators (KPIs) and Shared Savings. These changes would likely require CMS approval and
could potentially require a State Plan Amendment. The greatest risk to achieving this outcome is
that the solutions identified will not be operationally feasible. We also welcome the chance
provided by this Policy Academy to explore options implemented in other states.
In addition, we would like to formulate a vision for how to develop a Medical Neighborhood that
is able to support these complex clients. The state has heard from providers that many of these
clients engage in behaviors that make it challenging to connect them with specialty care. The
state would like to explore the possibility of facilitating this type of care through telehealth
Colorado – NGA Super-Utilizer Policy Academy
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programs. An enhanced telehealth program would likely require additional funding. Further,
gaining the support of various members of the health care system in order to develop a robust
Medical Neighborhood could require the leadership of the Governor’s office, and will need to
compete for limited state resources to reach completion.
Through the one-day workshop, the Policy Academy will provide an opportunity for the RCCOs
to share their intervention models (or one of their models) with each other, and with the other
workgroup members. This should generate discussion that will help the RCCOs develop a more
comprehensive system of care and will allow RCCOs to consider best practices in other regions.
Work Plan
Team leader will meet 1:1 with each Core Workgroup Member.
Workgroup will meet and be provided with options related to the program. Will
decide frequency and structure of meetings.
Team leader will partner each Core Team Member with a RCCO and have them do a
“ride along” for care coordination.
Identify super-utilizer clients to follow for the year-long initiative and work with
RCCO’s to gain permission from clients.
Develop a plan for tracking the clients’ experience.
Meet with other state staff to brainstorm ways to collaborate. Develop several
options to bring back to each agency.
Identify key members of the team that will work together on a regular basis (meeting
at least quarterly) for the foreseeable future to determine how to partner on serving
this population.
Day-long workshop. RCCOs share their intervention models (or one of their models)
and their data use methodologies with each other and the other workgroup members.
Community partners share their role in caring for this population.
Explore options from other states.
Meet with Academy faculty to brainstorm options to bring to workgroup.
Present options to workgroup.
Gain internal approval.
Assess whether or not CMS approval is necessary.
Assess whether or not any contract changes are necessary.
Week
07/08/13
07/22/13
08/12/13
08/26/13
09/02/13
TBD
TBD
TBD
TBD
02/03/14
02/17/14
03/03/14
03/17/14
04/07/13
04/21/13
Implementation Prospects:
The State of Colorado is highly committed to serving this population. As the infrastructure for
both the ACC and the COUP program are in place and the goal of Colorado’s participation in
this Policy Academy is high quality comprehensive care, the state is very likely to be successful
in making measureable change over the course of the year. The Policy Academy complements
other activities in which Colorado is already engaged, including the Comprehensive Primary
Care initiative (CPC) and the State Innovation Models Initiative (SIM), both administered by the
Center for Medicare and Medicaid Services (CMS) Innovation Center.
Colorado is one of seven states chosen to participate in CPC, a multi-payer initiative (public and
private) with the goal of strengthening primary care. To be selected to participate, Colorado
primary care practices had to demonstrate their commitment to coordinating care for their
patients. Participating practices are given a bonus payment for each of their clients. In order to
receive the PMPM payment for Medicaid patients, the practices must contract with the ACC.
Colorado – NGA Super-Utilizer Policy Academy
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This contingency ensures that the state’s long-term health care reform program aligns with shortterm initiatives. The state’s participation in CPC guarantees that lessons learned around care
coordination across the system can be shared and disseminated to a multi-payer audience. In
addition, small private practices that may not have experience working with complex Medicaid
clients with significant health utilization needs may be more comfortable accepting these clients
if there is a strong system of non-medical care to complement the medical services.
Colorado has received SIM Pre-testing funding to further develop our State Health Care
Innovation Plan, with a focus on behavioral health integration. One aspect of integration is an
assessment of what would be required operationally for implementing Health Homes in 2015.
The SIM pre-testing period includes a robust stakeholder process, and one of the concerns we
have heard from providers is that PCPs may not be the appropriate primary point of care for
some super-utilizers. Health Homes will provide an opportunity to rethink who can be the
primary point of care. This Policy Academy aligns with SIM activities in both timing and focus.
