Colorado Department of Health Care Policy & Financing (HCPF) Market Research Report

Background

The Colorado Department of Health Care Policy & Financing (HCPF) is a principal department of the Colorado state government responsible for administering Health First Colorado (Colorado's Medicaid program), Child Health Plan Plus (CHP+), and other public health care programs for eligible Coloradans.

Mission: To improve health care equity, access, and outcomes for the people served while saving Coloradans money on health care and driving value for Colorado.

Vision: To make members healthier while maximizing the value of every dollar spent on health care.

Primary Area of Focus: Administration of Medicaid and CHP+ programs, along with other public health initiatives targeting low-income families, the elderly, and individuals with disabilities.

Industry Significance: HCPF plays a critical role in providing health care coverage to a significant portion of Colorado's population, ensuring access to essential health services and promoting health equity across the state.

Key Strategic Focus

HCPF's strategic focus encompasses several core objectives:

Medicaid Sustainability: Implementing frameworks to manage Medicaid cost trends effectively, ensuring the program's long-term viability.

Home and Community-Based Services (HCBS): Utilizing federal funding to enhance and expand HCBS for older adults and individuals with disabilities.

Behavioral Health Transformation: Collaborating with the Behavioral Health Administration to strengthen Colorado's behavioral health safety net system.

Health Equity: Developing comprehensive plans to address health disparities in areas such as prevention, maternal health, and behavioral health.

Affordability Leadership: Partnering with hospitals and other stakeholders to improve pricing transparency and reduce health care costs for Coloradans.

Financials and Funding

HCPF's financial operations are characterized by:

Fiscal Year 2024-25 Budget: A total of $15.9 billion, with $5.0 billion allocated from the General Fund, reflecting approximately one-third of Colorado's state budget.

Funding Sources: Primarily federal and state funds, with significant investments from federal stimulus programs like the American Rescue Plan Act (ARPA) to support HCBS and other initiatives.

Utilization of Capital: Funds are directed towards provider reimbursements, program administration, system enhancements, and initiatives aimed at improving health care access and affordability.

Pipeline Development

HCPF's pipeline development focuses on:

HCBS Initiatives: Implementing over 60 projects funded by ARPA to enhance services for older adults and individuals with disabilities, with an end date of March 31, 2025.

Medicaid Delivery System: Advancing the Accountable Care Collaborative (ACC) Phase III, effective July 1, 2025, to improve care coordination and health outcomes.

Behavioral Health Services: Expanding access and services through new models of care informed by extensive stakeholder engagement.

Technological Platform and Innovation

HCPF leverages several technological platforms and innovations:

Customer Contact Center: Migrated to Salesforce Service Cloud, enabling agents to deliver better service faster and providing a unified platform connecting various stakeholders.

Colorado Social Health Information Exchange (CoSHIE): A tool designed to connect individuals to health-related social needs supports, such as housing and nutrition services.

Prescriber Tool and eConsults: Innovations that facilitate access to affordable medications and specialist consultations.

Leadership Team

The leadership team at HCPF includes:

Kim Bimestefer: Executive Director, leading the department's strategic initiatives and operations.

Christine Comer: Director of Customer Experience, overseeing the modernization of the customer contact center and service delivery improvements.

Leadership Changes

Recent leadership developments include:

Executive Director Appointment: Kim Bimestefer was appointed as Executive Director by Governor Hickenlooper on January 2, 2018.

Competitor Profile

Market Insights and Dynamics:

Market Size: HCPF serves a substantial portion of Colorado's population, with Health First Colorado covering over 1.7 million individuals, including more than 40% of the state's children and births.

Growth Potential: Ongoing initiatives aim to expand coverage and improve service delivery, indicating potential for growth in program reach and impact.

Competitor Analysis:

Private Health Insurers: Compete with HCPF in providing health coverage, focusing on different market segments and offering various plan options.

Other State Programs: Similar state departments and programs in Colorado and neighboring states may offer comparable services.

Strategic Collaborations and Partnerships

HCPF has engaged in several strategic collaborations:

Salesforce Partnership: Collaborated with Salesforce to modernize the customer contact center, enhancing service delivery.

Behavioral Health Administration: Partnered to strengthen Colorado's behavioral health safety net system through new service models and payment methodologies.

Operational Insights

HCPF's operational considerations include:

Medicaid Sustainability: Addressing fiscal challenges through the Medicaid Sustainability Framework to manage cost trends effectively.

System Enhancements: Investing in technology and infrastructure to improve service delivery and operational efficiency.

Strategic Opportunities and Future Directions

HCPF's strategic roadmap includes:

Medicaid Delivery System Enhancement: Implementing ACC Phase III to improve care coordination and health outcomes.

Health Equity Initiatives: Executing the Healthy Colorado For All Plan to address health disparities in prevention, maternal health, and behavioral health.