Colorado s Accountable Care Collaborative

Transcription

1 Colorado s Accountable Care Collaborative Suzanne Brennan, Medicaid Director May 19, 2013

2 Who We Serve 2

3 Alignment with Triple Aim 3

4 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. 4

5 Shifting To a Health Based Model of Care Delivery centric Access Diagnosis Treatment Habilitation Maintenance Person centric Prevention Community support Screening Community alternatives 5

6 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 6

7 ACC Program Statewide Data and Analytics Contractor (SDAC) Regional Care Collaborative Organizations (RCCOs) Primary Care Medical Providers (PCMPs) 7

8 ACC Enrollment 300, , , , ,000 50,000 Mar 13 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 8

9 Colorado s Regional Care Collaborative Organizations (RCCO s) 9

10 Components of the ACC RCCO Responsibilities 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 10

11 Components of the ACC PCMP serves as a Medical Home Member/family centered Whole person oriented Coordinated care Promotes client selfmanagement Care provided in a culturally sensitive and linguistically sensitive manner Accessible Primary Care Medical Provider Responsibilities 11

12 Components of the ACC SDAC Responsibilities Data Repository Data Analytics & Reporting Web Portal & Access Accountability & Continuous Improvement 12 13

13 Delivery System Transformation Slide provided by Colorado Health Institute

14 Payment Reform 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 14

15 Payment Reform (Con t) 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 15

16 Lessons Learned/Challenges 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 Change is hard 16

17 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 17

18 Slide provided by Colorado Health Institute

19 System Change from Every Angle 1. Delivery System Redesign 2. Benefits Design & Management 3. Payment Reform 4. State administrative improvements 5. IT in execution and evaluation 19

20 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 20

21 Questions Suzanne Brennan Medicaid Director Colorado Department of Health Care Policy & Financing 1570 Grant Street Denver, CO