Cover: Right here, right now!

Friday, November 01, 2013 12:01 PM
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I was alive and I waited, waited
I was alive and I waited for this
Right here, right now
There is no other place I want to be
Right here, right now
Watching the world wake up from

      – Lyrics from Right Here, Right Now, by Michael Edwards

Dear Physician,

Salutations! Today, I ask you to take a moment to consider the profound opportunity our House of Medicine has in ushering in the new age of health care right here in Colorado.  The Affordable Care Act is the “law of the land” as House Speaker John Boehner proclaimed last year upon learning the Supreme Court’s decision to uphold the individual mandate. Yet, as I stressed to the physician attendees at the CMS Spring Conference in Vail in May, assembly is required; although Obamacare exists in statute, it is hardly built as a working, functioning construct for health care reform. 

In fact, 2014 will see significant changes for us all, not only as the individual mandate for health insurance rolls out, but also with the implementation of the health insurance exchange projected to add 250,000 people to the list of insured and Governor Hickenlooper’s expansion of Medicaid projected to add 160,000 people to Medicaid. And although these newly insured 410,000 people make up a little less than half of the total uninsured in the state of Colorado, there does seem to be a daunting challenge before us as we learn how physicians will supply the labor necessary for this increased demand.

I am optimistic for physicians in Colorado, and the reason has less to do with Obamacare or the Medicaid expansion, and more to do with market forces that have already been in play for some time. Health care is undergoing profound changes, especially in the last decade as we transition from a 1970s paper-based, cottage age industry into an information age, digital delivery system. We found that scientific breakthroughs in pharma and surgery, although impressive, have had less impact on the business of medicine than the impact of the Internet and electronic health records. And yet we have not even felt but the tip of the iceberg in health care transformation.

The reality is, we have never been positioned so well to leverage technology to lower costs, improve outcomes and become more efficient. Although some may question whether they are truly faster, more efficient or happier in the digital health care world, the fact remains that coordinated team-based care capable of managing entire populations is now realistic through an electronic medical record, and disruptive innovators are finding new ways to address health care access problems that have plagued our state for years.

Having said that, new computer technologies by themselves do not make us more efficient or capable of magically seeing an additional 410,000 people. Typically, new technologies require new business models (translation: payment reform) and changes in regulations. Primary care physicians are beginning to see the light at the end of the tunnel with Medicaid. Federal dollars that “bump” Medicaid rates to Medicare rates, Regional Collaborative Care Organizations (RCCOs) right here in Colorado that pay physicians per member per month care coordination fees, and faster claims processing have produced a system that is showing a 10-15 percent reduction in global health care costs!

As CMS president, I will seek to see that the gains primary care physicians are now enjoying that make Medicaid a viable payer are extended to specialty care. The three asks for my Presidential Medicaid specialist payment reform platform:

  1. Pay for telemedicine in all its forms, not just hospital-based technologies, but also for asynchronous, remote-only visits of cognitive consultations.
  2. Enact into statute legislation calling for direct RCCO contracting with specialists; these are specialists who agree to integrated care delivery with health information exchange, referral tracking through iNEXX, etc. This could be increased reimbursement or gain-sharing, but probably a combination of both. Currently RCCOs are not allowed to contract directly with specialists, and even if they did, there is no payment reform they can offer.
  3. Health Care Policy and Finance to pay for Medicaid beneficiaries to have their procedures in private sector ambulatory surgery centers. Nothing else will compel private sector specialists in Colorado to agree to take more Medicaid in 2014 than this one ask, and nothing else will show such an immediate decrease in costs and return on taxpayer dollars.

Please feel free to share your ideas with me for the Medicaid expansion and how to make it work in Colorado. I can be reached by email at

Posted in: Colorado Medicine | Cover Story


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