The SIM Pre-testing funds period ends September 31, and CMS has not released anticipated
dates for awarding the next round of SIM Testing funds. The Policy Academy would provide
structure for the state to continue conversations with some of the same participants in SIM over
the course of the year and pilot some intervention models with this smaller population.
Participation in this Policy Academy will further the efforts in the NGA sponsored Prescription
Drug Abuse Reduction Policy Academy by focusing narrowly on a population and a program
that has not received much attention within that Academy.
In addition to state administered interventions, there are a multitude of localized interventions
taking place in Colorado, many of which are in collaboration with their local RCCO. For
example, the Colorado Springs Fire Department has partnered with community medical and
safety-net organizations, including their local RCCO, to implement a pilot program that uses the
Fire Department’s resources and medical expertise to address “frequent fliers” in their
community. The Policy Academy will give the state the opportunity to share these ideas
between regions and assess scalability.
Description of the Super-Utilizer Population that will be Served:
For the purposes of this project, the state will focus on clients who meet the eligibility criteria for
COUP and are enrolled in the ACC. Clients enrolled in COUP are not able to see multiple
providers, ensuring continuity of care and heightening the potential for developing an effective
intervention. COUP clients have documented evidence of abuse or over-utilization of allowable
medical benefits. Clients become COUP eligible if they exceed any one of the following
parameters during a three-month period:
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Use of sixteen or more prescriptions;
Use of three or more pharmacies;
Use of three or more drugs in the same therapeutic category, i.e., Oxycodone, Oxycontin,
Hydrocodone;
Has excessive ER and physician visits; OR
A referral or analysis indicates possible overutilization.
The ACC program is designed to be iterative; the state is committed to making significant
ongoing changes. The Policy Academy will give state staff and stakeholders a chance to
thoughtfully improve how the program serves this super-utilizer population.
Colorado – NGA Super-Utilizer Policy Academy
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STATE OF COLORADO
OFFICE OF THE GOVERNOR
136 State Capitol
Denver, CO 80203 - 1792
Phone (303) 866-2471
Josette Gbemudu
Senior Policy Analyst
National Governor’s Association
444 N. Capitol St., Suite 267
Washington, DC 20001-1512
via email to jgbemudu@nga.org
May 31, 2013
____________________
John W. Hickenlooper
Governor
Dear Ms. Gbemudu,
We are pleased to submit this application for Colorado’s participation in the National Governors
Association Policy Academcy for Developing State-Level Capacity to Support SuperUtilizers.
Colorado’s goal is to become the healthiest state in the nation by achieving the best care and
producing the best health outcomes with the best value. As such, we would like to use this
opportunity to promote inter-agency and multi-sector collaboration in order to meet the needs of
individuals who have unnecessarily high utilization rates in our healthcare system.
In particular, we will use this Policy Academy to focus on interventions for super-utilizer
Medicaid clients enrolled in the Accountable Care Collaborative (ACC) program, Colorado’s
preeminent payment and delivery system reform initiative. The Colorado Department of Health
Care Policy and Financing (HCPF), Colorado’s single Medicaid state agency, will be the lead
agency for this effort, and our designated team includes:
 Kathryn Jantz, MSW, MPH, ACC Program Lead, Health Programs Office, HCPF
(Team Lead and Administrative Coordinator)
 Laurel Karabatsos, Deputy Medicaid Director, HCPF
 Joel Dalzell, Section Manager, Health Data Strategy Section, HCPF
 Gabriel Kaplan, PhD, MPA, Director, Prevention Health Policy, Systems and Analytics
Branch, Colo. Dept. of Public Health & Environment
 Lisa Clements, PhD, Director, Office of Behavioral Health, Colo. Dept. of Human
Services
 Katherine Blair, Senior Policy Advisor for Health, Governor’s Office
We intend to use this opportunity to actively engage many other experts and stakeholders in
Colorado, including Regional Care Collaborative Organizations within the ACC, medical and
behavioral healthcare providers, patient advocates, county departments, federally qualified health
centers, and health data organizations.
