Ways of the RAEs: Health Colorado on Why Integrating Health Care Matters in Southeast Colorado
Fourth in a series of interviews with leaders of Colorado's Regional Accountable Entities, or RAEs. Amy Downs, CHI's former vice president, interviews Alonzo Payne, executive director of Health Colorado, the RAE for southeast Colorado.
This episode was recorded before the RAE was launched in July 2018.
Topics covered include Alonzo Payne's personal connection to southeast Colorado and his take on some of the benefits and difficulties that come along with working in the state's poorest region.
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Jackie Zubrzycki: Hi and welcome to The Checkup, the Colorado Health Institute’s podcast about health in Colorado and the policies that affect it. I’m your host Jackie Zubrzycki, the communications specialist here at CHI.
Health First Colorado the state’s Medicaid program, just launched five new Regional Accountable Entities, or RAEs, as part of an effort to improve care and reduce costs. The RAEs are managing physical and behavioral health together for the first time.
We recently published a paper on the RAEs, which you can find on our website www.coloradohealthinstitute.org.
We wanted to get a sense of what’s going to change now that these new regional organizations are managing care.
Today we’ll be talking with Alonzo Payne. Alonzo is the executive director of Health Colorado, a brand-new organization that’s managing physical and behavioral health care for Colorado’s Medicaid program in the southeast part of the state.
Health Colorado’s region includes the entire southeast part of the state. It includes some of the state’s most beautiful – and most impoverished – areas.
Alonzo spoke with Amy Downs’, CHI’s former vice president, about his personal investment in southeast Colorado and why he thinks it’s so important for the health system to deal with the whole person. They spoke earlier this summer, shortly before the launch of the RAEs.
Alonzo Payne: My name is Alonzo Payne, and I am the CEO program officer for health Colorado the regional accountable entity for region Four.
Amy: Well, thanks for coming today Alonso. We really appreciate your time. I’m wondering if you can tell us how you would explain what a regional accountable entity or a RAE is to someone like a family member or a friend someone who might not know much about it.
Alonzo: So, um, I've been asked that because this is a new position for me. I used to work at a federally qualified Health Center prior to working with RAE the regional accountable entity.
So I've had multiple people asked me what in the world is that and what I've explained to them is that It’s really an effort by the state to ensure that our Medicaid population is receiving the appropriate behavioral health, substance abuse treatment, and coordination with the primary care and specialists that are necessary so we can help reduce the cost curve.
I really see it as an avenue where we can provide that sort of health care for our members. In Region 4, I think it's beyond important just because of the makeup of our communities. They are the poorest counties in the state, so it’s very, very relevant.
We have a large Medicaid population in our region, and I think we need to do a great job so that we serve that Community, but the community and whole.
Amy: So the RAE would be coordinating across all of these different providers in your community to ensure that individuals and Medicaid have access to Coordinated Care, correct?
Alonzo: Right. We need to make sure that they have access to the appropriate Behavioral Health Services to substance abuse services, and that they get treated like a whole person because I think what the health care industry has done has a they bisected the individual and I'm really hoping that we can move towards a point where we are treating our members as a whole person.
So this is a really big change to Colorado Medicaid the creation of these RAEs. I wonder if you could tell our audience a little bit about what drives you to do this work.
Alonzo: Um, so again being from San Luis, Colorado and Costilla County, one of the poorest in the state and the nation, these are my friends. These are my neighbors. Um, this isn't something foreign to me. Medicaid population is everywhere in our region that's important because it's where I live but it's also important because I've seen what a lack of Behavioral Healthcare can do.
I lost my parents when I was five years old murder-suicide there was a lack of behavioral Health Care. There's a lack of substance abuse. So that's that with me from a very early age, that you needed to make sure you had those sorts of resources.
Working at a federally qualified Health Center, I started figuring out that people aren't treated as a whole person. So, it's it has been sort of a personal endeavor of mine to make sure that the again my friends neighbors and family have access to these sorts of services because I've seen firsthand what happens when there's a lack of it.
Sure sure. Um, so how do you expect to this shift to the raised within Health First Colorado to affect members in your region? How do you think their lives are going to be different?
Alonzo: So I hope their lives are going to be different because again that they have resource to the appropriate level of service.
They need whether it be a psychiatrist whether it be counselor, whether it be access to primary care so they can get control of their diabetes or obesity. Um substance abuse problems. That we don't leave people out, I guess in the cold because they are a Medicaid member from my perspective. They deserve as good if not better health care than any of us because um, that's what's going to have an effect on our entire Society.
We want to make sure people are pulled up and that they have opportunities to succeed. Um having the appropriate health care and Behavioral Health Care is critical
Amy: Now in the past, individuals in Medicaid have often cited challenges in getting access to some of the services that you're mentioning.
What are you going to do in your RAE to ensure that they actually can get in to see these providers?
