Overview

CoverColorado is a nonprofit insurance program created by the state legislature in 1990 to provide comprehensive medical insurance coverage to approximately 5,000 residents who are unable to obtain private insurance because of a preexisting conditions. Colorado joined with four other states—Kansas, Oklahoma, Washington, and Arkansas—to form the Advanced Care Management Task Force (ACMTF), a cooperative outcomes research effort that combines and assesses high-risk pool data from participating states.

The objectives were to obtain a definitive, reliable picture of high-risk pool enrollees, and to measure and document the impact of specific disease and care management strategies on high-risk populations. Another goal was to develop a national database that allows state high-risk pools and other coverage programs to compare costs and best practices for treating specific health conditions, and to better manage costs. This information also can potentially help prepare and plan care for an aging U.S. population.

Colorado incorporated "advanced care management" into its high-risk health insurance program with the goals of reducing costs and improving the quality of life for enrollees. It hoped to achieve this by integrating disease management and care management interventions for a population with costly, complex chronic medical conditions. Disease management strategies include education and treatment guidelines for specific conditions such as asthma, diabetes, congestive heart failure, and coronary artery disease. Care management encompasses personalized nurse counseling, pharmacy review, utilization management, case management, and depression management programs. These interventions combine high-tech tools for identifying and monitoring participants with personalized nurse counseling and advocacy—including negotiating with providers and medical device and equipment suppliers for lower fees.

Despite these efforts, claims costs have continued to rise. A program evaluation revealed that approximately 200 individuals from the 5,000 enrollees accounted for 60% or approximately $13 million in claims paid during the study period (October 1, 2004 and September 30, 2005). It concluded that the care management systems in place were inadequate and ineffective for managing the highest-cost, highest-risk CoverColorado participants. The state is therefore requesting Bonus Grant funds to implement a community-based, intensive, and patient-centered care management program. The state hopes that this model of care management will be more effective in helping CoverColorado participants receive the right care for their specific needs.

For More Information

Web site: www.covercolorado.org Contact: Barbara Brett, Executive Director, CoverColorado; Team Leader, ACMTF Phone: (303) 863-1961 E-mail: bbrett@covercolorado.org