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  • Accountable Care Collaborative Phase II Concept Paper

    October 20, 2015

    Please send questions and comments to RCCORFP@state.co.us

  • ACC Phase II Concept Paper Page | 1

    Contents 1.0. Introduction ........................................................................................................................................... 3

    2.0. Colorado Medicaid ................................................................................................................................. 4

    2.1. Accountable Care Collaborative ......................................................................................................... 5

    2.2. Community Behavioral Health Services Program .............................................................................. 7

    2.3. Long-Term Services and Supports ...................................................................................................... 8

    3.0. ACC Phase II Principles ........................................................................................................................... 9

    3.1. Person- and Family-Centeredness ..................................................................................................... 9

    3.2. Outcomes-Focused and Value-Based .............................................................................................. 10

    3.3. Accountability at Every Level ........................................................................................................... 12

    4.0. ACC Phase II Overview ......................................................................................................................... 13

    5.0. Detailed ACC Phase II Program Description ......................................................................................... 16

    5.1. Client ................................................................................................................................................ 16

    5.1.1. Onboarding ............................................................................................................................... 17

    5.1.2. Client Engagement .................................................................................................................... 18

    5.1.3. Client Incentives ........................................................................................................................ 18

    5.2. Health Neighborhood ...................................................................................................................... 19

    5.2.1. Health Team .............................................................................................................................. 19

    5.2.2. Health Neighborhood ............................................................................................................... 22

    5.3. Regional Accountable Entity (RAE) .................................................................................................. 24

    5.3.1. Contract and Oversee the Health Team Network .................................................................... 24

    5.3.2. Community Engagement .......................................................................................................... 27

    5.3.3. Manage Systems of Care for Special Populations ..................................................................... 28

    5.4. State Agency .................................................................................................................................... 30

    5.4.1. Flexible Benefit Package ........................................................................................................... 30

    5.4.2. Client Enrollment in the Regional Accountable Entities ........................................................... 31

    5.4.3. Cross-Program and Cross-Agency Alignment ........................................................................... 32

    6.0. Tools for Transformation: Program Infrastructure .............................................................................. 33

    6.1. Payment ........................................................................................................................................... 33

    6.1.1. Shifting from Fee-for-Service to Value-Based Payments .......................................................... 34

    6.1.2. Per-member Per-month Payments ........................................................................................... 36

    6.1.3. Outpatient Professional Capitation .......................................................................................... 37

    6.2. Health Information Technology ....................................................................................................... 38

  • ACC Phase II Concept Paper Page | 2

    6.2.1. State Agency Infrastructure ...................................................................................................... 38

    6.2.2. State and Regional Health Information Exchange (HIE) Network Infrastructure ..................... 39

    6.2.3. RAE Infrastructure ..................................................................................................................... 39

    6.3. Sound Administration ...................................................................................................................... 40

    6.3.1. Program Oversight .................................................................................................................... 40

    6.3.2. Program Maximization .............................................................................................................. 41

    7.0 Conclusion ............................................................................................................................................. 42

  • ACC Phase II Concept Paper Page | 3

    Accountable Care Collaborative Phase II

    1.0. Introduction The Accountable Care Collaborative (ACC) is the core delivery system for Colorado Medicaid. The ACC

    Program is operated by Colorado's Single State Agency, the Colorado Department of Health Care Policy

    and Financing (the State Agency). The first ACC clients were enrolled in May 2011 and as of August

    2015, more than 940,000 of the 1.26 million total Medicaid enrollees were in the ACC. To date, the ACC

    has demonstrated cost and system efficiency results, including more than $29 million in net savings in

    state fiscal year 2013-14. The first five years of the program have created a platform for future reform

    efforts. The ACC is intended to be an iterative program, driving a steady sustainable shift in the delivery

    system from one that incents volume to one that incents value. Contracts for the Regional Care

    Collaborative Organizations (RCCOs), a core component of the ACC, expire in July 2017, creating a key

    opportunity for the State Agency to evolve the program.

    The goal of the next iteration of the ACC is to optimize health for those served by Medicaid through

    accountability for value and client experience at every level of the health system and at every life

    stage.

    Successfully capitalizing on this re-procurement opportunity will require the partnership of all of our

    stakeholders. This Concept Paper serves as a request for our federal, state, and local partners to

    collaborate with us as we work towards building a more integrated health system, to improve the health

    of low-income and underserved Coloradans in an innovative and cost-efficient manner.

    This Concept Paper is organized into the following sections:

    2.0 Colorado Medicaid

    3.0 ACC Phase II Principles

    4.0 ACC Phase II Program Overview

    5.0 Detailed ACC Phase II Program Description

    6.0 Tools for Transformation: Program

    Infrastructure

    While there are clear changes when the current contracts

    expire and the new contracts are implemented, the program is in a constant state of evolution. The

    State Agency will continue to develop and improve the program leading up to and following the

    implementation of Phase II.

    The paper will refer to the program

    model between 2011 and June 30,

    2017 as Phase I and the model after

    July 1, 2017 as Phase II.

  • ACC Phase II Concept Paper Page | 4

    2.0. Colorado Medicaid Colorado Medicaid serves 1.26 million people. In the last five years, eligibility for Medicaid has

    expanded to include more children, pregnant women, parents, and low-income adults. Today, Medicaid

    serves as part of the continuum of health insurance coverage which is made up of employer-sponsored

    insurance, individual and exchange purchased plans, and public coverage like Medicare and Medicaid.

    Figure 1. Demographic breakdown for Colorado Medicaid.

    Colorado Medicaid made great strides in the last two decades to move from caring for the people we

    serve in institutional settings to providing community-based services and supports. The number of

    psychiatric beds has decreased, as have inpatient and institutional stays for individuals with disabilities

    or behavioral health needs. Colorado now has one of the highest rates of home and community-based

    services in the nation. This deliberate change has reduced institutional costs and improved the

    experience for clients and their families.

    Colorado Medicaid enrollees are primarily served through three major systems: the ACC, the

    Community Behavioral Health Services Program, and the Lon

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