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Medical Home: Making the

Investment in Primary Care

Sandeep Wadhwa, MD, MBA

Medicaid Director and Chief Medical

Officer

State of Colorado

October 2008

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Colorado Health Care Snapshot

8.8%1.1%

Medicare404

Medicare &Medicaid

49

MedicaidOnly346

Non-Group157

EmployerRetiree

54

EmployerWorkers &

Dependents2,605

TRICARE/Other111

Uninsured785

7.6%

57.1%

1.2%3.5%

2.4%

17.2%

Total Population = 4,564

SCHIP531.1%

8.8%1.1%

Medicare404

Medicare &Medicaid

49

MedicaidOnly346

Non-Group157

EmployerRetiree

54

EmployerWorkers &

Dependents2,605

TRICARE/Other111

Uninsured785

7.6%

57.1%

1.2%3.5%

2.4%

17.2%

Total Population = 4,564

SCHIP531.1%

Source of InsuranceNumbers in Thousands – Source: June 2007 Lewin Report

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Medical Services PremiumsCaseloadFY 07-08

Other5% Elderly and

Disabled24%

Low-Income Adults15%

Low-Income Children

56%

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Medical Services PremiumsPer Capita Cost

FY 07-08

$0.00

$2,000.00

$4,000.00

$6,000.00

$8,000.00

$10,000.00

$12,000.00

$14,000.00

$16,000.00

Elderly andDisabled

Low-IncomeAdults

Children Other

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State’s Role in Primary State’s Role in Primary Care ReformCare Reform

• Legislative/regulatory authority

• Catalyst for encouraging public/private collaboration

• Active participant in the community of payers

• Dominant payer for safety net

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Financing Primary Care Financing Primary Care Reform Medicaid - Reform Medicaid -

Phase 1Phase 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

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Financing Primary Care Financing Primary Care Reform Medicaid - Reform Medicaid -

Phase 2Phase 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)

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State Based Primary State Based Primary Care ReformCare Reform

• Participate in multi-payer collaborative

• Created public-private value- based healthcare center to collaboratively address structuring/financing of primary care

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Thank you

Sandeep Wadhwa, MDsandeep.wadhwa@state.co.us