Kim Bimestefer, Executive Director
The Department of Health Care Policy & Financing (the Department) provides health coverage to low income and disabled Coloradans through safety net programs like Health First Colorado (Colorado's Medicaid program) and the Child Health Plan Plus (CHP+). With the economic impact of the novel coronavirus disease (COVID-19) pandemic, the Department is covering more Coloradans than ever -- over 1.4 million, representing almost one in every four Coloradans. Given that, it is no surprise that the Department is projected to consume 29% of the State's general fund budget and 35% of total state funds (total funds include federal dollars) in the 2021-2022 fiscal year.
Carefully controlling our health care expenditure helps protect our programs, cover all Coloradans who qualify and ensures the state can invest in our schools, roads and infrastructure, parks, programs for older adults and people with disabilities and more.
Addressing health care affordability is not only critical to the state government, but also to those served by our safety net programs. It is also a top concern for Colorado families and businesses. For this reason, Department leadership and staff leverage our expertise, influence and not-for-profit values to drive health care affordability measures that will benefit all Coloradoans, not just Department programs.
As part of Gov. Jared Polis's Wildly Important Goals to improve health care affordability for all Coloradans, he created the Office of Saving People Money on Health Care (OSPMHC). He appointed Lt. Gov. Primavera, who leads the Health Cabinet, to spearhead the work. Department leadership is an active and engaged member of the Health Cabinet and a significant contributor to the affordability agenda, work and results.
The Department is working in collaboration with the Health Cabinet on goals and key strategies to achieve Health Care Affordability for Coloradans, which is one of the Department's five strategic pillars.
Below are some of the key strategies to improve health care access, affordability and patient outcomes.
2021 Summer Health Cabinet Summit, hosted by HCPF - Aug. 19, 2021
Affordability in Hospital Costs and Community Investments - April 14, 2021
2021 Colorado Health Cabinet Health Policy Summit, hosted by HCPF - Jan. 12, 2021
- Listen to the presentations and access summit resources for the State of Reform 2021
- Questions and Answers
The Department is partnering with communities, employer organizations and consumer advocates to identify and implement shared strategies and innovations to reduce health care costs.
The Health Care Affordability Toolkit on this site is designed for Colorado communities to select and adopt tools to help achieve health care cost savings within their community. Since all health care is local, and each community has their own unique set of challenges, the Department has offered leadership, project management and data/research resources to support customized community affordability efforts. The Department has outlined a set of priorities and actions that you can take which can be found in the New Normal Fact Sheet. Those interested in working with our Affordability Team on creating a plan to improve affordability in their community, contact the team.
Collecting Data on Health Care Costs
- All-Payer-Claims-Database (APCD): The Colorado APCD collects data on claims paid from Medicare, Medicaid, commercial insurance carriers and some self-insured employers. The APCD aggregates this information into meaningful reports and tools. This data is essential to support high quality, accurate reporting and health care affordability.
- The APCD is administered by the Center for Improving Value in Health Care (CIVHC), which uses data to publish reports with insight into COVID-19 and local communities.
- Shop for Care: Consumers and purchasers can use the Shop for Care tool to show the average cost of many different procedures and their quality scores for every hospital and health facility in the state.
Best-Practices for Reducing Health Care Costs
- Hospital Transformation Program: The HTP transforms $1.4 billion in payments from the Department to hospitals from volume-based to value-based.
- Medicaid Alternative Payment Methodologies (APMs): APMs help the health care industry move from volume-based payments to value-based payments. They also serve to align compensation to achieve shared affordability and quality results, rewarding health care providers for high quality and high value care. Examples include the Department's new Maternity Bundled Payment Program and Primary Care Payment Reform.
- 2021 Reducing the Costs of Prescription Drugs in Colorado, 2nd Edition: The Polis Administration is committed to saving people money on health care, including implementing solutions to significantly improve the affordability of prescription drugs. This report is intended to inform meaningful dialogue about how to control the cost of prescription drugs to benefit all Coloradans, their employers and public plans supported through taxpayer dollars such as Health First Colorado and the state employee benefit plan.
- Telemedicine: Telemedicine is evolving into one of the most productive and beneficial aspects of the new normal in health care. It is expanding safe access to care, reduces barriers to care for older adults and those with disabilities, increases behavioral health care and more. The Department works closely with the Office of eHealth Innovation, for which it is the fiscal agent, to collaborate with the Office of Broadband, on broadband access and other connectivity opportunities to maximize this important technology.
- The Department is an engaged and active participant in the creation, implementation and follow-up work associated with the Behavioral Health Task Force BluePrint, a plan to streamline and integrate behavioral health programs. The State Innovation Models (SIM),a $65 million federal grant, integrated physical and behavioral care coordination and delivery between 2015 and 2019. This work laid the foundation for the Behavioral Health Task Force to drive integration, access and outcomes to the next level.
