Colorado Access, a nonprofit health plan, collaborated with the Center for Health Care Strategies and the State of Colorado Department of Health Care Policy Financing, to develop, implement, and evaluate a care management services pilot program focused on improving the quality of care and decreasing the cost of care for the highest cost, highest need Medicaid recipients. Colorado Access' preliminary internal evaluation demonstrated decreases in hospitalizations and emergency department utilization and increases in primary care ambulatory visits and member satisfaction. Qualitative analyses informed program implementation. Implementation lessons learned are discussed.