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Valued-based ‘Medicaid Prime’ program in Colo. held up as a national model

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Grand Junction, Colo. on the Western Slope.

A Colorado Public Radio story suggests that a  value-based healthcare experiment  called Medicaid Prime could become  a model for the rest of the country as policymakers consider changes to the Medicaid program.

The NPR affiliate said that program, started in 2014, is meant to lower costs and improve health outcomes for Medicaid enrollees on Colorado’s Western Slope. It currently serves about 35,000 people  in six counties.

Patrick Gordon, associate vice president at Rocky Mountain Health Plans, told the news outlet that its Medicaid Prime makes more resources available for primary care and behavioral healthcare, and works to connect patients with supportive services in the community.

Medicaid Prime has followed the growing  trend of a value-based payment model. Having a fixed budget means that  all stakeholders are held accountable and most stay engaged, Mr. Gordon says, “because it’s basically a sink-or-swim proposition.”

Mr. Gordon says that both times  that the state renewed the pilot program its budget had shrunk by 4 percent and 7 percent, respectively, and that last year the shared savings earned by the program let it  invest $5 million more in primary care and behavioral healthcare. Further, hospital readmissions have fallen and the program has met or exceeded medical-outcome targets.

He told Colorado Public Radio: “I think this is a model for urban areas, for rural areas, I think this is a model for any state. And in fact, I think it is precisely this kind of model that’s going to make coverage expansions work in the long run.”

To read the Colorado Public Radio piece, please hit this link.

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