INFORMATION & LOGISTICS RCCO Regions 3 & 5

November 19, 20141:30pm-4pm

Agenda

• Welcome and Introductions

• Quick Look: How We Support Each Other

• Facts, Reminders, and Stuff to Know

• Medical Benefit Updates

• Project ECHO

• Reminder: New Practice Supports

• Enhanced Primary Care Factors

• Plans for 2015

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Enrollment Summary

Region Members Adult Members Child Members % Attributed to a PCMP

2 61,242 24,447 36,795 81%

3 207,562 82,872 124,690 77%

5 59,790 29,766 30,024 82%

Total 328,594 137,085 191,509 78%

As of November 14, 2014 per Daily Member List

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Quick Look: How We Support Each OtherA BRIEF REPORT OF OUR IMPACT ON REGIONS 2, 3 & 5 – FY 2014

We’ve Strengthened Infrastructure while Responding well to Significant Growth

Our RCCO KPI Outcomes Reveal Long-Term Positive Cost Impact and Triple Aim Value

We’re Driving Successful Expansion of Provider Access, Support & Engagement

Effective Care Management Strategies are Improving Healthcare Utilization

Leveraging Data & Innovative Payment Models Bring Improved Outcomes, Collaboration & Cost

We’ve Strengthened Infrastructure while Responding well to Significant Growth

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Provider Access, Collaboration & Engagement Rising while RCCO Members Reap Benefits

500%INCREASEIN AFTER-HOURSACCESS

43NEW PCMPPRACTICES

Completed

ADD

ED

36IndividualizedPractice PerformanceMeetings with Client CaseReviews

AUTOMATEDOUTREACHCALLSto reach patientsnot coming infor needed care

Fund

ed

80%OF PRACTICESARE MEETINGCARE ACCESSIBILITYSTANDARDS*

* Some areas 90-95%

$300KIN PERFORMANCE

INCENTIVES AS GRANTS TO6 COMMUNITY PARTNERS

FOR INTEGRATED CARE PROGRAM DEVELOPMENT

REINVESTED

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69OF FIRST 100HIGH-RISKFBMMECLIENTSMET OR WILL MEETTO COMPLETE THE

SCP

Effective Care Management Strategies are Improving Healthcare Utilization

$84,000SAVINGSIN ER COSTS ALONE

78% WERE STILLENROLLEDAFTER 1 YEAR

56%REDUCED ER VISITS*

300 ER “SUPER USERS”

2CARE MANAGERS

* REDUCED BY ≥5 ER VISITS IN THE CURRENT VS. PRIOR 12 MONTH PERIOD

WORKING TOGETHER FOR A YEAR

TRUSTING RELATIONSHIPSCARE PLAN MANAGEMENTMEDICAL HOME CONNECTIONSEDUCATIONSUPPORT

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We’ve Strengthened Infrastructure while Responding well to Significant Growth

CARE MANAGEMENTTRAINERFOCUSED ON IMPROVINGMOTIVATIONAL INTERVIEWINGAND WHOLE PERSON CARE

HIRED A NEW

CARE MANAGEMENTSIGNIFICANT SCALING OF CORE

STAFF & BEST PRACTICES

PCMP DELEGATIONNEW MANAGER IN PLACE OVERSEEING

TO ROUTINELY REVIEW AUDITS, POLICY

Sept 2013 - July 20140

50000

100000

150000

200000

250000

300000

350000

MembershipIncrease

~70% NEW

INTEGRATED CAREDIRECTORBRINGING EXPERTISEACROSS RCCO & BHO

Facts, Reminders, and Stuff to Know

Increased Rates for Office Visits and Vaccine Administration – Beginning January 1, 2015, Colorado Medicaid will reimburse

covered office visit procedure codes and vaccine administration procedure codes for all providers at a rate equal to 100% of the Medicare’s December 2014 reimbursement rate. The new rate will be available to all enrolled providers that submit fee schedule claims for office visits or vaccine administrations. The new reimbursement rate will be in place until June 2016.

Coverage for US Preventative Task Force (USPTF) A and B Level Recommendations– Colorado Medicaid expanded primary care coverage to include

USPTF A and B level recommendations and the immunizations recommended by the Advisory Committee on Immunization Practices.

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Facts, Reminders, and Stuff to Know

Please Update Provider Contact Information in MMIS – Colorado has many new members looking for PCMPs

– Please verify and/or update provider informationin MMIS as soon as possible.

– Up-to-date information assures that payments and communications are sent timely and appropriately.