Thank you for your time and consideration,
John W. Hickenlooper
May 28, 2013
Marilyn S. Gaipa, LCSW, CAC III
Care Solutions, LLC working with
Jean East, PhD - Associate Dean of Academic Affairs
Graduate School of Social Work
University of Denver
2148 S High St
Denver, CO 80208
Dear National Governors Association:
On behalf of the Graduate School of Social Work, University of Denver and Care Solutions, LLC, it is
my pleasure to submit this letter of support for Colorado’s application for the National Governors
Association Policy Academy – Developing State-level Capacity to Support Super-Utilizers.
As an organization that provides academic preparation for social workers in all aspects of health care
delivery, we believe strongly in the importance of a statewide plan that focuses on care coordination for
super-utilizers who are enrolled in Medicaid. We are committed to the Governor’s vision of making
Colorado the healthiest state in the nation and believe that this opportunity will improve service delivery
to this population.
The Graduate School of Social Work is committed to developing social work health care professionals
that function at the highest level in health care services, including all levels of care coordination,
integrated physical and behavioral health care, medical social work/discharge planning, prevention/early
intervention and wellness activities. The Graduate program at GSSW is developing a health/wellness
concentration year curriculum, along with a continuing education program, to train effective and efficient
social workers to deliver these needed services.
Our organization will continue to share our perspective with the State and work collaboratively to design
a state action plan to better address the needs of super-utilizers in Colorado.
Sincerely,
Marilyn Gaipa, LCSW, CAC III
Care Solutions, LLC
Principal/Founder working with
Jean East, PhD –Associate Dean of Academic Affairs
Graduate School of Social Work
University of Denver
May 28, 2013
Marilyn S. Gaipa, LCSW, CAC III
Care Solutions, LLC working with
Jean East, PhD - Associate Dean of Academic Affairs
Graduate School of Social Work
University of Denver
2148 S High St
Denver, CO 80208
Dear National Governors Association:
On behalf of the Graduate School of Social Work, University of Denver and Care Solutions, LLC, it is
my pleasure to submit this letter of support for Colorado’s application for the National Governors
Association Policy Academy – Developing State-level Capacity to Support Super-Utilizers.
As an organization that provides academic preparation for social workers in all aspects of health care
delivery, we believe strongly in the importance of a statewide plan that focuses on care coordination for
super-utilizers who are enrolled in Medicaid. We are committed to the Governor’s vision of making
Colorado the healthiest state in the nation and believe that this opportunity will improve service delivery
to this population.
The Graduate School of Social Work is committed to developing social work health care professionals
that function at the highest level in health care services, including all levels of care coordination,
integrated physical and behavioral health care, medical social work/discharge planning, prevention/early
intervention and wellness activities. The Graduate program at GSSW is developing a health/wellness
concentration year curriculum, along with a continuing education program, to train effective and efficient
social workers to deliver these needed services.
Our organization will continue to share our perspective with the State and work collaboratively to design
a state action plan to better address the needs of super-utilizers in Colorado.
Sincerely,
Marilyn Gaipa, LCSW, CAC III
Care Solutions, LLC
Principal/Founder working with
Jean East, PhD –Associate Dean of Academic Affairs
Graduate School of Social Work
University of Denver
May 21, 2013
National Governors Association
444 North Capitol Street
Washington, D.C. 20001
Dear National Governors’ Association:
On behalf of the Colorado Coalition for the Homeless, it is my pleasure to submit this letter of
support for Colorado’s application for the National Governors Association Policy Academy –
Developing State-level Capacity to Support Super-Utilizers.
As a Federally Qualified Health Center: Healthcare for the Homeless Provider that delivers
housing, healthcare and supportive services to more than 12,000 homeless men, women and
children each year, we believe strongly in the importance of a statewide plan that focuses on care
coordination for super-utilizers who are enrolled in Medicaid.
The Coalition is committed to the Governor’s vision of making Colorado the healthiest state in
the nation. We believe that this opportunity will help us enhance our ability to deliver an
integrated model of care that includes primary care, mental health and substance treatment
services, dental, vision, pharmacy, respite care and mobile health services – along with housing
and benefits acquisition.
