department of health care policy and financing colorado department of health care policy and...
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Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing
Disclaimer:There are no conflicts of interest or restrictions (including off-label use
disclosure) related to this presentation and/or related materials
Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing
The Accountable Care Collaborative
Program
Presented at the 2013 CASBHC Annual ConferenceMay 2, 2013
by
Greg Trollan, MA
Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing
Healthcare Reform
Accountable Care Organizations (ACOs)• National Health Reform
Accountable Care Collaborative (ACC)• Colorado’s delivery system reform
-Governor’s Agenda-Stakeholder input-Budget Action
• Developed prior to federal ACO concept
Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing
Development of the ACC Program
Created in response to:
• Unsuccessful attempt at capitated Managed Care in Colorado
• 85% in an unmanaged Fee-For-Service (FFS) system
• Unprecedented economic situation, highest caseload and expenditures in the state’s history of Medicaid
• Desire not to continue to pay for higher volume/ utilization
Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing
Program Vision •No change to current Medicaid Benefit Package.
•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
Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing
RCCO Map
Region 1 Rocky Mountain Health PlansRegion 2 Colorado AccessRegion 3 Colorado AccessRegion 4 Integrated Community Health PartnersRegion 5 Colorado AccessRegion 6 Colorado Community Health AllianceRegion 7 Community Care of Central Colorado
Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing
• 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
Components of the ACC
RCCOResponsibiliti
es
Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing
PCP Responsibilitie
s
• PCP serves as a Medical Home
•Member/family centered
•Whole person oriented
•Coordinated
•Promotes client self-management
•Care provided in a culturally sensitive and linguistically sensitive
manner
•Accessible
Components of the ACC (cont.)
Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing
9
SDACResponsibilitie
s
• Data Repository
• Data Analytics & Reporting
• Web Portal & Access
• Accountability & Continuous Improvement
Components of the ACC (cont.)
Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing
ACC Process
Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing
ACC Referral Process
•The Accountable Care Collaborative Program does not require that specialists get an administrative referral from the Primary Care Medical Provider.
•The RCCOs and PCMPs are developing protocols for a clinical referral process.
Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing
•ACC Program Improvement Advisory Committee (quarterly)
•Subcommittees (monthly)Payment Reform, Provider and Community Relations, Quality and Health Improvement , Medicare-Medicaid Enrollees
•RCCO Performance Improvement Advisory Committees
ACC Advisory Committees
Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing
PCMP & RCCO Payment
• FFS reimbursement to PCMPs for medical services
• Per Member Per Month (PMPM) payment to PCMP for medical home services*
• PMPM payment to RCCOs for PCMP support and member care coordination
• Incentive Payments
*Children’s Medical Home providers do not receive the PMPM because they are already receiving an enhanced rate.
Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing
• FFS and Primary Care Physicians Program (PCPP) clients
• If possible, attached to provider based on claims history
• Voluntary (passive enrollment) • Notified by enrollment letter • Call HealthColorado to opt out • 303-839-2120 or 1-888-367-6557
Client Selection & Enrollment
Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing
Next Steps
• Enhanced Integration• CPC Initiative• Medicare-Medicaid Enrollees• 1281 Payment Reforms• Shared Savings• Enhanced Data Collection and Sharing
Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing
• RCCO 1: Rocky Mountain Health plans 800-667-6434
• RCCO 2: Colorado Access 855-267-2094
• RCCO 3: Colorado Access 855-267-2095
• RCCO 4: Integrated Community Health Partnership 855-959-7340
• RCCO 5: Colorado Access 855-384-7926
• RCCO 6: Colorado Community Health Alliance 877-919-2888
• RCCO 7: Community Care of Central Colorado 866-938-5091
RCCO Contact Information
Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing
Questions?Kathryn Jantz 303-866-5972
Catania Jones [email protected]
Gregory Trollan 303-866-3674 [email protected]
colorado.gov/HCPF