Accountable Care Collaborative Colorado Department of Health Care Policy and Financing

Transcription

1 Accountable Care Collaborative Colorado Department of Health Care Policy and Financing 1

2 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 2

3 Development of the Accountable Care Collaborative Program Created in response to: Failed attempts at capitated Managed Care in the state. 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 3

4 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 4

5 ACC Program Components 5 Medicaid Program Division

6 RCCO Map 6 Medicaid Program Division

7 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 7

8 PCMP Responsibilities PCMP 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 8

9 SDAC Responsibilities Data Repository Data Analytics & Reporting Web Portal & Access Accountability & Continuous Improvement 9

10 ACC DATA ANALYTICS- Opportunities 10

11 Referrals PCMP refers to specialists Referrals are not needed for: Obstetrical Services Dental and vision services Emergency Care Family Planning EPSDT Screening Behavioral health Anesthesiology services HCBS waiver services Transportation Hospice We are currently paying all claims regardless of whether or not we receive a referral. 11

12 ACC Advisory Committees ACC Program Improvement Advisory Committee Subcommittees Payment Reform, Provider and Community Relations, Quality and Health Improvement RCCO Performance Improvement Advisory Committees 12

13 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 RCCO s for PCMP support and member care coordination* Incentive Payments *Children s Medical Home providers do not receive the PMPM because they are already receiving the enhanced rate. 13

14 Client Selection & Enrollment FFS and PCPP clients 1/3 Children, 2/3 adult Exclude institutionalized and dual-eligible clients If possible, attached to provider Voluntary (passive enrollment) * Notified by enrollment letter Call HealthColorado to opt out or *Adults without dependant children will be mandatorily enrolled. 14

15 Program Phases Initial Phase: RCCOs select small focus communities within their region - 60,000 clients - Increased enrollment to 123,000/budget action Expansion Phase: increased enrollment after attainment of budget goals beginning July

16 April 2012 Enrollment (estimated *) RCCO Enrolled 1 13, , , , , , ,353 Total: 125,953 ( * - total enrollment figures vary daily due to eligibility and other factors) 16

17 Potential Next Steps Quality and clinical data Payment reform Health Homes Dual eligible project Program evaluation 17

18 Questions? Kathryn Jantz colorado.gov/hcpf 18