Transcript Components of the ACC (cont.)

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presentation and/or related materials
Department of Health Care Policy and Financing
Colorado Department of Health Care Policy and Financing
Department of Health Care Policy and Financing
Colorado Department of Health Care Policy and Financing
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 Financing
Colorado Department of Health Care Policy and Financing
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 Financing
Colorado 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 Financing
Colorado Department of Health Care Policy and Financing
RCCO Map
Region 1
Region 2
Region 3
Region 4
Region 5
Region 6
Region 7
Department of Health Care Policy and Financing
Rocky Mountain Health Plans
Colorado Access
Colorado Access
Integrated Community Health Partners
Colorado Access
Colorado Community Health Alliance
Community Care of Central Colorado
Colorado Department of Health Care Policy and Financing
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
Department of Health Care Policy and Financing
Colorado Department of Health Care Policy and Financing
Components of the ACC (cont.)
• PCP serves as a Medical
Home
•Member/family centered
•Whole person oriented
PCP
Responsibilities
•Coordinated
•Promotes client selfmanagement
•Care provided in a culturally
sensitive and linguistically
sensitive manner
•Accessible
Department of Health Care Policy and Financing
Colorado Department of Health Care Policy and Financing
Components of the ACC (cont.)
SDAC
Responsibilities
• Data Repository
• Data Analytics & Reporting
• Web Portal & Access
• Accountability & Continuous
Improvement
Department of Health Care Policy and Financing
10
Colorado Department of Health Care Policy and Financing
ACC Process
Department of Health Care Policy and Financing
Colorado 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 Financing
Colorado Department of Health Care Policy and Financing
ACC Advisory Committees
•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
Department of Health Care Policy and Financing
Colorado 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 Financing
Colorado Department of Health Care Policy and Financing
Client Selection &
Enrollment
• 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
Department of Health Care Policy and Financing
Colorado 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 Financing
Colorado Department of Health Care Policy and Financing
RCCO Contact Information
•
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
Department of Health Care Policy and Financing
Colorado Department of Health Care Policy and Financing
Questions?
Kathryn Jantz 303-866-5972
[email protected]
Catania Jones 303-866-3164
[email protected]
Gregory Trollan 303-866-3674
[email protected]
colorado.gov/HCPF
Department of Health Care Policy and Financing
Colorado Department of Health Care Policy and Financing