Alonzo: Well, first and foremost, I think what we're going to do is work closely with all of the providers in our region. We've made every effort to go out and contract with all the community mental health centers that serve our area we work with some of the individual providers that are out there. We're working with some of the hospitals to ensure. We have access to that if necessary. And, I think first we're making sure that we develop healthy neighborhoods and we make sure we have those connections with all of the providers whether they be specialist Primary Care behavioral of whatever it may be so, We're working as a ray to have those contracts in place so that our members have access to those services and also identifying that we aren't just Contracting with anybody that comes toward or that they're providing Quality Healthcare.
Um, and that it's not a fly-by-night operation that we can verify that we can quantify because the state is asking us to make sure that we're good stewards of their dollars.
Amy: Has that been challenging to create this larger network?
Alonzo: Uh, luckily where we are at in Region 4. Um, the owners of Health Colorado happened to be the for Community Mental Health Centers, one of the large federally qualified Health Centers down there along with our um, TPA or third-party administrator Beacon Health Options.
And so we've been lucky that a lot of the services that are provided to the Medicaid population are being provided by our owners. Um, so they have first-hand knowledge. What the barriers are for a lot of these populations. Um, thankfully everybody there is going to accept any Medicaid member that comes to the door.
We still have some issues with access to specialty care because it's just a difficult thing. There's probably not enough payment for some of the Specialists but I can't speak highly enough about the the federally qualified Health Centers and the community mental health centers in our region. They do an amazing job and I think the uh, Front Range should be envious of what we’re able to provide in our region
Amy: Can you tell our listeners a little bit more about the geographic area that comprises your RAE and how how unique that region is and what that means to you as a RAE?
Alonzo: So we’re 19 counties, for the most part they are Rural and Frontier. Our big city is Pueblo Colorado, so that's about as big as we get.
Some people say it's from Creed to Kansas. So it's an entire subsection of Southeastern Colorado. We have areas such as the Lower Arkansas Valley with Le home. Ford the Pueblo Trinidad the entire San Luis Valley, um Fremont County large area it takes a while to get around and it's not uncommon to drive an hour for groceries in our region.
So, there are barriers that the Denver region just does not have.
Amy: How are you going to address them within your organization that the geographic distance in this sparse population.
Alonzo: We're working with all of our community providers that are willing to work with us. Um tomorrow. I have a meeting in Pueblo with a lot of the hospitals. Um, The Community Mental Health Center the federally qualified Health Center some of the other area providers from the southeast on Lower Arkansas Valley region.
And so you end up having a mix of. Private practitioners of large groups that are all willing to see and serve this population because they also recognize that when our members aren't receiving Services, sometimes they end up bumping into the other system. So I think we have a wonderful opportunity for collaboration with all of the providers in our region.
Amy: Are there some specific approaches you can describe to our listeners that would explain how you're planning. Meet the needs of Health First Colorado members. So anyting particularly Innovative within your ray that you think listeners should know about
Alonzo: So I'm not so sure that it's necessarily Innovative, but we want to put our Members First um again because we are a multi-state corporation that is concerned solely about the bottom line.
We are locally owned. We understand that any dollar that we can put towards the service of the members going to be a benefit for them. So what we really try to approach is what's going to be in the best interest of the member. Obviously, we need to have concern about how our providers are doing making sure that they have enough to compensate for the services that they're doing and we're in a situation where we can have those negotiations because again, our driver is going to be the member and how are you going to be connecting with members?
Amy How are you going to what's that feedback loop going to look like to make sure that you are. Work is serving in the best interest of members.
Alonzo So, uh, we are going to have advocacy groups that are going to be made up of members that are going to be made up of providers that we get some feedback as to what are we doing Right? What are we doing wrong?
What are the barriers such as like we mentioned earlier distance travel, um access because sometimes even when we do have these larger systems in place, it's not uncommon for a member to still be 30 40 minutes out from. Even the most basic type of services they would need great any other um,
Amy: any other approaches you want to make sure listeners know about um, you know, I just want to make sure that they do reach out to us if they have concerns, right if they see something that they feel that needs to be addressed.
Our board is made up again of Community Mental Health Center, um, executive director of an mqa of federally qualified Health Center executive director. And so we want to make sure that all of the feedback that we get whether it goes through our board members or whether it goes directly to health Colorado that we understand what we're doing right and what we're doing wrong and if there's something that we can hopefully do better.
Amy: Sure. Alonzo tell me a little bit about what you think. The biggest challenges are going to be as we shift to this new model.
Alonzo: I think some of the biggest challenges that we're going to have or probably going to be. Maduk, um that we do not have a system at least from my perspective that treats the person as a whole person.
Um, I love seeing Integrated Systems. I love it when I can walk into a clinic and they have Primary Care they have integrated Behavioral Health. They have integrated Oral Care, um, that way our members can get the services they need and hopefully get back to work or whatever else that they're doing on because it's difficult, right?
I mean I. All that when I go in for my yearly exam it takes an hour feels like to um, and it sure would be nice if I could get some sort of Oral Care behavioral health care if I need a book my provider just simply doesn't have the resources for that right small local provider happy to get in and get my physical but I'm hoping that we can encourage the development of Integrated Systems, whether it be at a small private practice or a large federally qualified Health Center because that's really where we can hopefully save again our members some.
And in the long run the state some money.