Currently, assisting our clients in the enrollment process for Colorado’s Medicaid expansion
programs is a top priority. To date we have facilitated the submission of more than 1,500
applications for the Adults without Dependent Children (AwDC) program.
For 25 years, the Coalition has been crafting lasting solutions for individuals with extremely
complex needs. We believe we are well-positioned to share a meaningful perspective with the
State and to continue to collaborate on a state action plan to better address the needs of superutilizers in Colorado.
Sincerely,
BJ Iacino
Bette Iacino
Vice President, Public Policy and Communications
Colorado Coalition for the Homeless
(303) 285-5223
biacino@coloradocoalition.org
May 28, 2013
National Governors Association
Hall of the States
444 N. Capitol Street, Suite 267
Washington, DC 20001
Dear sir or madam:
On behalf of the Colorado Coalition for the Medically Underserved (CCMU), it is my pleasure to submit
this letter of support for Colorado’s application for the National Governors Association Policy Academy –
“Developing State-Level Capacity to Support Super-Utilizers.”
As an organization that actively works on improving the health care system so it meets the needs of all
Coloradans, we believe strongly in the importance of a statewide plan that focuses on care coordination
for super-utilizers in Medicaid. We are committed to the governor’s vision of making Colorado the
healthiest state in the nation and believe that this opportunity will improve service delivery to this
population.
The health care system only works if it works well for our most vulnerable populations—and many tend to
cost the system the most for various reasons. We at CCMU prioritize these populations in our health
system improvement work, and we have been pleased with the success thus far in the Accountable Care
Collaborative. As an increasing amount of vulnerable populations are being enrolled in the ACC, we need
to enable them to better their health outcomes with appropriate and beneficial use of the system. This is
even more critical with the impending enrollment of more low-income adults without dependent children—
many of whom have never before received coverage and face significant behavioral and physical health
challenges. Colorado has an immense opportunity to capitalize upon with the burgeoning growth and
continuing success of the ACC and the impending changes with health reform.
We are pleased with the state’s commitment to super-utilizers, and we will commit to working
collaboratively with the state to design an action plan and supporting them in their efforts.
Sincerely,
Aubrey Hill
Director of Health Systems Change
Colorado Coalition for the Medically Underserved
PO Box 18877, Denver, CO 80218 | 720.583.1760 | ccmu.org
Gretchen Hammer
Executive Director
Colorado Coalition for the Medically Underserved
Leading change for a healthier Colorado
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Laura Wedemeyer
May 24, 2013
National Governors Association
Ms. Krista Drobac
Health Division Director
Dear National Governors Association:
On behalf of Community Health Partnership it is my pleasure to submit this letter of support
for Colorado’s application for the National Governors Association Policy Academy –
Developing State-level Capacity to Support Super-Utilizers.
CHP is a community coalition formed in 1992 by local health care leaders to foster a
coordinated approach to health care issues, and every major health care provider in our
region is a member. CHP is also the coordinating body for RCCO Region 7, Colorado’s
innovative accountable care model for Medicaid. This ACO is dedicated to providing care
coordination and population management for the growing Medicaid population in our
region.
We believe strongly in the importance of a statewide plan that focuses on care coordination
for super-utilizers who are enrolled in Medicaid. We are committed to the Governor’s vision
of making Colorado the healthiest state in the nation and believe this opportunity will
improve service delivery to this population.
RCCO Region 7 currently serves 57,000 Medicaid enrollees. RCCO-level care coordination
efforts focus on top emergency department utilizers – individuals who have been in the ED
more than ten times in the past twelve months with no in-patient admission. We work
collaboratively with primary care providers to ensure case management services for these
individual clients. We are piloting innovative interventions to reduce ED utilization, including
working with Fire Department paramedics, and ED in-person interventions.
