5:30am

Fri August 9, 2013
Health

Colorado Healthcare Providers Focus On Cost-Cutting

Northern Colorado care providers seeking less expensive ways of caring for low-income patients are seeing results from a new pilot program.

Some in the healthcare industry think it could change how doctors care for all patients, not just those on Medicaid.

The idea behind the Accountable Care Collaborative program is to move away from the traditional fee-for-service model of health care financing, which many experts say is expensive and outdated.

"And it starts with Medicaid, because that population costs a lot of money for the healthcare industry every year – and for the state and federal government," says Molly Armbrister, healthcare reporter for the Northern Colorado Business Report.

Changes mandated by the Affordable Care Act will ultimately mean a shift in the way doctors and hospitals are reimbursed for Medicaid patients - and some see the ACC program as a 'baby step' toward a new model.

The program focuses on three key metrics: hospital re-admissions within a month of a patient’s initial release; emergency room visits; and the use of high-cost imaging (such as MRIs).

"So many [enrollees] haven't been exposed to having a primary care provider before... It's hard to convince them that the emergency department isn't always the place they want to be."

Providers who meet certain benchmarks are eligible for cash incentives from the state and federal government. Northern Colorado providers received nearly $56,000 in payments in the fourth quarter of 2012.

They have been successful in cutting re-admissions and the use of high-cost imaging. But reducing ER visits has proven much more difficult.

"It has a lot to do with the culture of enrollees in the program," says Armbrister. "So many of them haven’t been exposed to having a primary care provider before, and going to the Emergency Department was their source of health care. It’s hard to convince them that the emergency department isn’t always the place they want to be."

Armbrister says as the program expands, providers will continue to address that area.

"This is kind of a pilot program to try and figure out what works and what doesn’t. And then those ideas can perhaps be applied in the future, not just to government insurance, but private insurance as well," she adds.

The two regions that include Larimer and Weld counties have seen enrollment grow to more than 73,000 Medicaid patients this year.

You can read Molly Armbrister's article in Friday's Northern Colorado Business Report.