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Case Manager's Corner
November 1, 2018                                                                            
In This Issue
Welcome! 
Welcome to the first edition of the Department of Health Care Policy & Financing's (the Department) new Case Manager newsletter. The purpose of this newsletter is to provide timely and relevant information to the staff responsible for case management of Health First Colorado (Colorado's Medicaid Program) members. 

The Department will publish this newsletter quarterly in an attempt to provide relevant information in a consolidated format.

In our first edition, we'll provide information about large-scale implementations. If you have suggestions for the content included in this newsletter, please leave us a comment. 
Message from the Executive Director: Tools of Transformation
I want to share some of the important work happening at the Department of Health Care Policy & Financing (the Department). Our Strategic Policy Initiatives and related goals are outlined in our  Department's Performance Plan. I'll focus on tools of transformation in this message.

The Department is in the process of designing tools of transformation to improve the delivery of care to our members. With system implementations, challenges and periods of adjustment occur. In that spirit, Department staff are moving forward with a person-centered mindset and partner collaboration as foundations.

We are excited to collaborate on these innovations with providers, case managers and care takers to ensure the best outcomes for our members.

Electronic Visit Verification
In compliance with the 21st Century CURES Act, the Department is implementing an Electronic Visit Verification (EVV) system.

The purpose of an EVV system is to ensure members are receiving the care they need from their providers while taxpayer money is appropriately allocated. The Department has signed a contract with DXC Technology (DXC) to design and implement the system. For more information on EVV implementation,  visit our EVV web page.

New Provider Tools
Over the coming months, the Department will be rolling out a suite of powerful cost and quality assessment capabilities to the seven Regional Accountable Entities (RAEs), hospitals and primary care providers. The new Prometheus tool will identify Potentially Avoidable Costs (PACs) on member care, which can then be rolled up to identify opportunities at the individual physician, primary care medical home, specialist and hospital levels.

Prometheus will also enable providers to improve their referral patterns towards more cost effective, quality physicians and hospitals. It can further enable hospitals to identify and self-correct inefficient, lower quality care delivery. RAEs can use it to target members for care management. The Department will also empower it to drive members seeking provider locator services to higher performing providers. Clearly, we are excited to roll out the Prometheus tool.

Physician Prescribing Tool
Upon the unanimous approval of SB 18-266 the Department is preparing to release a Request for Information for the development of a new Prescription Drug Prescribing Tool to be used by physicians. Payers and providers will benefit from the use of a shared prescribing tool that loads all the prescription drug reimbursements, plan designs, and copays by carrier into a single tool that connects to the patient's Electronic Medical Record (EMR). The tool then employs all those facts to provide the physician with insights into the most efficacious prescription to prescribe to each patient. The Department is working closely with stakeholders to draft the Request for Information to ensure the tool is developed with the input of our provider and payer partners.

Ultimately, prescribing physicians will have one tool that incorporates the insights from their patients' medical condition, their Rx plan design and formulary to enable more efficacious prescribing patterns. To physicians and providers, this also drives increases Value Based Performance Payments while improving quality care. To carriers, cost performance and quality outcomes improve.

The Department will continue to share updates as the development of these cost saving person-centered tools of transformation progress.

As always, we appreciate your partnership.
Kim Bimestefer
Update on Colorado Choice Transitions Sustainability 
At the Medical Services Board meeting on October 12, 2018, the Department postponed the rules that would create sustainability for the CCT program due to stakeholder feedback. As a result, the Department anticipates that there may be a gap in services for members beginning the transition process after January 1, 2019 until a resolution is reached. 

The Department encourages stakeholders to review the meeting links in this notice and submit written feedback to CCT@state.co.us . Notice of additional stakeholder meetings will be sent out via future Informational Memos.
Update on the Bridge Case Management System
The Department has published the following new training modules for Bridge users:
The Bridge Training web page has been created as a central location for Bridge-related training modules and resources such as these. Additional training modules and other helpful resources are currently in development and will be posted on the page once they are complete. For updates on Bridge issues, please visit the Bridge Issues page .
Department Developing New Needs Assessment Process
Since 2014, The Department has been working to transform its Long Term Supports and Services (LTSS) processes. Colorado currently uses more than 30 tools to conduct assessments for adults and children utilizing Home and Community Based Services (HCBS). 

These tools are used to determine a variety of decisions and needs, such as: 
  • Functional eligibility
  • Level of care needed
  • Financial planning
  • Rate setting 
  • Support plan development

Through the passage of Senate Bill 16-192 in 2016, the Department is directed to develop a needs assessment tool for all persons receiving LTSS, including persons with intellectual and developmental disabilities. 

 

The Department, in collaboration with stakeholders, has selected and customized a new process for eligibility determination, needs assessment, and support planning for all individuals seeking or receiving LTSS. The new LTSS Assessment and Support Planning process will ultimately replace the ULTC 100.2 and other tools used in Colorado to assess and develop support plans for individuals receiving LTSS. 

 

The Department will incorporate automated eligibility determination, needs assessment, and support planning documents in the Aerial Case Management System. 

 
For more information including assessment modules, training manuals and support plan documents please visit the LTSS Assessment and Support Plan web page
Department Seeks Case Managers to Test New Aerial Case Management System
The Department has signed a contract with DXC to design, implement and operate its new HCBS Case Management Data system. The new Case Management Data system (Aerial) will be implemented in two phases, with a full implementation date of January 2022. Phase one has officially begun. To read the full Aerial announcement, please refer to our informational memo

The Department is currently working to automate the eligibility determination, needs assessment, and support planning documents in the new case management data system, Aerial. For more information, including how to volunteer, view our recent informational memo
More Information About EVV
The Department is moving forward with the implementation of an Electronic Visit Verification (EVV) System for select Personal Care and Home Health services provided to Health First Colorado members. The new EVV System will incentivize heightened care coordination in the health care delivery system to ensure quality and timely health services in home and community-based settings.

Critical Incident Reporting Updates to the BUS
On October 15, 2018, twelve (12) enhancements were made to the Critical Incident Reporting (CIR) module, and an enhanced Case Manager Quick Links workspace will be made available for use by Case Management Agencies (CMAs).

These changes are being made to enhance the reporting of CIRs. These changes will allow CMAs to report more accurate CIRs, improve preventive measures, create improved reporting capabilities for the Department, and will ensure compliance with Centers for Medicare and Medicaid (CMS) federal guidelines. This upgrade will also allow Agency Administrators to pull CIRs data for their agency.

For more information about this update, please refer to our BUS Update Memo.