Department News: Resources for your Membership
November 2018
Welcome to the new look and focus of the Department of Health Care Policy & Financing (the Department's) newsletter for health care leaders.

This newsletter was originally started to update health care leaders with pertinent information on the then-new Colorado interChange.

Now that the Colorado interChange and the fiscal agent are in normal operations, we hope to move the focus of this newsletter onto topics that provide additional support and information to you -- our partners.

If you would like to provide feedback for the topics this newsletter addresses, please feel free to share your thoughts here
Message from the Executive Director
Thanks to many of you who have helped further the message of the Lift the Label Campaign. As a reminder, Lift the Label aims to remove damaging labels and stigmas that prevent those with opioid addiction from seeking effective treatment.

The Department continues to work with our partners to make actionable policy changes to help address the opioid crisis.

As you may recall, we have implemented several policies over the past two years which have resulted in a 30% reduction in the number of pills prescribed. These included a policy to limit prescriptions for people who are naive to opioids to 7 days at a time. Additionally, prescriptions exceeding 21 days require a prior authorization, and, in some cases, a review by a pain specialist.The Department implemented this policy in response to an identified correlation between days supply of initial prescription for an opioid and continue opioid use.

Effective Nov. 15, 2018, there will be a 4-day limit for opioid prescriptions after a dental procedure. The Department has been working on the development of this policy with dental-provider and community partners. 

On the same day, the Department will further reduce the total allowable daily Morphine Milligram Equivalents (MME) from 250 to 200. When this calculation exceeds the 200 MME limit, prior authorizations will be required, and processes will be set in motion to allow time for the prescriber to begin working with the member to safely taper their opioid doses down while ensuring adequate pain control is maintained. 

As with the current MME policy, exceptions will be identified for certain cases where chronic pain management exceeding these limitations may be needed. 

You can learn more about the fight against opioid addiction in Colorado by visiting the Colorado Consortium for Prescription Drug Abuse Prevention. For more information about how the Department is addressing opioid addiction, you can refer to our Opioid Use in Colorado Overview document and the Department's Opioid Resource web page.

Thanks for your partnership on this important issue.
Kim Bimestefer
Ziegler Named Director of New Cost Control and Quality Improvement Office
Stephanie Ziegler joined the Department in August to direct the Cost Control and Quality Improvement Office, which was created under Senate Bill 18-266 . Under her leadership, the team will pursue cost-control strategies including value-based payments and other approaches. 

"Stephanie brings a strong track record in the health care industry as an executive and consultant who has successfully managed multi-disciplinary teams across private, government, Medicaid and non-profit sectors," said Executive Director Kim Bimestefer. "Stephanie's deep and strategic business experience with numerous diverse health care organizations equips her well for the work in this role."

The role will develop and implement cost-control programs and monitor trends and initiatives that align with the Department's mission. Ziegler will also coordinate and work closely with Department partners and stakeholders to identify and implement cost-control strategy best practices.
The Department Pursues Tools of Innovation
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.

Upon the unanimous approval of SB 18-266 the Department is also releasing 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.
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