– The Web Portal via MMIS Provider Data Maintenance option is the easiest and most efficient method to keep information current. • However, providers who do not have the capability to make updates through

the Web Portal may use the Provider Enrollment Update form to make the necessary changes. Please call the Department’s fiscal agent, Xerox State Healthcare for assistance with this process at 1-800-237-0757.

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Medicaid Benefit Updates

The final version of the Dental Services for Children rule, will be effective on November 30, 2014. Scroll to section 8.201, on the Code of Colorado Regulations website.

– The DentaQuest Medicaid Dental Provider Office Reference Manual will be updated to reflect the revised children’s dental benefits and published within the coming weeks on the DentaQuest Colorado Providers website.

Effective November 1, 2014 , the new NEMT broker is Total Transit. Total Transit serves: Adams, Arapahoe, Boulder, Broomfield, Denver, Douglas, Jefferson, Larimer and Weld counties. – The Department sent letters to approximately 19,000 members who have

used NEMT services within the past year

– Please contact Doug Van Hee at Doug.Vanhee@state.co.us or by phone at 1-303-866-4986 with questions.

Always remember to read the Provider Bulletins each month!

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You are Invited!On behalf of your RCCO, Colorado Access, I am inviting you to participate in an exciting and innovative new program to help your patients get needed care--the Project ECHO-Chronic Pain Management Program. In this program, PCMPs consult directly with a multidisciplinary team of pain specialists regarding your adult patients with pain and learn best practices for managing a complexity of chronic pain conditions.We asked for your feedback regarding needed practice supports that RCCOs and the State could provide to PCMPs. We heard your need for pain management and the State has responded with a state-of-the-art, novel, and statewide effort that leverages cutting edge tele-health technologies, to connect PCMPs to needed specialists. The Colorado Department of Health Care Policy and Financing will sponsor approximately 50 PCMPs to participate in Project ECHO. Participation is easy and the benefits for you and your patients are significant:– Gain expertise in treating and managing your patients with a variety chronic pain conditions,– Keep your patients in your practice and in their communities,– Easy attendance from anywhere through an online video conference system,– Earn CME credit for attending the ECHO pain management sessions, and– NO COST to participate.

Become a pioneer and be part of project ECHO! Click here to participate. Participation is on a first-come basis. Please sign-up by December 31, 2014 and feel free to contact me for further information. Sincerely yours,

Deb Parsons, MD, FACPSenior Medical Director, Colorado Access720-744-5411debra.parsons@coaccess.com 11

Reminder: New Practice Supports

• Integrated Care Innovations Program

• Tele-Behavioral Health

• Adolescent Depression Screening (PIP)

• Well Child Check IVR Campaign

• ED Diversion Booklet

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Enhanced Primary Care Factors

To be eligible for the enhanced primary care payment, PCMPs must meet 5 of the 9 factors

– The enhanced primary care payment will be a $0.50 PMPM for each month between July 1, 2014 and June 30, 2015, the PCMP has met at least 5 of the 9 factors.

– Payment will be made as a one-time, lump-sum payment on or before August 31, 2015. The payment will be calculated based on the number of attributed members a provider had for each month of eligibility.

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Enhanced Primary Care Factors: Provider Education & Timeline for AttestationLook for information about the enhanced primary care payment in our provider meetings, upcoming webinars, and the PCMP newsflashs.

– To attest your practice meets the criteria for the enhanced primary care payment, at any time between July-Dec 2014, please submit the required documentation to your contract manager by December 31, 2014.

– All attestations a practice has met the criteria for the enhanced primary care payment, at any time, between January-June, 2015 (and those not submitted by December 31st) may be submitted, on a rolling basis, through May 1, 2015.

***No submissions will be accepted after May 1, 2015***

– A practice becomes eligible for the payment the first full month the practice can prove they have met at least 5 of the 9 enhanced standards. • If a provider becomes eligible after the first day of a month, their eligibility will

begin as of the next month.

The Colorado Access RCCO team and CCHAP will assist in devising a work plan for any practice that requests assistance.

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Enhanced Primary Care Factors: Timeline for Attestation & Review of AttestationColorado Access will ask PCMPs in multiple regions, to which RCCO their practice would like to submit the required documentation. – If the multi-region PCMPs select Colorado Access, then their Contract Manager will

notify the other RCCO Regions of the PCMPs selection.

The nine factors are and how they are measured can be found here.

The documentation checklist can be found here.