Page 2
Letter of Support
Sincerely,
Debbie Chandler
Valerie Herl
Chief Executive Officer
Colorado Springs Health Partners
VP of Business Operations
Pikes Peak Hospice & Palliative Care
Robin Johnson, MD, FACEP
Jill Law
Emergency Room Physician
Public Health Director
El Paso County Public Health
Jefferson Martin
Pam McManus
Executive Director
Open Bible Medical Clinic/TLC Pharmacy
President
Peak Vista Community Health Centers
Bruce Minear
Kelly Phillips-Henry
Chief Executive Officer
Mountain View Medical Group
Chief Operating Officer
AspenPointe
Mike Scialdone
Nancy Smith
Chief Executive Officer
UC Health/Memorial Hospital
Dean and Professor
Beth El College of Nursing & Health Sciences
Jameson Smith
Richard Spurlock MD
Chief Administrative Officer
Penrose-St. Francis Health Services
Kaiser Permanente
May 21, 2013
National Governors Association
Hall of the States
444 N. Capitol Street, Suite 267,
Washington, DC 20001-1512
Dear National Governors Association:
On behalf of the Center for Improving Value in Health Care (CIVHC), it is my pleasure to
submit this letter of support for Colorado’s application for the National Governors Association
Policy Academy – Developing State-level Capacity to Support Super-Utilizers.
CIVHC is dedicated to achieving the Triple Aim in Colorado by expanding access to and use of
data, and facilitating the development of new delivery and payment models for both Medicaid
and commercial payers. As such, we believe strongly in the importance of a statewide plan that
focuses on care coordination for super-utilizers who are enrolled in Medicaid. We are committed
to the Governor’s vision of making Colorado the healthiest state in the nation and believe that
this opportunity will improve service delivery to this population.
Our organization will continue to share our perspective with the State and work collaboratively
to design a state action plan to better address the needs of super-utilizers in Colorado.
Sincerely,
Philip B. Kalin
President and CEO
May 28, 2013
Gretchen McGinnis
Colorado Access
RCCO 2, 3 and 4
10065 E Harvard Ave, Suite 600
Denver, CO 80231
Dear National Governors Association:
On behalf of Colorado Access, it is my pleasure to submit this letter of support for Colorado’s
application for the National Governors Association Policy Academy – Developing State-level
Capacity to Support Super-Utilizers.
As an organization that holds the Regional Collaborative Care Organization (RCCO) contracts
for three of the state’s seven regions as well as functioning as the Behavioral Health
Organization in the city and county of Denver and the largest CHP+ HMO in the state, we
believe strongly in the importance of a statewide plan that focuses on care coordination. This
grant’s project for super-utilizers who are enrolled in Medicaid is a positive step in that direction.
We are committed to the Governor’s vision of making Colorado the healthiest state in the nation
and believe that this opportunity will improve service delivery to this population.
Colorado Access, in our 17 year history, have created and implemented many nationally
recognized programs focused on the unique needs of the state’s neediest populations in
Medicaid. This opportunity to focus on this important population in a more coordinated and
collaborative fashion is exciting and one that we look forward to participating in.
Our organization will continue to share our perspective with the State and work collaboratively
to design a state action plan to better address the needs of super-utilizers in Colorado.
Sincerely,
Gretchen McGinnis
Sr. Vice President of Public Policy and Performance Improvement
_____________________________________________________________________________________________
10065 East Harvard Avenue Suite 600 Denver, Colorado 80231-5963
Phone: 720.744.5100 Fax: 303.751.9048
STATE OF COLORADO
Nation
OFFICE OF BEHAVIORAL HEALTH
Lisa M. Clements, PhD, Director
3824 W. Princeton Circle
Denver, CO 80236
Phone: 303-866-7434 Fax: 303-866-7090
lisa.clements@state.co.us
John W. Hickenlooper
Governor
Reggie Bicha
Executive Director
May 23, 2013
National Governor’s Association
Hall of the States
444 N. Capitol St., Suite #267
Washington, DC 20001-1512
Dear National Governors Association:
On behalf of the Colorado Department of Human Services, Office of Behavioral Health (OBH), it is my
pleasure to submit this letter of support for Colorado’s Developing State-level Capacity to Support
Super-Utilizers National Governors Association Policy Academy application.
OBH believes strongly in the importance of a statewide plan that focuses on care coordination of superutilizers in Colorado. Through the Accountable Care Collaborative (ACC), the State has made
significant strides towards addressing this population of Medicaid clients. This opportunity will allow
the State to revisit its approach and further align the activities of the various state agencies for the ACC
enrolled population as well as those not enrolled. OBH continues to work with the Colorado Behavioral
Health Transformation Council to provide consumers with timely access through multiple points of
entry to a full continuum of culturally responsive services, including prevention, early intervention,
crisis response, treatment, and recovery.
