In an effort to control health care costs and improve quality of care for Medicaid patients, the Colorado Department of Health Care Policy & Financing is overseeing the Hospital Transformation Program (HTP). Estes Park Health is one of 76 hospitals in Colorado taking part in this state endeavor.

Certified Nurse Case Manager Leah Smith is one of a handful of people on the Estes Park Health team handling the Hospital Transformation Program.

“HTP started about five years ago,” Smith explained. “It’s an initiative that aims to improve the quality of hospital care provided to Medicaid patients. The program will tie Estes Park Health’s supplement payments to the hospital’s ability to meet certain patient care quality targets, improve the health of priority populations, create meaningful community engagement, and reduce costs.”

Estes Park Health will help in several ways:

·        Aiding patients in obtaining follow-up appointments with physicians

·        Finding patients a primary care physician if they do not have one

·        Link patients with other services in Estes Park (Crossroads Ministry, Estes Park Housing Authority)

The idea is to help patients use the system more effectively, not just at Estes Park Health, but in the entire community.

“It’s not uncommon that people are not aware of the resources right in their backyard,” Smith said. “It’s our goal to help remind our Medicaid patients of what we do have here in Estes Park.”

Sometimes patients turn down the opportunity to have a discussion with a case manager or a social worker at the hospital. The Hospital Transformation Program is designed to make patients more open to this help.

“Barriers to care we see are really expensive rent, the inability to buy a house, and unfortunately, food insecurity,” Smith stated. “People shouldn’t have to make a choice between paying rent or getting groceries. It is our dream as case managers and social workers to assist people and let them know what kind of services are available to them.”

Estes Park Health cares about more than just patients’ acute medical issues. EPH wants people to find a sustainable, healthy lifestyle.

“We want individuals to succeed,” Smith emphasized, “whether that means coming into the Emergency Department for your needs or finding a primary care provider here in the area who could take care of your concerns before it turns into that tragedy in the ER. It also means good follow-up care. When you have consistent follow-up care, it could prevent further visits to the hospital.”

Social workers and case managers are going to be more involved in Medicaid patient care, from bedside assessment interviews and follow-up phone calls.

As with many complicated health care issues, the collection of data will be crucial in gauging the success of HTP.

Mayur Nadig is a Quality Analyst for Estes Park Health. He is part of the EPH HTP team.

“The goal of HTP is to improve patient outcomes through care design and integration of care across settings,” Nadig said. “HTP also aims to improve the performance of the delivery system by ensuring appropriate care in an appropriate setting. Other goals are to help lower costs for Health First Colorado through a reduction in hospital utilization and increased effectiveness and efficiency in care delivery.”

As the Hospital Transformation Program progresses, other states around the country will be looking at Colorado as an example of better care and controlled costs.

Colorado has been chosen to be the pilot state for HTP.

“It’s exciting to know that our state will be leading and innovating this opportunity to find creative ways to link our clientele with the local resources they need.”