Bringing Accountable Care To Medicaid · help them understand their insurance and ensure they receive thebenefits for which theyhave. Supported by OIT. ** programs thatseek to improve

Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing

Bringing Accountable Care To Medicaid

Susan E. Birch, MBA, BSN, RN Executive Director, Colorado Department of Health Care

Policy & Financing 1


AgendaColorado Overview

Accountable Care Collaborative Program Structure

Regional Care Organizations

Primary Care Providers

Statewide Data and Analytics

Results

2012 Annual Report

2013 Annual Report

Future of the Program

Medicaid Expansion

Expanding coverage & improving value

2


Governor’s State of Health: Four Focus Areas


4

Our mission: Improving health care access and outcomes for people

we

serve while demonstrating sound stewardship of

financial resources


Administers the

Medicaid and

CHP+* as well as a

variety of other

programs for

Colorado's low‐

income individuals,

families, and

persons with

disabilities.

Supported by OIT.**

Administers

assistance

programs such as

food and cash

assistance that

improve the safety,

independence and

well‐being of

Coloradans. Also

works closely with

HCPF on the

coordination of

behavioral health

and substance

abuse benefits.

Supported by OIT. **

Health Insurance

Marketplace for

individuals,

families and small

employers to

compare health

plan options, apply

for insurance

affordability

programs and to

buy health

insurance and use

new financial help

to reduce the cost

of insurance.

Regulates insurance

industry to ensure

companies follow

the laws and can

afford to pay claims.

Works with

consumers to

answer questions,

help them

understand their

insurance and

ensure they receive

the benefits for

which they have

paid.


Administers

programs that seek

to improve health

outcomes through

the promotion of

health, wellness

and prevention.


Working Together for Colorado

*CHP+ is the Child Health Plan Plus **OIT is the Governor's Office of Information Technology


Colorado Medicaid Expansion & Marketplace

6

Marketplace> 400% FPL

Marketplace> 250‐400% FPL*

Marketplace> 250‐400% FPL*

Marketplace> 133‐400% FPL*CHP+

> 133‐250% FPL

CHP+> 185‐250% FPL

Medicaid< 185% FPLMedicaid

< 133% FPLMedicaid< 133% FPL

Children Pregnant Women Adults

* Advanced Premium Tax Credits and Cost Sharing Reductions


7

Historical Model: Before Accountable Care Collaborative

??

?

?


Improving health care accessand outcomes for the peoplewe serve while demonstrating sound stewardship of financial resources

Our Mission:

New Model: Accountable Care Collaborative


9

Regional Care

Collaborative

Organizations (RCCOs – 7)

Primary Care Providers(PCPs)

Statewide Data

and Analytics

Contractor(SDAC)

Components


10


Regional Care Organizations

•• Achieve health & financial

outcomes • Ensure comprehensive care

coordination, Medical Home

level of care • Network

Development/Management • Provider Support • Medical Management &

Care Coordination • Accountability/Reporting


• Serves as Medical Home

• Member/family centered

• Whole person oriented

• Coordinated

• Promotes client self‐management

• Care provided in a culturally sensitive and linguistically sensitive manner

• Accessible

Primary Care Providers


Statewide Data and Analytics

13

•Data Repository

• Data Analytics & Reporting

• Web Portal & Access

• Accountability & Continuous

Improvement


14

Client Success Story

A diabetic male ACC member was unable to transfer his Food Stamps

from one county to another. As a result the client began dumpster diving

in order to eat. Not only did this new diet exacerbate his diabetes he also

contracted bed bugs from the dumpsters themselves. As a sufferer

of

sleep apnea he was forced to sleep in a recliner, however due to

the bed

bugs the recliner had to be thrown away and the patient had to sleep on

the floor.

With both of his conditions acting up, he often frequented the ER. After

uncovering the needs of the client, the RCCO was able to transfer his

Food Stamps from one county to another and through the help of local

charities they were able to get him a new recliner. He has not gone to the

ER since.


Enrollment 200,000

Performance Incentives

Medicare‐Medicaid

Enrollees Implementation

with CMS approval

HB12‐1281

Implementation

Accountable Care Collaborative

By June 2013, enrollment at 352,236

$1.1M given to Providers and RCCOs for

meeting performance metrics

Submitted implementation plan in May

2013. Waiting on CMS approval

Rocky Mountain Health Plans pilot project

selected in competitive process. Pilot will

begin in 2014

2013 Results2013 Goals


What’s Ahead for the ACC?

ACCACC5 Point 5 Point

PlanPlan

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Documents

Bringing Accountable Care To Medicaid · help them understand their insurance and ensure they receive thebenefits for which theyhave. Supported by OIT. ** programs thatseek to improve