We commit to working collaboratively to implement a plan that will make a positive difference in the
care experience and health outcomes for individuals identified as “super-utilizers” in Colorado.
Sincerely,
Lisa M. Clements, PhD.
Director
Our Mission is to Design and Deliver Quality Human Services that Improve the Safety and Independence of the People of Colorado
May 28,2013
DonnaMills
IntegratedCommunityHealth Partners
503N Main St. Ste.202
Pueblo,CO 81003
DearNationalGovernorsAssociation:
On behalfof IntegratedCommunityHealthPartners(ICHP),it is my pleasureto submitthis
letterof supportfor Colorado'sapplicationfor the NationalGovemorsAssociationPolicy
Academy- DevelopingState-levelCapacityto SupportSuper-Utilizers.
As a memberof the State'sAccountableCareCollaborative,we believestronglyin the
importanceof a statewideplanthat focuseson carecoordinationfor super-utilizers
who are
enrolledin Medicaid.We arecommittedto the Governor'svision of makingColoradothe
healthieststatein the nationandbelievethat this opportunitywill improveservicedeliveryto
this population.
Our vision for the super-utilizers
in the Stateof Coloradois betterquality andquantityof life. A
supportsystemthat allowsfor the Triple Aim: populationhealth,experienceof care,andper
capitacosts.We believethat healthcareis local anda Statewideapproachwith caveatsallowing
for communitydifferencesis inperative.
Ow organizarionwill continueto shareour perspectivewith the Stateandwork collaboratively
to designa stateactionplanto betteraddressthe needsof super-utilizers
in Colorado.
DonnaMills
Chief ExecutiveOfficer
503 North MainStreet. Suite #300 r Pueblo,Coloradoc 81003 o Phone; 71954$L3M
o Fax 71951134069
QualityHealthNetwork.org
May 21, 2013
National Governors Association
Hall of the States, 444 N. Capitol St., Ste. 267
Washington, D.C. 20001-1512
Dear National Governors Association:
This letter is to confirm the support of Quality Health Network (QHN) for Colorado’s application for the National Governors
Association Policy Academy – Developing State-level Capacity to Support Super-Utilizers.
As a nonprofit community collaborative located in Grand Junction, Colorado, Quality Health Network (QHN) is focused
on health information technology adoption, health information exchange (HIE), and the innovative use of information for
improved healthcare outcomes in the communities across western Colorado. QHN provides for the secure exchange of
health information to optimize the health of the region, improve economic efficiencies, and to bring value to healthcare and
community stakeholders.
QHN supports and believes strongly in the importance of a statewide plan that focuses on care coordination for superutilizers who are enrolled in Medicaid. We are committed to the Governor’s vision of making Colorado the healthiest state
in the nation and believe that this opportunity will improve service delivery and quality of care to this population.
As a fully operational HIE, since 2005, QHN has undertaken a significant initiative to deploy innovative data analytics which
provide risk stratification and predictive modeling tools to medical providers in the QHN western Colorado network. These
tools improve care coordination for chronic disease states and support patient behavior change for all patients; however
super-utilizers, our most medically and psychosocially complex patients, are frequently the noteworthy beneficiaries of
these practice transformation tools.
The maturity of QHN’s data base also supports hot-spotter identification and the potential to deploy healthcare
interventions in the primary care setting to help care providers predict needs, prioritize resources and engage in
preventative care. The QHN HIE is an integral part of clinical transformation providing data and performance measurement
tools across multiple payers as well as providing primary physicians with real time “alerts” when their patients are admitted
to emergency or acute care settings.
Our organization will continue to share our perspective, knowledge and expertise with the State and work collaboratively to
design a state action plan to better address the needs of super-utilizers in Colorado.
Sincerely,
Dick Thompson
Executive Director & CEO
Quality Health Network
744 Horizon Drive, Suite #210 • Grand Junction, CO 81506 • 970-248-0033