By Katie Kerwin McCrimmon
KEYSTONE — Medicaid patients who get access to “medical homes” are supposed to get better care and save taxpayers money, but so far, savings are minimal, prompting analysts to give Colorado a lower grade this year for delivering health care.
Policy experts at the Colorado Health Institute released their second edition of Reaching Our Peak: Scorecard for a Healthier Colorado today as the Colorado Health Symposium begins in Keystone.
Analysts evaluated policies and progress in five key areas: health care delivery, places we age, schools, workplaces and communities.
“The bottom line for Colorado: communities and schools improved, aging and the workplace stayed the same, and health care moved lower,” the study authors wrote.
Overall, the pace of reform is slow and progress is uneven.
“(That’s) in part because of the sheer size of the challenges, the reality of red tape, and the difficulty of getting everyone on the same page,” the report said.
The private sector and foundations have led the way as catalysts for improvement in health care while “the public sector often moves cautiously,” the authors found.
One of the areas of reform that has offered great hope — but so far is yielding little savings — is the medical home movement.
Little progress and minimal savings on health care delivery were what prompted the study authors to lower the grade this year over last.
Under the Affordable Care Act, Colorado has dramatically expanded its Medicaid population by about 30 percent to 1 million people this year.
More than half of Medicaid enrollees — about 612,000 — are part of an Accountable Care Collaborative, a program that aims to give patients better primary and preventive care, better disease management and help from care coordinators.
As the population of patients covered through the publicly funded program expands, scrutiny on Medicaid spending will increase, said lead author of the report, Sara Schmitt.
“We’re investing a lot on that (Accountable Care) model and the return has been relatively modest,” said Schmitt, director of community health policy for the Colorado Health Institute.
For example, in the 2012-13 fiscal year, Colorado saved $6 million for people who were enrolled in the Accountable Care Collaborative. But that’s a very small portion of the overall $7.5 billion budget for Colorado’s Medicaid department. And administrative costs for the program totaled more than $36 million.
The Reaching Our Peak report found that people with chronic conditions had lower rates of complications than those who weren’t in the collaborative. And while ER use increased among patients with medical homes, it went up less than for other patients. Overall, small improvements in cost and outcomes are beginning to emerge, the report found.
“Medical homes have been promoted — particularly among children — since late 2007,” Schmitt said. “Studies continue to show mixed results. We need to keep understanding the ways that homes can improve quality and control costs.”
Colorado Medicaid managers say the Accountable Care Collaborative should pay off over the long term and that the program offers local communities and providers incentives to improve care and patient outcomes.
“The ACC has exceeded our expectations through the first three yeas and preliminary data from fiscal year 2013-14 looks strong,” Marc Williams, spokesman for Colorado’s Medicaid program said.
Two years ago, he said the program resulted in a net savings of $3 million and last year the savings doubled to $6 million.
“We expect to see continued savings in future years as the program evolves and achieves greater integration and coordination of medical and non-medical services,” Williams said.
Beyond medical homes, Schmitt of the Colorado Health Institute, said the outlook is better. She cited increased use of Health Impact Assessments and greater access to fresh fruits and vegetables.
“We really saw growth in these areas,” Schmitt said.
With respect to schools and health, results are mixed. Studies show that higher taxes on sugar-sweetened beverages could cut consumption of the drinks that contribute most to obesity. But it’s clear that people in Coloradans have little appetite for additional taxes, and attempts in Colorado and elsewhere around the country to heavily tax soft drinks have failed.
In terms of healthy eating, the new “Breakfast After the Bell” program will kick off this year, and Schmitt said more kids will have access to nutritious meals through an expanded school lunch program.
On aging, Colorado is expecting a “silver tsunami” and it’s clear that more seniors will need support as they age.
“Change is happening and progress has occurred. It’s just really slow,” Schmitt said.
A program called Colorado Choice Transitions is supposed to help move Medicaid patients from nursing homes to community-based centers. Colorado received a $22 million federal grant in 2011, but managers didn’t begin transitioning people until March of 2013. In the first 10 months of the program, Colorado moved 35 people from nursing facilities to the community.
“This program is far from its goal of moving 500 Medicaid enrollees to community-based housing by the end of the five-year grant in 2016,” the report found.
Schmitt said demand is already great for better aging options. But few centers exist so far.
Finally, wellness programs are popular in workplaces, but it’s not clear yet whether employees will take part or whether they’ll get healthier if they do.
“We just haven’t seen anything really illuminating taking hold yet,” Schmitt said. “Interest is high among employers for wellness programs. (But) the evidence base is not really emerging to show huge savings.”
It’s clear, said Schmitt, that change takes time.
“Overall I feel very positive about the direction in which we’re heading,” she said. “The business community really is focused on health and seeing that as an economic advantage for the state. We’re starting to see tracks in place that could have long-terms impacts.”