Exec: Colorado's 'Medicaid Prime' a model for other states

Colorado welcome sign
Medicaid Prime, a value-based managed care arrangement serving Colorado's Western Slope, has produced promising results. Image: Getty/welcomia

A successful value-based healthcare experiment in Colorado called Medicaid Prime could serve as a model for the rest of the country as policymakers consider changes to the Medicaid program, according to one executive.

The program started in 2014 with the goal of lowering costs and improving health outcomes for Medicaid enrollees on Colorado’s Western Slope, according to Colorado Public Radio. It currently operates in six counties and covers about 35,000 people.

The idea behind Medicaid Prime was to design a program that makes more resources available for primary care and behavioral healthcare, as well as connect patients with supportive services in the community, Patrick Gordon, associate vice president at Rocky Mountain Health Plans, said in an interview with the news outlet.

To make that possible, Medicaid Prime embraced the growing industry trend of a value-based payment model. Having a fixed budget, Gordon said, ensures that all stakeholders accountable and engaged “because it’s basically a sink-or-swim proposition.”

The results of the experiment so far are promising, he added, noting that both times the state renewed the pilot program its budget shrunk by 4% and 7%, respectively. Last year, the shared savings earned by the program allowed it to invest $5 million toward primary care and behavioral healthcare.

Readmissions are also on the decline, especially in one county where rates were cut in half in 2016. And the program has met or exceeded targets set by the state for other outcome measures such as how well patients manage diabetes, depression and obesity.

Gordon also sees great potential if future healthcare policy takes into account the lessons learned from Medicaid Prime and the patchwork of other pilots like it around the country.

“I think this is a model for urban areas, for rural areas, I think this is a model for any state,” he said. “And in fact, I think it is precisely this kind of model that’s going to make coverage expansions work in the long run.”

This is not the first time that Colorado’s Western Slope has been held up as an example of healthcare innovation. In 2009, President Barack Obama held a town hall meeting in Grand Junction, Colorado, to tout its successful efforts to reduce costs for Medicare patients.