Disclaimer:

1. Disclaimer: There are no conflicts of interest or restrictions (including off-label use disclosure) related to this presentation and/or related materials

2. The Accountable Care Collaborative Program Presented at the 2013 CASBHC Annual Conference May 2, 2013 by Greg Trollan, MA

3. 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

4. Development of the ACC Program • 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

5. 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

6. RCCO Map

7. 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: NetworkDevelopment/Management Provider Support Medical Management and Care Coordination Accountability/Reporting

8. Components of the ACC (cont.) PCP 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 PCP Responsibilities

9. Components of the ACC (cont.) SDAC Responsibilities Data Repository Data Analytics & Reporting Web Portal & Access Accountability & Continuous Improvement

10. ACC Process

11. 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.

12. 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

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 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.

14. 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

15. Next Steps • Enhanced Integration • CPC Initiative • Medicare-Medicaid Enrollees • 1281 Payment Reforms • Shared Savings • Enhanced Data Collection and Sharing

16. 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

17. Questions? • Kathryn Jantz 303-866-5972 • Kathryn.Jantz@state.co.us • Catania Jones 303-866-3164 • Catania.Jones@state.co.us • Gregory Trollan 303-866-3674 • Greg.Trollan@state.co.us • colorado.gov/HCPF