Affordability Matters
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+).
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 Coloradans, 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 six strategic pillars.
Below are some of the key strategies to improve health care access, affordability and patient outcomes.
- The Department submits multiple reports and responds to legislative requests for information. This resource center includes links to reports, fact sheets, and overviews of the budget process
HCPF Value Initiatives
- Accountable Care Collaborative: HCPF created the Accountable Care Collaborative (ACC) for its members to deliver cost-effective, quality health care services and to improve the health of Coloradans. ACC Phase III begins July 1, 2025
- Health-Related Social Needs (HRSN): HCPF has ongoing and emerging initiatives to address the HRSN of Health First Colorado and CHP+ members. HCPF is committed to supporting members by removing barriers to care and expanding access to services that promote members’ health and well-being
- Nurse Assessor and Skilled Care Acuity Assessment: A new process to streamline the way members are wholistically assessed, using a 3rd party skilled nurse assessor, for the appropriate level of skilled care services across selected service modalities.
- HCPF's Alternative Payment Models to Support Primary Care and Maternity Payment Reform
- 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
- Implementation of a Canadian Prescription Drug Importation Program
Provider Tools
- eConsult Platform: A Medicaid electronic consultation platform that allows participating providers to communicate electronically with specialty providers. This allows participating providers to work together to decide the best treatment options for Members in a way that is convenient, ensuring a Member-centered approach to care
- Prescriber Tool: A multifunctional platform accessible to prescribers through most electronic health record (EHR) systems, which is a real-time prescription benefit check for providers that makes prescription writing easier, helps Health First Colorado members get the medications they need to stay healthy, and saves Colorado and Coloradans money on prescription drugs
- Telemedicine Provider Information: This website gives information on COVID19 Emergency Telehealth Response for providers and telemedicine resources for members
- 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
Consumer, Insurance Purchasers and Community Tools
- Know Your Health Coverage Options and Help Keep Coloradans Covered
- HCPF’s Hospital Reports Hub: This webpage contains links to the HCPF’s hospital reporting, as well as links to sister agencies and other hospital resources
- Hospital Price Transparency: Colorado is at the forefront of reviewing and utilizing hospitals’ price transparency initiatives to provide a free flow of hospital price information
- Prescription Drug Costs: Colorado legislators put in place laws to save employers and consumers prescription drug costs. To opt-in to Rx savings, email the Division of Insurance Rules and Records DORA_INS_RulesandRecords@state.co.us
- HB22-1370: Beginning 2024, health insurers required to ensure 100% of rebates are used to lower costs for employers and consumers
- HB23-1201: Effective Jan. 1, 2025, eliminates “spread pricing,” or up-charging of Rx drugs by carriers/PBMs on insured individual and group policies. Employers often unknowingly pay more for drugs, causing their benefit costs to be significantly higher than necessary
- CIVHC's Shop for Care, Medicare Reference-Based Pricing and Report on Low Value Care in Colorado. Consumers and purchasers can
- Show the average cost of many different procedures and their quality scores for every hospital and health facility in the state
- Rate negotiations referenced to Medicare
- Identify and shift practices for low-value health care services
Additional Research and Resources
- 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
- Visit the Office of eHealth Innovation (OeHI) and view the Colorado Health IT Roadmap
- Get the latest on broadband at the Colorado Broadband Office website, including data, advisory board information, and more
- Colorado All Payer Claims Database (CO 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.