A committee will review the documentation submitted by the PCMP, prior to submitting the documentation to HCPF. – The date of this review will be the date Colorado Access verified the PCMPs eligibility.

– The committee will be comprised of contract managers, delegate manager, and care managers, and will determine whether the PCMPs documentation will be submitted to HCPF.

– The Contract Manager will communicate the committee’s decision within 2 business days to the PCMP, and provide confirmation of when the documentation has been submitted to HCPF. • If the submitted documentation has not met the requirements, the PCMP has until May 1,

2015 to resubmit the required documentation.

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Enhanced Primary Care Factors:1. The PCMP has regularly scheduled appointments (at least one time

a month) on a weekend and/or on a weekday outside of typical workday hours. RCCO reviewed one of the following forms of documentation specifically showing that the PCMP offers appointments at least 1 time a month (RCCOs may allow some seasonal exceptions) either on weekends, before 7:30 am during the week, or after 5:30 pm during the week:

□ Patient handout/brochure

□ Appointment card

□ Photo of office sign showing office hours

□ Website

□ Copy of schedule with at least 1 month of data showing availability of after-hours appointments

□ Report (aggregated data) showing after-hours availability

□ Documented process: policy, procedure, or workflow with date of implementation

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Enhanced Primary Care Factors2. The PCMP provides timely clinical advice by telephone or secure electronic

message both during and after office hours. Patients and families are clearly informed about these procedures.RCCO reviewed one of the following forms of documentation showing how the PCMP communicates to patients and families regarding the PCMP’s policy to provide clinical advice by telephone or secure electronic message both during and after office hours:□ Patient handout/brochure□ Website□ Documented process: policy, procedure, or workflow with date of implementation □ Secret shopper program□ Report (aggregated data showing evidence) 5 days of calls and/or 5 days of electronic messages□ Report (aggregated data showing evidence) monitoring timeliness of the response against the

practice policy□ Three examples of clinical advice documented in patient record (de-identified)□ Report for 1 month demonstrating documentation of clinical advice with a rate during office hours

i. Denominator = # of patients receiving telephone or electronic clinical advice during office hoursii. Numerator = # of patients with telephone or electronic clinical advice during office hours documented in

the EMR□ Report for 1 month demonstrating documentation of clinical advice with a rate for after hours

i. Denominator = # of patients receiving after-hours telephone or electronic clinical adviceii. Numerator = # of patients with after-hours telephone or electronic clinical advice documented in the

EMR

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Enhanced Primary Care Factors3. The PCMP uses available data (e.g., SDAC, clinical information) to identify

special patient populations who may require extra services and support for medical and/or social reasons. The Practice has procedures to proactively address the identified health needs.RCCO reviewed one of the following forms of documentation showing the PCMP has developed a list (de-identified) of at least one special patient population within the practice (e.g., diabetic, heart failure, mental status, cultural/linguistic):□ Paper list

□ Electronic list

□ Documented process: policy, procedure, or workflow to address the comprehensive health assessment of these populations with date of implementation

PLUS one of the following examples of proactive outreach to at least 1 special patient population

□ Documented process: policy, procedure, or workflow to proactively address the identified needs of this population with date of implementation

□ Mail reminder

□ Email reminder

□ Telephone reminder

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Enhanced Primary Care Factors4. The PCMP provides on-site access to behavioral health

care providers. RCCO reviewed one of the following forms of documentation showing the PCMP offers on-site, face-to-face access (including live video) to a licensed behavioral health care provider (BHP) for the equivalent of at least 1 day a month:□ Employment record/job description for BHP

within practice

□ Contract with BHP for provision of services

□ Published information with on-site behavioral health provider’s schedule

□ Documented process: policy, procedure, or workflow showing integration of behavioral health services into physical health workflow with date of implementation

□ Submit a registry or list of patients (de-identified) being seen by behavioral health care provider

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Enhanced Primary Care Factors5. The PCMP collects and regularly updates a behavioral health screening

(including substance use) for adults and adolescents and/or developmental screening for children (newborn to five years of age) using a Medicaid approved tool. In addition, the practice has documented procedures to address positive screens and has established relationships with providers to accept referred patients or utilizes the standard referral and release form created by the Behavioral Health Organizations.RCCO reviewed one of the following forms of documentation showing the PCMP regularly administers behavioral health and/or developmental screening and has procedures to address positive screens: □ Report (paper or electronic) listing behavioral health, substance use, or developmental

screenings provided within the past month

□ Form for behavioral health, substance use, or developmental screening that is given to patient at least annually

□ Documented process: policy, procedure, or workflow for conducting, collecting, and documenting behavioral health, substance use, and/or developmental screenings.