Amy: So um, one of the things you're referring to is colocation where you have different providers and this similar location, is that something that you're actively working on within your ray or something that's more farther down the future.
Alonzo: So, um, the RAE isn't necessarily actively working on it, but a lot of our provider partners are and what we've had discussions with those, providers again those that are within our organization, those that are outside of the organization, is that there is going to be opportunity for developing systems that are going to be able to capture the new payment structures that we believe are coming down the road. The consensus is that at some point, Health Care is going to be paid by quality as opposed by quantity.
And so we're encouraging everybody to identify those areas where we can improve the quality of care that we're given folks.
Amy: And the new model being rolled out to some extent does bring in quality metrics, yes? So maybe a step in the direction of paying for Value as opposed to volume.
Alonzo: Exactly. Exactly.
Amy: Great. So looking back, um in three to four years, how will we know if the approach in your region is successful? How do we know if this new approach in the state of Colorado is successful. You tell our listeners a little bit about how you're thinking about success.
Alonzo: So I think the first thing that we need to look at is some of the metrics that the Department of Health Care policy and finance have put in front of the regional accountable entities.
Amy: Can you tell listeners a little bit about some of those metrics
Alonzo: One of those metrics are emergency room diversion, right? Um, so they recognize that some utilizers of the system use emergency rooms as opposed to primary care.
So that ends up costing the system. Um, another metric is uh, oral health, right? Are they getting the appropriate? Cleanings are there getting the appropriate screenings when necessary again to help reduce the cost of Health Care in the future? Because if they have some sort of issue that is oral.
It may spread and may become a much bigger thing and where they could have dealt with some pretty straightforward dental work, we're now dealing with some complicated problems at a hospital. So I think the state's been really good about putting out some metrics that we believe are going to change right because things change.
And we can identify where the quality is and what also helps bend that cost curve because of being good stewards of state dollars is very important. I know that the state is concerned that we're spending money appropriately and we identify people that need that assistance to find the right place for care.
Amy: Sure. Are there other things that the state's not measuring but you want to measure that you think are really important that you're going to move the needle on that. We should be thinking about.
Alonzo: I don't know how they would measure it or if you can but from my perspective is how integrated can we make these systems down the road?
How can we ensure that when somebody walks in for something as straightforward as a strep throat and they identify that they may have some issues with depression or they're wondering about their body mass index and if there are other options for that member and if it can be addressed at that same time in place, right?
Either nurse practitioner has a Behavioral Health Specialists in the facility that can help someone address with postpartum depression and not have to have the new mother scheduled for an appointment two weeks down the road so that she misses work again has to find access to babysitting. I think that the more integrated the systems and Colorado become the better off everybody’s going to be.
Amy: You bring up a really good point when the goal is integration making sure that we can measure that. Alonzo are there any questions I haven't asked that I should be asking. Did you like to inform our answer for our listeners?
Alonzo:So. From my perspective. I just think that everybody in the state needs to recognize that it doesn't end in begin on the I-25 Corridor. There are areas such as Los Alamos Colorado, such as Antonito Colorado, such as Center Colorado, that have Medicaid members – they have a lot of Medicaid members in relation to the population that's in that area.
And it's important that they receive the same level of health care that you would be able to receive in a metro area and quite frankly, my goal is is that it's much better. Because we do have access to the Health Care Systems that are in the region, they’re willing to work with us and they understand how important it is that the Medicaid population receives the best care possible.
So, I think we're at an advantage compared to some of our Metro friends, um, because it's a lot more difficult when you have 100 providers to choose from to work with some of the members as to where's the best place? How can we get that access? Do they even want to serve Medicaid members? We don't run into that issue in rural Colorado.
We have a lot of providers that are happy to see the Medicaid population. Um, they'd be happier if they got paid a little bit more, but I guess that's everybody's thing, right? So we're hoping that we can coordinate with them so that our members are receiving high quality health care, whether it be behavioral health, primary care, oral care and that we improve their lives.
And I think that the ultimate goal is that we pull everybody out so that they're successful and that they have opportunities to maybe even Venture into the commercial market right now.
Amy: Yeah, so it sounds like what you're saying in some ways being in a rural area. It's a lot easier to collaborate
Alonzo: We're forced to do that. Sure. We're forced to do that. The beauty of rural Colorado is the even if you have disagreements with your neighbor, they're still your neighbor and you don't have 10 others to choose from.
Amy: Yeah. Absolutely. Well Alonso, I want to thank you for coming in and speaking with us today, and we'll be really eager to be following your results and how this rolls out.
Alonzo: And Region Four is going to be eager to show that we are the top Regional accountable Entity stay. We are very proud that we can do that .
Amy: A little competition there, huh?
Alonzo: I love it.
Jackie: Alonzo Payne is the executive director of Health Colorado, which is the RAE for southeast Colorado.
You can listen to our interviews with other regional leaders on our website, . There, you can also read our new report on the RAEs and how they work and more of our work on other health policy issues.
Make sure to follow us on Twitter and instagram @cohealthinst, and follow us on Facebook. Thanks for listening! I’m Jackie Zubrzycki at CHI.