Colorado s Accountable Care Collaborative
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1 Colorado s Accountable Care Collaborative Creating a Culture of Change Presented by: Susan Mathieu February 10,
2 Presentation Outline ACC Overview Initiatives Support for Behavioral Health Integration Coordinating with LTSS Coordinating with Public Health Maximizing Community Resources 2
3 What is the ACC? Managed Fee-for-Service Program Offers the full benefits of Medicaid Gives each member a Primary Care Medical Provider (PCMP) a single point of contact for medical care Connects members to appropriate medical care and nonmedical (social) services
4 ACC Components Statewide Data and Analytics Contractor (SDAC) Regional Care Collaborative Organizations (RCCOs) Primary Care Medical Providers (PCMPs) 4
5 Seven RCCOs RCCO 6: Colorado Community Health Alliance RCCOs 2, 3, 5: Colorado Access RCCO 1: Rocky Mountain Health Plans RCCO 7: Community Care of Central Colorado RCCO 4: Integrated Community Health Partners
6 ACC Payment Structure Per Member Per Month (PMPM) payment to RCCOs and PCMPs Pay for Performance incentives Key Performance Indicators Extra PMPM for meeting enhanced medical home standards Higher PMPM for members attributed to a medical home Potential bonus based on certain care standards 6
7 Support for Behavioral Health Integration Coordination requirements for RCCOs and BHOs Community mental health centers can serve as PCMP if contract requirements met Incentive payment for advanced medical home On-site access to behavioral health care providers Behavioral health and developmental screening protocols Protocols to address positive screens Guidance for integrated CMHCs to bill FFS for physical health services 7
8 Support for Behavioral Health Integration RCCO 2: Cross-training with BHO managers and care coordinators to ensure better integration of services RCCO 6: Co-locating mental health providers in primary care practices, developing telehealth options 8
9 Coordinating with LTSS Accountable Care Collaborative: Medicare Medicaid Program (ACC: MMP) Intensive service coordination for Medicare-Medicaid clients RCCOs coordinate acute and community-based services Service Coordination Plan Increased collaboration with Single Entry Points and Community Center Boards 9
10 ACC: MMP Program RCCO coordinates both acute and communitybased services for ALL enrolled clients Acute Care and Hospital services Service Coordination Plan Community -Based Services and Supports Coordination of Primary Care, Acute, Sub-Acute, and Specialty Care clients receiving LTSS: existing long-term care Service Plans and other assessments largely inform the SCP 10
11 Coordinating with Public Health RCCO 6 Current relationship: Some interaction Specific interest: Visioning RCCO 2 Current relationship: Developing, not all LPHAs interested Specific interest: Visioning, Regular meetings, LPHA sits on RCCO Board, Community Health Assessment RCCO 5 Current relationship: Some interaction Specific interest: Visioning, Project, LPHA sits on RCCO Board RCCO 3 Current relationship: Some interaction Specific interest: Undetermined RCCO 1 Current relationship: Some contracts, some interaction, not all LPHAs interested Specific interest: Visioning, Regular meetings, Community Health Assessment, LPHA sits on RCCO Board, Contract RCCO 4 Current relationship: Strong relationship in Pueblo, not all LPHAs interested Specific interest: Visioning, Regular meetings, Community Health Assessment RCCO 7 Current relationship: Strong relationship in El Paso Specific interest: Regular meetings, LPHA sits on RCCO Board, Project, Contract
12 Coordinating with Public Health RCCO 1 Mesa County: focus on suicide prevention, obesity, unwanted pregnancy San Juan Basin: creation of Community Care Team RCCO 2 Partnership with special districts and local providers to provide care coordination Support for focus on reducing impacts of food deserts RCCO 7 Funding to 2 LPHAs to hire community resource navigators help clients with WIC, TANF, SNAP, etc. 12
13 Maximizing Community Resources RCCO 3 Diversion project connecting non-emergent 911 users with appropriate medical/behavioral care in lieu of transport to ER RCCO 7 Program for high-utilizers of 911 that includes household budgeting support, patient activation, personal goal setting Helped some people find housing 13
14 Maximizing Community Resources RCCO 1 Community Care Teams (CCTs): Meet individuals in their homes & neighborhoods Connect PCMPs with care coordination, social and behavioral health services. Teams of social workers, behavioral health specialists and others. RCCO 3 & 5: Cross-Systemic Care Coordination Conference with multiple entities Pilot program to utilize social services systems to serve as medical homes for those without PCMP 14
15 Maximizing Community Resources RCCO 4 Data match to support care for individuals while detained and upon release Software system to enhance communication available to PCMPs, specialists, community resources RCCO 5 Staffing at homeless shelters to help connect clients to community resources Health Neighborhood discussions: education, communication and collaboration 15
16 Maximizing Community Resources RCCO 7 Partnership with local mental health center to connect clients to GED and vocational rehab programming Partnership with non-profit in rural county that reaches out to connect members to social and community services 16
17 Contact Information Susan Mathieu ACC Program Manager 17
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