□ Report (aggregated data showing evidence) of screening:i. Denominator = # of patients seen by practice at least once during the reporting period (3 months)

ii. Numerator = # of patients for whom the screen was performed

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Enhanced Primary Care Factors5. The PCMP collects and regularly updates a behavioral health screening (including

substance use) for adults and adolescents and/or developmental screening for children (newborn to five years of age) using a Medicaid approved tool. In addition, the practice has documented procedures to address positive screens and has established relationships with providers to accept referred patients or utilizes the standard referral and release form created by the Behavioral Health Organizations.RCCO reviewed one of the following forms of documentation showing the PCMP regularly administers behavioral health and/or developmental screening and has procedures to address positive screens: (CONT.)PLUS an example of at how the PCMP manages positive screens, such as formal or informal referral agreements with specialty providers:□ Copy of compacts and/or co-management agreements with Behavioral Health Organizations.□ Referral request form (e.g., “Referral and Release Form Behavioral Health Services” developed by BHOs)□ CO Medical Society primary care-specialty care compact□ Documented process: policy, procedure, or workflow regarding referrals and the exchange of

information with the date of implementation□ Documented process: policy, procedure, or workflow regarding partial or full integration of behavioral

health care services with the date of implementation□ Report (aggregated data showing evidence of) referral for positive screens

6. Denominator = # of patients with a positive screen during the reporting period (3 months)7. Numerator = # of patients referred

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Enhanced Primary Care Factors6. The PCMP generates lists of patients actively receiving

care coordination. RCCO reviewed one of the following forms of documentation showing the PCMP has a recently updated (within last 3 months) list of patients receiving care coordination: □ Paper list of patients and families (de-identified) receiving

care coordination within the previous 3 months

□ Electronic list of patients and families (de-identified) receiving care coordination within the previous 3 months

□ Sample of care plans that have been updated in the last 3 months

□ Documented process: policy, procedure, or workflow with date of implementation

□ Documentation of conversation with RCCO care coordinator and care management plan

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Enhanced Primary Care Factors7. The PCMP tracks the status of referrals to specialty care providers

and provides the clinical reason for the referral along with pertinent clinical information. RCCO reviewed one of the following forms of documentation showing how the PCMP provides relevant supporting information with referrals and tracks the status of referrals: □ Documented process: policy, procedure, or workflow

with date of implementation

□ CO Medical Society primary care-specialty care compact

□ Printed tracking sheet for referrals

□ Electronic list of referrals for tracking purposes

PLUS an example that the PCMP has implemented the process□ Sample of referrals

□ Report (aggregated data showing evidence) of referral tracking for a 3 month period1. Denominator = # patients referred to specialty care providers

2. Numerator = # of referrals with the clinical reason and pertinent clinical information

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Patient Referrals

Enhanced Primary Care Factors

8. The PCMP will accept new Medicaid clients for the majority of the year. RCCO reviewed one of the following forms of documentation of the PCMP’s willingness to accept new Medicaid clients:

□ Written agreement with RCCO

□ Monthly Provider Directory shows PCMP was “open” for at least 7 of 12 months

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Accepting New

Patients!

Enhanced Primary Care Factors9. The PCMP and patient/family/caregiver collaborate to develop

and update an individual care plan.RCCO reviewed one of the following documentation of the PCMP care planning □ Documented process: policy, procedure, or

workflow for creating individual care plans with date of implementation

□ Sample (2) of care plans

PLUS the care plan must include documentation of 3 of the following:

□ Incorporates patient preferences and functional/lifestyle goals

□ Identifies treatment goals

□ Assesses and addresses potential barriers to meeting goals

□ Includes a self-management plan

□ Is provided in writing to the patient/family/caregiver

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New Year, New Format: RCCO Provider and Community Forum What is the RCCO Provider and Community Forum you may ask?

• An opportunity to for providers and community partners to come together one day, every other month to discuss and learn.

• Forum Agenda:– Delegates Care Management Meeting: 10:00am–11:30am– Networking Lunch: 11:30am–12:15pm– Information & Logistics Meeting: 12:15pm–2:15pm– Break: 2:15pm–2:30pm– Health Neighborhood Meeting: 2:30pm–4:00pm

• These meetings will occur every other month beginning January 15, 2014.

• Please tell us any topics you would like covered!

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