The Colorado Department of Public Health and Environment (CDPHE), Colorado’s state health department, is submitting an application to the CDC-RFA-DP-23-0004, The National Cardiovascular Health Program funding opportunity. The focus area is Colorado (statewide) and CDPHE has the experience and capacity to work statewide, as well as with specific priority populations, including Medicaid-insured, un/underinsured, Black and Hispanic populations, and women. CDPHE is located at the following permanent address, in the state of Colorado, relevant to the service area proposed in this response: 4300 Cherry Creek Drive South Denver, CO 80246.
Cardiovascular disease (CVD) is the leading cause of death in Colorado and nearly half (48.4%) of all Colorado adults 18 and older are living with a CVD diagnosis of either high blood pressure (HTN) or high cholesterol. The prevalence of CVD is not distributed equally in Colorado, revealing underlying inequities in power, and prevention and management resources. Over a quarter (26%) of Colorado adults have HTN, but this figure is higher among those identifying as Black (27.5%) and those on Medicaid (50.5%). Recognition of the intersectional aspect of these communities is essential as those who identify as members of more than one of these communities have relatively worse outcomes. Over a third (32%) of adults have high blood cholesterol, with higher prevalence among women living at 0-250% of the federal poverty level (FPL; 34%) or Hispanic women (35%). As Colorado’s population grows and becomes more diverse, it is imperative to work with entities serving priority populations to provide culturally-tailored services to prevent and manage cardiovascular disease, address health-related social needs, and increase access to social services.
CDPHE is well-poised to achieve the outcomes of this cooperative agreement. Over the last 10 years, CDPHE has built an infrastructure of dedicated staff with expertise in program development, implementation, and sustainability. CDPHE will leverage existing infrastructure to increase the use of technology to support practice transformation and adoption of team-based care (TBC) approaches, and strengthen community-clinical linkages. CDPHE will partner with practice transformation organizations and Colorado Medicaid (Health Care Policy and Financing, HCPF), who are committed to working together to build clinical capacity to use their own data to identify patient needs, coordinate care, and improve clinical quality measures and health equity. CDPHE will develop a statewide learning collaborative (LC) through the Regional Health Connector (RHC) program and partnerships with innovative programs that are building bi-directional referral networks, training for community pharmacists to deliver disease management programming, and others who are training Community Health Workers (CHWs) to support clients with chronic disease.
By the conclusion of the five-year performance period, CDPHE aims to break down care silos and bridge together statewide initiatives in order to maximize their impact and sustainability, and reach program goals, including; improved blood pressure control among populations within partner healthcare and community settings, reduced disparities in HTN control among populations within partner healthcare and community settings, and increased utilization of social services and support among populations at highest risk of CVD, with a focus on hypertension and high cholesterol.