Adaptation: Colorado's Medicaid program has adopted the Bright Futures Guidelines as the standard of care in the state. The Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program follows the Bright Futures/American Academy of Pediatrics (AAP) Periodicity Schedule and the Guidelines' pediatric screening recommendations. Colorado policy mentions that the EPSDT program must address coverage for preventive purposes and treat both physical and mental conditions.
Implementation: The Colorado Department of Health Care Policy & Financing developed and financed Healthy Communities – an initiative that connects Medicaid's EPSDT program and Child Health Plan Plus program into one model to better meet the needs of children and pregnant women. Family health coordinators ensure that children, families, and pregnant women receive preventive care, resources to obtain immunizations, appropriate referrals to care, and connections to medical or dental care. In addition, they orient families to available program and services, answer questions, and follow-up on missed appointments. The program helps people obtain coverage and access to coordinated health care services, and the family health coordinators provide education and follow-up to enhance EPSDT outcomes.
A recent report shared by the Colorado Department of Health Care Policy & Financing stated that, since 2007, Colorado's EPSDT annual screening ratios have been decreasing, especially among 6- to 20-year-olds, while national screening trends have been increasing. Although screening ratios among these age groups have been decreasing, the ratios among children younger than 3 are very high and have reached nearly 100%. The state is committed to increasing its understanding of what may account for the decrease and quickly improving results. To improve EPSDT screening outcomes, Colorado has focused on the geographic areas with the highest concentration of eligible clients.
Quality Improvement. Colorado has selected 9 pediatric preventive care measures to focus on including child and adolescent access to primary care providers, well-child visits in the first 15 months, well-child visits among 3- to 6-year-olds, adolescent well-child visits, childhood immunizations, childhood immunization status, chlamydia screening, body mass index (BMI) assessment of children and adolescents, and preventive dental visits. These 9 pediatric care measures are closely aligned to the Bright Futures Preventive Services Quality Improvement Measures. Colorado's Accountable Care Collaboratives have demonstrated commitment to these measures by focusing on implementing child health performance improvement projects related to well-child care, childhood immunizations, BMI assessment, and follow-up communication between referring primary care providers and pediatric obesity specialty clinics.