Colorado
Building strong provider networks has been an early focus of the Colorado Child Health
Plan Plus (CHP+) program. Such networks are being built through careful selection of
providers to be included in the network and through coordination with other health
systems. SCHIP Workshop (July 1998) presenter Sarah Schulte of the Colorado Department of
Health Care Policy and Finance summarized the early Colorado CHP+ program experience as
follows.
Provider Selection
Obtaining the right types of providers to meet the health care needs of the target
population was a key issue in the development of the CHP+ service delivery system. This
was ensured through:
- Contract provisions which specified that the HMO must:
- Be licensed.
- Provide adequate network providers and standing specialist referrals for members with
special needs.
- Provide case management when medically necessary.
- Carve-outs of services such as mental health, substance abuse, dental, and transplants.
- Inclusion of essential community providers who helped to ensure that the necessary
providers were part of the networks.
Health Systems Coordination
Colorado CHP+ has coordinated with the mental health, substance abuse, and special
health care needs systems throughout the State.
- Mental health and substance abuse coordination includes:
- A wrap-around package for children identified with special needs.
- Coordination with mental health and substance abuse agencies which brings expertise and
an established structure to the program.
- Pilot programs that will be used to test the effectiveness of the efforts.
- The Health Care Program for Children with Special Needs, developed through coordination
with special needs service systems, will provide benefits to meet chronic physical health
care needs not provided by commercial benefit packages such as:
- Special therapies.
- Durable medical equipment.
- Hearing and vision services.
Service Delivery Systems Monitoring Strategies
Quality assurance and program monitoring efforts of the Colorado SCHIP service delivery
system include use of:
- HMO contracts as tools to assure appropriate access to care.
- Existing performance measures to assess the adequacy of provider networks.
- HEDIS data to track children’s access to primary care and pediatric physician
specialists.
Related Questions
What led to this?
Give me an overall context
Show me some lessons learned
Show me more State
strategies
Who presented this material?
|
Benefit Design 
data to assess
ease of referrals to specialist, waiting time for appointments and access to assessment,
tests, and treatment.