I_StatewideHealth_2021A 11/03/2021 09:38:36 AM Committee Summary

Kelly Erb, Policy and Advocacy Manager, Colorado Rural Health Center, told the committee about the mission of the Colorado Rural Health Center.  She presented on the use of telemedicine in rural areas of the state.  She discussed the efforts of rural providers to use telemedicine prior to the pandemic; the cost of providing telemedicine; Medicaid specialty and behavioral health providers; workflow changes; patient access to electronic devices; and provider and patient hesitance to utilize telemedicine.

Ms. Erb discussed the advantages of using telemedicine in rural areas. She discussed innovations in telemedicine, such as remote patient monitoring (RPM) and cooperation with state agencies. She told the committee that Medicaid does not reimburse rural health clinics for RPM.

Ms. Erb discussed ways the General Assembly can help rural areas of the state, including maintaining reimbursement parity for telemedicine.  Ms. Erb responded to questions about expanding provider eligibility for RPM and explained the efforts of the Holyoke Health Clinic in the area of RPM.  She spoke about the equipment needed to provide RPM and the security of health data collected via RPM.  She responded to questions about the use of telepsychiatry in rural areas and stated that the use of telemedicine reduces the number of patients who miss appointments.

Raine Henry, Department of Health Care Policy and Financing (HCPF), discussed HCPF's efforts to support the use of telemedicine.  Ms. Henry's slides may be viewed on the committee website at http://leg.colorado.gov/sites/default/files/images/1_hcpf_telemed.pdf. She stated that HCPF has allowed the use of telemedicine since 2005 and discussed utilization rates, the ways HCPF has expanded telemedicine during the pandemic, and the changes that allowed rural health centers to bill for separate encounters.  She told the committee about payment parity for telemedicine services and the increase utilization of telemedicine during the pandemic.  She discussed studies focused on how telemedicine may increase access to care. She pointed out that the use of telemedicine helps reduced racial and ethnic disparities in no-show rates for primary care.

Ms. Henry discussed how telemedicine reduces disparities in primary care no-show rates for medically complex patients and increases access for those with complex needs. She discussed HCPF's telemedicine policy goals stating that HCPF is committed to developing a comprehensive telemedicine policy that: improves access to high-quality services; promotes health equity; integrates with medical home & neighborhood; encourages innovation through aligned payment policy; and ensures value for the taxpayer.

Ms. Henry responded to questions about policies related to care provided through telemedicine. She stated that there is no requirement that a patient utilize telemedicine appointments prior to an in-person appointments.

Carrie Paykoc, Director, Office, Hospital and Specialty Care Unit Manager, Office of e-Health Innovation (OeHI), explained that the Office of e-Health was established by executive order in 2015 to define and evolve the state’s health information technology strategy.  She discussed the office's efforts to develop Colorado's Health IT Roadmap and supports for telemedicine, focus on health equity, and virtual health and information sharing.  She discussed the Refreshed 2021 Strategy of the E-Health Commission.  She referenced Senate Bill 20-212 and funding to help community members get access to devices to participate in telehealth and funding to boost rural clinics access to broadband. She discussed the office's partnership with HCPF.

Ms. Paykoc continued her presentation and discussed community recommendations, including continued focus on telebehavioral health care, digital health equity, wifi/braodband. She suggested that going forward policies should engage the community in human-centered design, maintain payment parity, simplify contracting, and continue Medicaid payments for e-consults and telepsychiatry.

Stephanie Pugliese, State Health IT Coordinator, Deputy Director, OeHI, discussed innovations in telemedicine, including backpacks for individual experiencing homelessness, and access for senior citizens. She discussed digital health equity, and stated that not all patients or providers have access to devices to facilitate telemedicine. She discussed the challenges of telemedicine, including  broadband connectivity, the use of telephones, and connectivity to electronic health records. She discussed the need to increase connectivity in rural areas.

Ms. Paykoc responded to questions about how OeHI is addressing access to telemedicine for seniors and vulnerable populations.

Ms. Frank responded to committee questions. She told the committee that primary care visits were down in 2020 and that people are still hesitant to get health care services. Ms. Paykoc told the committee that the Health Insurance Portability and Accountability Act of 1996 (HIPAA) rules apply to telemedicine services.  Ms. Frank spoke about drug rebate collection and alternate payment model information located on the CIVHC website. This information is collected by type of drug, i.e. speciality, brand, and generic. She told the committee that CIVHC will begin collection of additional information about prescription drugs soon.

John Farris, Community Paramedic, Eagle County Paramedic Services (ECPS), presented on the activities of ECPS.  Mr. Farris' presentation slides may be viewed on the committee webpage at http://leg.colorado.gov/content/istatewidehealth2021acommdocs-0. He stated that ECPS offers 30 services and focuses on providing the right resource to the right patient at right time.  He discussed the cost savings realized through the use of the services provided.  He spoke about the number of visits that his agency completed in 2020 and 2021. Mr. Farris explained that all providers in the area can refer patients to ECPS for services.  He spoke about how the COVID-19 pandemic allowed his agency to show how useful they are to the community as they were the only at-home care for COVID-19 patients during the pandemic.  He discussed the need for paramedic programs to receive recognition as approved providers of medical services beyond current definition of transport so they could bill insurance for the services they provide. 

