Policy Speakout

In an effort to extend the health care policy discussion, each month The Colorado Health Foundation invites a different health care policy expert to share their views on a single issue. The views presented by these experts do not necessarily reflect those of The Colorado Health Foundation.

Sandeep Wadhwa, MD, MBA is the state Medicaid director for the Colorado Department of Health Care Policy and Financing. Dr. Wadhwa oversees the state’s Medicaid and Child Health Plan Plus (CHP+) which serve approximately 475,000 Coloradans who qualify for public health insurance due to income, age or disability. These programs account for about 16 percent of the state’s budget for a total of approximately $3.8 billion a year.

Maximizing Public Health Insurance Programs

The traditional policy issues that dominate public health insurance programs center on expanding or limiting populations covered, modifying rates for providers, and evaluating new benefits. However, I believe there’s an overriding issue that has not been as emphasized: maximizing the health, functioning, well-being and self-sufficiency of the population served within the allotted budget.

The Department is undergoing a process of translating our mission of delivering cost-effective, accessible care into measurable goals. We’ve divided our goals into four quadrants: 1) health, 2) satisfaction, 3) efficiency, and 4) access, and are defining multiple metrics for each quadrant. By quantifying our goals, we will hold ourselves, our contractors, our providers (and perhaps our clients) accountable to their achievement. 

One of our metrics is hospitalizations for “ambulatory care sensitive conditions”. These are conditions that can be predominately managed in outpatient settings and a high rate indicates opportunities for improvement perhaps through better care coordination, a medical home, or a more informed client. Our goal is to become a state with one of the lowest rates in the country. In addition to reducing rates of bad outcomes, we want to also measure and improve positive metrics such as clients’ self-assessment of health and functioning as measured by a validated health assessment tool. 

Our performance metrics then cascade from a department level to individual program outcome goals. These metrics are much more focused on specific programs like long-term care or CHP+. Examples include readmission rates for residents in nursing homes and reducing adverse drug reactions.

As we benchmark our performance against other states, or benchmark within our state regions and populations, we intend to reexamine how we are financing and structuring our health care delivery system to achieve optimal health for the dollars expended.  

The transformation from a focus on the volume and price of health care services to a focus on the outcomes will result in a healthier Colorado.

Sandeep Wadhwa, MD, MBA
State Medicaid Director
Colorado Department of Health Care Policy and Financing