Click here to download the Proposed Pilot Program PDF

This  project has been made possible through the generosity of;

• Temple Buell Foundation
• Rose Community Foundation
• Caring for Colorado Foundation
• Colorado Health Foundation

Key Program Features

Pursuant to SB-128, CAHI submitted a Proposed Pilot Program for Persons with Disabilities Living in Colorado to the Colorado Department of Health Care Policy and Financing (HCPF) on September 1, 2006. SB-128 requires a response from HCPF to CAHI by January 1, 2007. The proposed program consolidates over a year of development, including consumer forums, multidisciplinary committee deliberations, and research into successful programs in other states.
Key features of the proposed pilot program include:

• Focus on complex, costly clients receiving Medicaid benefits;
• Emphasis on consumer goals, choice, and dignity;
• Program flexibility, leading to efficient use of resources while improving client satisfaction;
• Reduced healthcare costs through avoidance of unnecessary hospitalizations and institutional placements;
• Primary care setting as a focal point for care coordination;
• Integrated, team approach to care coordination;
• Training programs aimed at improving the quality of care for people with disabilities; and
• Voluntary enrollment

Stakeholders

CAHI interim board members and participants are from the disability community, the Colorado Cross-Disability Coalition (CCDC), Family Voices, two Federally Qualified Health Centers (FQHCs), and Denver’s Single Entry Point, Longterm Care Options. Family Voices and CCDC serve as CAHI’s corporate members and will select CAHI’s permanent board of directors.
Two FQHCs will serve as the pilot sites: the Metro Community Provider Network (MCPN) and Valley-Wide Health Systems, Inc. MCPN serves an urban population in Adams, Arapahoe, and Jefferson counties. Last year MCPN inaugurated its Center for Exceptional Healthcare at the Potomac Street Health Center, a facility that provides high quality primary care to PWD and trains physicians to care for this population. Valley-Wide is a rural FQHC with 14 primary care sites that serve 12 southern Colorado counties. The disabled population in Valley-Wide’s service area is dispersed and does not have easy access to transportation.

Therefore, Valley-Wide has developed effective decentralized systems that allow clinic staff to coordinate their services. At FQHCs, physicians, nurse practitioners, physician assistants, certified nurse midwives, clinical psychologists, and clinical social workers provide services to PWD including medical nutrition therapy, preventative.

Background Information

The Medicaid Disability Redesign Committee (MDRC) was formed in 2004 to coordinate the efforts of disability advocates, policy analysts, and providers to design new care approaches for People with Disabilities (PWD) who are served by the Medicaid program. The MDRC met bimonthly and was facilitated and supported by The Colorado Community Managed Care Network (CCMCN), an association of Federally Qualified Health Centers.

Senate Bill 06-128 states that a “nonprofit organization shall be based in Colorado and shall be governed by a board composed of persons interested in recipients with a disability that contains a majority of recipients with a disability, or familial representatives of recipients with a disability, who have experience in representing the interests of persons with a disability”… “to submit a proposed pilot program to the Department of Health Care Policy and Financing on or before September 1, 2006.” In order to meet the requirements of SB128, the MDRC formed a new non-profit, the Colorado Alliance for Health and Independence (CAHI). This organization is intended to serve PWD through an integrated, consumer-centered health plan. CAHI’s board of directors includes a majority of People with Disabilities (PWD) or their familial representatives.

Funding sources

$65,000 has been raised from charitable foundations in support of this effort. Funders include Caring for Colorado Foundation, Colorado Health Foundation (formerly HealthONE Alliance), Temple-Buell Foundation, and Rose Community Foundation. These awards enabled the MDRC to hire consultants from John Snow, Inc. (JSI) to design the pilot programs. CAHI is now pursuing local and national funding sources to secure the capital needed to implement the pilot programs.
If the Colorado Department of Health Care Policy and Financing (HCPF) adopts one or more of the CAHI’s proposed models, an implementation phase will ensue. Working with HCPF, CAHI will conduct feasibility studies and actuarial analyses to determine the scope of each pilot project, determine reimbursement methodology, and pursue working capital to finance an administrative, clinical, care management, and information systems infrastructure.

Evaluation

CAHI will perform an analytic evaluation of the pilot programs. An initial baseline study will capture PWDs’ utilization and cost history within the Medicaid program and examine measures such as primary care access, emergency room use, and the incidence of avoidable secondary conditions. Data sources will include claims and enrollment data, and validated consumer measures. We expect to observe improvements in primary care accessibility and preventative health measures, consumer satisfaction, and coordination with LTC services.