James McLaughlin, Director of Community Paramedicine, Ute Pass Regional Health Service District (UPHSD), presented on the UPHSD. His presentation slides may be viewed on the committee website at http://leg.colorado.gov/sites/default/files/images/2_ute_pass_regional_health_service_district_paramedic_program_presentation.pdf . He state that his agency provides the right care at the right time and place. He discussed the community paramedic provider training program and stated that his agency is licensed as a  a home health care agency.  He discussed the agency's mental health assessment program (MHAP) and how the paramedics  de-escalate situations in the field and get patients to the care they need. He discussed the outcomes for clients who receive MHAP services. He spoke about the Medication Assisted Treatment that is offered through his agency.  He discussed the patient satisfaction rate and a grant received from OeHI to assist with telemedicine appointments.

Mr. McLaughlin continued his presentation and provided additional examples of specific cases where his agency provided care. He discussed the cost of care, comparing the cost for his agency and the cost for emergency rooms.

Mr. McLaughlin told the committee that community paramedic programs need a sustainable funding source and recognition as a licensed community integrated health care service agency.  He stated that community paramedic programs provide value to the community in the following ways: by acting as intervening professionals in an M-1 hold situation and safely transporting patients who are experiencing a mental health crisis for additional evaluation; they help reduce hospital readmission by providing care to individuals who a recently released from the hospital; and they can support local physicians and laboratory services.

Chief Tim Dienst, Ute Pass Regional Health Service District, told the committee about the supports community paramedics are able to provide to patients in the community, including helping seniors access telehmedicine services. He stressed the need to make community paramedics a payable service.

The panel responded to committee questions. Mr. McLaughlin explained his agency's community outreach efforts.  Chief Dienst told the committee that much of the behavioral health services provided by community paramedic agencies are paid for by the Office of Behavioral Health and some health services are paid through private insurance, but most are services are reimbursed through private pay. Chief Dienst stated community paramedic services need to be recognize to be seen as a viable source of care.

Committee questions and discussion about how best to utilize the services of community paramedic programs to provided health care services to the community ensued.  The committee discussed scope of practice for community paramedics, funding mechanisms, behavioral health interventions provided by community paramedics, and paramedic training partnerships.

Steve Holloway, Director, Health Access Branch, Colorado Department of Public Health and Environment (CDPHE), presented on CDPHE's role in the collection workforce data. Mr. Holloway provide three handouts to the committee, which can be viewed on the committee website at:

• https://leg.colorado.gov/sites/default/files/images/3.1_cdphe_public_health_health_care.pdf
• https://leg.colorado.gov/sites/default/files/images/5.1_cdphe_colorado_health_service_corps_fact_sheet_1.16.20.pdf
• https://leg.colorado.gov/sites/default/files/images/5.2_cdphe_hpsa.pdf

Mr. Holloway discussed the CDPHE website tool that shows access to providers across the state.

Lee Wheeler Berliner, Managing Director, Colorado Workforce Development Council, presented on health care workforce shortages and employer needs.  His presentation slides may be viewed on the committee website at  https://leg.colorado.gov/sites/default/files/images/3.3_cdle_presentation.pdf.  Mr. Wheeler Berliner discussed industry projections for health care providers and indicated that there is expect growth in the health care and social assistance industry of 29.69 percent between 2020 and 2030.  He pointed out that health care providers are Colorado's fastest growing occupation group after Computer and Mathematical occupational groups

Michele Shimomura, Director, Office of Public Health Practice, Planning, & Local Partnerships, CDPHE, discussed the public health workforce. She discussed the barriers that public health agencies face when hiring and retaining staff, including the mental health toll of working in public health, low salaries, and lack of advancement in opportunity.  Ms. Shimomura's presentation slides are available on the committee's webpage at https://leg.colorado.gov/sites/default/files/images/3.2_cdphe_workforce.pdf. She discussed the public health workforce distribution and composition. She spoke about steps that can be taken to support the public health system.

Michael Nicoletti, Director of Legislative Affairs, Colorado Department of Regulatory Agencies (DORA), presented the timeline for issuing provider licenses and streamlining the licensure process. His presentation slides may be viewed on the committee website at  https://leg.colorado.gov/sites/default/files/images/3.3_cdle_presentation.pdf.  Mr. Nicoletti discussed actions DORA took to reduce licensing barriers for health care workers during COVID, including emergency licensure, suspending educational requirements, and expanding scope of practice.

The panel responded to committee questions related to the following: the number of emergency health care provider licenses issued by DORA;  the Colorado Health Service Corps' lack of diverse applicants and ideas for increasing diversity in the education pool; wages for Certified Nursing Assistants; programs in CDPHE that provide supports to medical professional that are not covered by the Health Service Corps; health care provider burnout and the need to focus on developing resiliency tools; and the additional workload placed on the public health community during the pandemic.

Representative Lontine recessed the meeting.

Mr. Laughlin responded to questions about direct care workforce training and compensation.

Kyle Rojas Legleiter, Senior Director of Policy, The Colorado Health Foundation, presented to the committee. He provided an overview of The Colorado Health Foundation and how the foundation is working to increase the primary health care workforce. Mr. Rojas Legleiter discussed the need for community ties, connectedness with providers, continuity in care, and cultural responsiveness. He discussed the focus on primary care by the foundation and the continuum of care. Mr. Rojas Legleiter discussed providing funding for loan repayment programs that is expanded beyond physicians. He discussed supporting "grow your own" programs in rural areas of the state.