• Support PCPs and behavioral health providers through a multidisciplinary team of clinical care coordinators (nurses, social workers and behavioral health specialists) and non-clinical member support specialists (resource experts, community health workers and peer support specialists).
• Assist providers with Health First Colorado members, especially those who:
  
  • Call frequently
  • Have complicated health needs or trouble getting the health care they need
  • Need to connect with non-medical resources such as transportation, childcare, food assistance or housing
  • Would benefit from additional disease/medication education
  • Require in-home evaluation
  • Miss appointments or have transportation issues
  • Are diagnosed with complex or chronic disease
  • Frequently visit the hospital or ER
  • Frequently utilize behavioral health or crisis support services
• Work together with providers and members to develop care plans, support transitions of care, offer community resource guidance and provide health education

Need to refer a Health First Colorado member for care coordination services? Complete the form below.

Referral form for members attributed to providers in Boulder, Broomfield, Clear Creek, Gilpin and Jefferson counties (Region 6)

Referral form for members attributed to providers in El Paso, Park and Teller counties (Region 7)

• Connect network providers to CCHA services and provide assistance with anything related to care for our Health First Colorado members
• Serve as the liaison between providers, the Department of Health Care Policy and Financing, and CCHA leadership
• Educate providers about Health First Colorado participation and resources available to support their success
• Establish relationships with and build connections between hospital, dental and other specialty providers to improve access to care

• Help primary care practices adapt to changes and build sustainable processes to deliver comprehensive, patient-centered care through data and continuous quality improvement efforts
• Support primary care providers and practice staff with key performance measure initiatives
• Use data to identify interventions and programming in support of behavioral health incentive measures
• Develop relationships with primary care practices to facilitate a Performance Improvement Plan

• Train on how to access the Data Analytics Portal (DAP) and help understand how to use the data most effectively
• Deliver reports regarding attributed members including info such as high risk, inpatient admissions and frequent ER utilizers
• Provide individual practice data showing progress with key performance indicator measures and gaps in care
• Offer guidance with benchmarking efforts and best practices
• Track, trend and analyze grievances and Quality of Care concerns in support of improved processes and programs
• Support community mental health centers in developing effective programming in support of behavioral health incentive measures

• Outreach members and provide information about Health First Colorado and CCHA services
• Help members understand and use their health care benefits and find providers for their physical and behavioral health needs
• Encourage self-management of chronic health conditions and educate about diseases and medications, pregnancy and family planning, community resources for non-medical needs, etc.
• Provide participating providers with tools and materials to help educate patients and succeed with achieving performance goals

Access Free Patient Education Materials & Provider Tools

• Promote and foster collaborative relationships with vital organizations in the community and health neighborhood to ensure members are getting access to needed services
• Establish efficient processes for bi-directional member referrals and provide updates on current Health First Colorado and CCHA initiatives