|
Social Determinants of Health System Transformation to Improve Whole Person Health
Thank you for partnering with the Department of Health Care Policy & Financing (HCPF) to evolve Colorado’s social determinants of health supports, improve whole person health, and reduce health disparities. Key HCPF initiatives include:
- Working with the Office of eHealth Innovation (OeHI) to finance and build the Social Health Information Exchange (SHIE). The Social Health Information Exchange (SHIE) leads the next phase of evolving prescriber tools. It will enable providers, Regional Accountable Entities (RAEs) and community workers to better support individuals through payer programs, state programs, and community supports. Long term, the tool will help connect individuals to payer health improvement programs like prenatal and related maternity programs, diabetes management, cardiac or asthma programs; it will help refer individuals to state health related social needs (HRSNs) program such as Supplemental Nutrition Assistance Program (SNAP), Special Supplemental Nutrition Program for Women, Infants and Children (WIC), or Housing Vouchers; it will also aid provider care teams and community workers in connecting individuals to community food banks, homeless shelters and other related supports. The SHIE has been successfully financed through two sources. First with HCPF American Rescue Plan Act dollars, which need to be spent by September 2024 on designing and building the initial foundation for the tool. The second source is through a HCPF/OeHI budget request enabling a 90/10 federal match, with the 10% state funds approved by both the Joint Technology Committee (JTC) and the Joint Budget Committee (JBC) during this legislative session. The contract with Resultant, the state’s vendor partner, was executed in November of 2023.
- Working with national experts and the Center for Improving Value in Health Care (CIVHC) leadership, who is the appointed administrator of the state’s All Payer Claims Database, and its Advisory Committee to determine how to code and capture payments related to social determinants of health for future analysis, tracking and reporting.
- Collaborating to increase access to SNAP and WIC enrollment to improve food access and security.
- Including member incentives in the Accountable Care Collaborative (ACC) Phase III that encourage engagement in health improvement programs as well as value-based payments that encourage provider care teams to connect patients to whole person care programs that improve Health First Colorado (Colorado’s Medicaid program) member health.
- Exploring permanent supportive housing benefits through an 1115 waiver. HCPF hosted our first stakeholder meeting in March to launch our work on the feasibility of leveraging Medicaid to help pay for food and housing. Over 200 participants attended to provide their thoughts and perspectives. The goal is to amend HCPF’s existing 1115 waiver to include HRSNs.
- HCPF is engaged with the Colorado Food is Medicine Summit and evolving movement, along with more than 200 stakeholders from almost 80 organizations. Together we’re working to tackle the critical issue of how to increase health through access to essential nutrition programs. This is in complement to home delivered meals HCPF already provides for older adults and people with disabilities discharged from inpatient hospital care and through community-based services available through Long-Term Services and Supports (LTSS) services.
- Pursuing authority to expand coverage to certain populations through an 1115 waiver. HCPF submitted an amendment to our 1115 waiver on April 1, 2024, seeking:
- Criminal justice reentry services effective July 2025
- Serious mental illness and serious emotional disturbance (SMI & SED) inpatient care effective July 2025
- Continuous eligibility coverage for children 0-3 years effective January 2026
- Continuous eligibility coverage for adults released from Colorado Department of Corrections facilities effective January 2026
The ACC is the primary vehicle for delivering health care to Health First Colorado members, with RAEs as the central component responsible for propelling members’ physical and behavioral care coordination, case management and overall health. As such, Phase III of the ACC, scheduled to begin July 1, 2025, is designed to incorporate HRSNs support and advance whole person care to improve member health and reduce health disparities. This is one of the most important advances in the ACC Phase III Draft Contract, which outlines the RAE contractual requirements for prospective bidders. The Draft Contract is based on the policy and programmatic recommendations outlined in the ACC Phase III Concept Paper, which leveraged the tremendous feedback received from about 1,000 stakeholders across 20 stakeholder meetings.
April is the twelfth month of Colorado’s public health emergency (PHE) unwind process, reflecting the state’s and the nation’s return to business as usual eligibility processing, post the Continuous Coverage PHE chapter. All members can still leverage the 90-day reconsideration period to submit their renewal information late, or after that, submit new applications for coverage. More information is on our updated website, reporting webpage and in our newsletters. Please help members and partners complete the renewal process: Update Your Address, Understanding the Renewal Process and Take Action on Your Renewal (available in the top 11 languages spoken by our members). Flyers have been developed for employers to distribute to employees to remind them to look for their Health First Colorado renewal packet and where appropriate, how to transition to employer-sponsored coverage, and the importance of doing so in a timely manner. We ask that all stakeholders leverage these tools.
We are also continuing to implement supports and flexibilities for counties, Case Management Agencies (CMAs) and Health First Colorado members with disabilities who are eligible for LTSS. This is in response to concurrent challenges impacting the LTSS system, including:
- System issues with the implementation of the new Care and Case Management IT platform that are causing work-arounds and longer processing time for case managers;
- Unforeseen complications with the transition of members to new CMAs to achieve the federally required conflict-free case management;
- A backlog of requests for medical records acquired from hospitals and other providers by industry vendors, providing critical information necessary for the federal disability determination required for long-term care eligibility;
- Increased county workload due to the end of the PHE combined with a record number of Health First Colorado and SNAP renewals.
In the coming months, the IT innovations and case management redesign modernizations will create a better system for members, providers and CMAs. But the unintended impact of all three occurring at once has caused short-term challenges to member program eligibility, provider reimbursement, CMAs processing and member service response time.
HCPF has been pursuing a number of solutions to address these issues and protect coverage for LTSS members through system and process changes, mitigating payment delays for providers to ensure care access, resourcing escalation processes for members struggling to navigate the renewal process, supporting counties and CMAs, and working with providers and vendors to address unprecedented backlogs in securing medical records necessary for disability determinations. Please visit CO.gov/HCPF/stabilizing-LTSS for more information.
Thank you for engaging to propel system transformation that improves whole person health, for your continued engagement to Keep Coloradans Covered, and for your partnership to navigate and address LTSS system transformation challenges.
| 
