Managing care

Tuesday, May 07, 2013 01:11 PM
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Colorado Access provides innovative patient-centered care through collaboration

Palwasha Khan, Marketing Communication Coordinator, Colorado Access

Colorado Access is a local safety net health plan that aims to provide high quality and innovative care for its members. Plan administrators understand that the best way to deliver care is though collaboration with members, providers and other organizations, as these groups are an integral part of the health engagement process.

Community education is key, and Colorado Access is focused on bringing care management delivery as close to the medical home as possible. The organization delegates its care management to practices that can participate within the Regional Care Collaborative Organization (RCCO). Practices that are able to partake in care management delegation receive an additional payment and expand the services they can offer to patients within their practice.

The RCCO model allows Colorado Access to offer unique opportunities for healthcare professionals to engage with one another. One such opportunity is through its Best Practices & Clinical Transformation meetings. These quarterly meetings bring together a wide array of health care professionals to participate in conversations about transforming care based on best practices and available data.

The organization has also developed the Virtual Community for Collaborative Care, or VC3. This web-based interactive platform provides an opportunity to continue the collaboration between the meetings in a virtual format to increase awareness, promote best practices, share resources and ideas, and showcase a vision for support of health and wellness for Colorado’s Medicaid members.

Colorado Access also works to engage directly with practices in many different ways. The organization collaborates with Sister Joanna Bruner Family Medicine Center, a patient-centered medical home. The Colorado Access RCCO teamed with the clinic to analyze data, create action plans, measure outcomes, effectively use care management, coordinate care through transitions, integrate behavioral health and participate in collaboration.

“Involvement with Colorado Access RCCO has been a great opportunity for us,” said Aaron Gale, executive director of Sister Joanna Bruner Family Medicine Center. “We strive for certain benchmarks of health care, like continuity of care and reduction of emergency room utilization. Collaboration with a health plan like Colorado Access can bring us closer to achieving these benchmarks. The goal is to target patients who are ER super utilizers and connect them to a medical home through a care management program. Our efforts are working. We are seeing a decrease in unnecessary ER use and high-cost imaging.”

Colorado Access has been active in facilitating the bidirectional integrated care partnership with Sister Joanna Bruner Family Medicine Center as well as the Mental Health Center of Denver (MHCD). Mid-sized organizations can successfully work together to improve the healthcare of patients who are a part of the behavioral health system.

Through this collaboration, the organizations are able to track improvements by finding high-risk patients and intervening for better patient outcomes.

Colorado Access also provides additional services to all practices that participate in the RCCO. In 2009 Colorado Access developed a Transition Access Program (TAP) specifically for practices that are not yet ready to take on delegated care management. TAP is a patient-centered intervention that is designed to improve continuity of care from inpatient hospital to medical home, improve member outcomes and decrease avoidable hospital readmissions, which result in lowering the cost of healthcare.

Through TAP, care managers work one-on-one with members who were recently discharged from an inpatient hospital and also work with their providers. Care managers intervene by helping members better understand their diagnosis and encourage members to play an active role in self-care. The program has been successful throughout all of Colorado Access’ lines of business, including Access Advantage, Access Behavioral
Care, RCCO and CHP+.

“Because of our TAP program, we have seen a real decrease in the number of hospital admissions and readmissions. We want to get patients connected to a medical home because we know that is where patients will get comprehensive care,” said Laura Coleman, director of coordinated clinical services at Colorado Access. “We want our members to understand the value of a medical home relationship.”

The overall goal is to improve quality of care while reducing costs. By aligning patients with effective care management and a medical home, they can begin to receive care that is more tailored to their needs. With this, we can begin to see a trend for better care, healthier communities and reduced cost of care, Coleman said. Health plans and practices can symbiotically work together to promote effective coordination of care, ensure Coloradans have access to a medical home and support the most effective prevention treatments.

Posted in: Colorado Medicine | Practice Evolution | Payment Reform | Interacting With Payers | Practice Redesign | Accountable Care Organizations | Health System Reform


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