Colorado s Accountable Care Collaborative

(1)

Suzanne Brennan, Medicaid Director

Colorado Department of Health Care Policy and Financing

Colorado’s Accountable Care

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HCPF Goals

1. Transforming our systems from a medical

model to a health model.

2. Moving toward person‐centered, integrated

and coordinated supports and services.

3. Leveraging efficiencies to provide better

quality care at lower costs to an expanded

population.

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Shifting To a Health Based

Model of Care

• Delivery‐centric

• Access

• Diagnosis

• Treatment

• Habilitation

• Maintenance

• Person‐centric

• Prevention

• Community support

• Screening

• Community alternatives

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Accountable Care Collaborative (ACC)

Program Vision

• _{Delivery System Reform}

– Improve health outcomes

– Reduce costs

– Improve the client and provider experience

– Focal point of care for all clients

– Introduce unprecedented data and analytics

• _{No change to current Medicaid benefit package}

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ACC Program

Statewide Data and

Analytics Contractor

(SDAC)

Statewide Data and

Analytics Contractor

(SDAC)

Primary Care Medical

Providers (PCMPs)

Primary Care Medical

Providers (PCMPs)

Regional Care

Collaborative

Organizations

(RCCOs)

Regional Care

Collaborative

Organizations

(RCCOs)

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ACC Enrollment

‐

50,000

100,000

150,000

200,000

250,000

300,000

May

‐11

Jun

‐11

Jul

‐11

Aug

‐11

Sep

‐11

Oct

‐11

Nov

‐11

Dec

‐11

Jan

‐12

Feb

‐12

Mar

‐12

Apr

‐12

May

‐12

Jun

‐12

Jul

‐12

Aug

‐12

Sep

‐12

Oct

‐12

Nov

‐12

Dec

‐12

Jan

‐13

Feb

‐13

Mar

‐13

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Colorado’s Regional Care

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RCCO

Responsibilities

Components of the ACC

Achieve financial and health

outcomes.

Ensure comprehensive care

coordination and a Medical

Home level of care for every

member through

• Network Development/

Management

• Provider Support

• Medical Management

and Care Coordination

• Accountability/Reporting

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Primary Care

Medical Provider

Responsibilities

PCMP

serves as a Medical

Home

Member/family centered

Whole person oriented

Coordinated care

Promotes client self‐

management

Care provided in a culturally

sensitive and linguistically

sensitive manner

Accessible

Components of the ACC

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SDAC

Responsibilities

Components of the ACC

Data Repository

Data Analytics &

Reporting

Web Portal & Access

Accountability &

Continuous

Improvement

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• Per Member Per Month reimbursement

– RCCOs

–

_PCMPs

• Implemented incentive payment

–

$1 PMPM to RCCOs and PCMPs based on

performance on ER visits, high cost imaging

and 30 day all cause readmissions

• _{Shared savings}

Payment Reform

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• 1281 Payment Reform Pilots

–

Experiment with different payment types on the

continuum

–

Received 10 proposals from RCCOs

• Payment reform moving forward

–

Reimbursing specialists for non‐visit consultation

–

Telemedicine/Project ECHO

–

Risk adjusted Per Member Per Month

–

More dollars at risk

–

Multipayer efforts

Payment Reform (Con’t)

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• Enrollment– Enrollment & attribution methodology,

provider contracting

• Communication – Consistent and ongoing

internal/external messaging, training and stakeholder

engagement

• Administrative referrals – Did not accomplish goal of

coordinated care and information sharing between

providers. The RCCOs and PCMPs are now developing

protocols for a clinical referral process not tied to claims.

• Setting an appropriate Per Member Per Month

• Measuring Savings

Lessons Learned/Challenges

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Accountable Care Collaborative

First Year Results

• FY11‐12 Department reduced Medicaid health costs by

$20 million

• Returned nearly $3 million to state and federal

taxpayers since its inception

• Indicators – ACC Clients

– Hospital Readmissions

8.6% Reduction

– Emergency Room Utilization .23% Increase

– High‐Cost Imaging

3.3% Reduction

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1. Delivery System Redesign

2. Benefits Design & Management

3. Payment Reform

4. State administrative improvements

5. IT in execution and evaluation

System Change from Every Angle

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Department Initiatives Under

Development

• LTSS Transformation

• Enhanced Integration

– SIM – Behavioral Health Integration

• TeleHealth/Project Echo

• Access to Specialty Care

• Medicaid Expansion

• Medicare‐Medicaid Enrollees

• HIT

– MMIS

– Cross Agency

– Coordination with HIE

– Enhanced Data Collection and Sharing

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Questions

Suzanne Brennan

Medicaid Director

Colorado Department of Health

Care Policy & Financing

1570 Grant Street

Denver, CO 80203

[email protected]

303‐866‐3058