Coordinating a Multi-Community Approach with Local Solutions for Improving Healthcare Affordability and Outcomes Across Colorado Goals, Premises and Alignment Strategies

Coordinating a Multi-Community Approach with Local Solutions for
Improving Healthcare Affordability and Outcomes Across Colorado
Goals, Premises and Alignment Strategies

Goal/Objectives: Improve affordability and outcomes for all Coloradans, making Colorado the most affordable state in the country.

• Reduce/eliminate cost shifting across markets and regions.
• Addressing unwarranted pricing differentials using Medicare as a reasonable benchmark.
• Create payment mechanisms that promote accountability and “two-sided risk” arrangements, encouraging providers to determine what they can and cannot afford to offer.
• Improve outcomes in both chronic and acute care, reducing potentially avoidable outcomes.

Premises/Principles of Employer-Led, Market Reform:

• Form should follow function. Local issues will be best addressed locally and statewide issues will be best addressed statewide Fix problems, not blame.
• The issues are economic, not organizational or personal.
• Create win-win possibilities whenever possible – across purchasers and with providers.
• Reform will requirement unprecedented alignment and collaboration.

Alignment Strategies for Market Reform:

Communities working collaboratively across the State through a central structure with a common goal and vision are best positioned to:

•  Optimize purchasing power of all employers in Colorado, helping smaller employers gain from the efforts of larger employers.
• Mitigate or eliminate the need for provider/hospital cost shifting.
• Support communities with common infrastructure, economies of scale, and shared best practices.
• Coordinate with Statewide agencies – insurers and government including Medicaid and Medicare – on aligning provider payment mechanisms and performance.
• Address utilization and quality issues at the local/regional level through direct employer-provider discussions and negotiations about improvement targets.
• Devise a collaborative, community focused approach whereby local hospitals can thrive.

Each community working independently through a multi-stakeholder group, can best:

• Bring local employers and community providers together to address both supply and demand challenges on behalf of the community.

Identify community-specific challenges, opportunities, and goals for improving utilization, appropriateness, and quality of health care delivery:

• Increasing under use – mostly preventative, primary, and mental health care.
• Decreasing overuse – targeting low-value services
• Decreasing avoidable complications and errors.
• Empowering local physicians to meet the demand
• Keeping care within the community.
• Address the social determinants of health within the community.