Health care is an incredibly complex industry, which makes it harder to identify sound affordability solutions. To help facilitate affordability dialogue between communities, businesses, providers, policy makers and other stakeholders, the Department produces evidence-based reports to illuminate the drivers of rising health care costs and the possible solutions to address them. Reports include:
- HCPF’s Hospital Reports Hub
- Hospital Cost Shift Report: This report sheds light on the drivers of cost shifting in an effort to assist policymakers and stakeholders to work together to ensure all Coloradans have access to affordable health care.
- Legislative Reports
- CIVHC's Medicare Reference-Based Price Report
- 2021 Reducing Prescription Drug Costs in Colorado, 2nd Edition
The Affordability Toolkit
The Affordability Toolkit is designed to assist Colorado communities in selecting and adopting tools to help achieve health care cost savings within their community. The Toolkit is segmented into five areas to help users zero in on areas most relevant to their community. These tools include fact sheets on Department initiatives and reports to inform and spark action, and information on Affordability programs and policies, both current and upcoming. Communities are welcome to then review and select the tools right for them.
Hospital and Health Care Costs
- Hospital Transformation Program (HTP): The HTP builds upon the existing hospital supplemental payment program to incorporate value-based purchasing strategies into existing hospital quality and payment improvement initiatives.
- Hospital Transformation Program Rural Support Fund: The Rural Support Fund is complementary funding to the HTP. This funding is intended to prepare rural hospitals for the future value-based payments, such as technology and care access expansion, and other alternative payment methodologies.
- CIVHC's Shop for Care tool: Select a service to compare prices and quality at Colorado health care facilities.
- Hospital Transformation Program Fact Sheet
- Rural Hospital Transformation Program Fact Sheet
- Transparency Fact Sheet
- Implementation of a Canadian Prescription Drug Importation Program: This website includes background and resources.
- Drug Importation Fact Sheet
- Prescriber Tool Website: This website gives an overview of the project and the coming implementation plans.
- Prescriber Tool Fact Sheet
- Reducing Prescription Drug Costs in Colorado, 2nd Edition, Jan. 2021
Innovation and Technology
- Telemedicine Provider Information: This website gives information on COVID19 Emergency Telehealth Response for providers and telemedicine resources for members
- Telemedicine and eConsults Policy Development
- Home Health Telehealth: This allows for the monitoring of a member's health status remotely via equipment, which transmits data from the member's home to the member's home health agency.
- Visit the Office of eHealth Innovation (OeHI) and view the The Colorado Health IT Roadmap and get data insights on COVID-19 efforts.
- Get the latest on broadband at the Colorado Broadband Office website, including data, advisory board information and more.
Delivery Reform, Alternative Payment Models
- HCPF's Alternative Payment Models to Support Primary Care Payment Reform
- Alternative Payment Model Fact Sheet
- CIVHC's Report on Low Value Care in Colorado
- Low-Value Care Fact Sheet
Population Health and Behavioral Health
- Behavioral Health Task Force and Blueprint: This website has information for implementation details of the Task Force recommendations.
- Substance Use Disorder Treatment and Prevention: This website includes information on Medicaid's the new residential care benefit effective Jan. 1, 2021.
- Maternity and Child Bundled Payment Program Fact Sheet: An overview of the program and a link to other bundled payments.
Affordability Slide Deck Presentations
Affordability Toolkit: Additional Research and Resources
Saving People Money in Colorado
- Office of Saving People Money: This website has information on work done by the state to reduce patient costs for hospital stays and expenses, improve price transparency, lower the price of prescription drugs and make health insurance more affordable.
- See progress reports on the Governor's Health Dashboard.
- The Affordability Roadmap, a statewide approach to Affordability.
Community Data and Reports
- Colorado Health Institute
- Community Health: 2019-20 Needs, Improvement and Assessments:
- Community Health Access Survey 2019 Report
- Pueblo - Community Health Access
- Grand Junction/Mesa County - Community Health Needs Assessment
- Eastern Plains - 2020 Community Health Improvement Plan, 2019 Community Health Needs Assessment
- Northern Colorado/Larimer County - 2019 Community Health Needs Assessment
- Summit - 2018-2022 Community Health Improvement Plan
- Summit County - 2017 Community Health Needs Assessment
- Eagle/Vail Valley - 2019 Community Health Needs Assessment
- Community Health: 2019-20 Needs, Improvement and Assessments:
- See how Colorado ranks nationally in health:
National Reports on Affordability
- RAND Who Pays for Health Care Costs? The Effects of Health Care Prices on Wages: July 2020 reporting and analysis from RAND.
- RAND Nationwide Evaluation of Health Care Prices Paid by Private Health Plans Findings from Round 3 of an Employer-Led Transparency Initiative
- New York Times article: Why Are Nonprofit Hospitals So Highly Profitable?
- National Nurses United - New Study Shows Hospitals Hike Charges 18 Times the Cost
- Kaiser Family Foundation Health System Tracker: See the foundation's website for trending data and up-to-date information.