Understanding the ACC Program Health Programs Services and Support

1. Understanding the ACC Program Health Programs Services and Support

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

3. Development of the Accountable Care Collaborative Program • Created in response to: • Unsuccessful attempt 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

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

5. RCCO Map

6. 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

7. 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

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

9. ACC Process

10. Provider Recruitment • Initial recruitment has been geared towards current Medicaid providers. • RCCOs conduct outreach with providers to discuss program benefits and participation. • Providers must contract with the State and the RCCO in order to participate.

11. 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.

12. Client Selection & Enrollment FFS and Primary Care Provider Program (PCPP)clients If possible, attached to provider based on claims history Voluntary (passive enrollment) Notified by enrollment letter Call HealthColorado to opt out 303-839-2010 or 1-888-367-6557

13. Explanation of Cost Savings Report • Medicaid health expenditures decreased by $20 million with its ACC Program. • Nearly $3 million was returned to state and federal tax payers. • The ACC program has seen promising reductions in key performance indicators for ACC clients: • Hospital Readmissions: There was an 8.6 reduction in readmissions among ACC clients. • Emergency Room Utilization: Overall, there was a 1% increase among Medicaid clients, but only a .23% increase among ACC enrollees. • High Cost Imaging: 3.3% decrease among ACC clients.

14. Next Steps • Enhanced Integration • Increase Enrollees • Payment Reform • Enhanced Data Collection and Sharing

15. Questions? • Gregory Trollan303-866-3674 • Greg.Trollan@state.co.us • Kathryn Jantz 303-866-5972 • Kathryn.Jantz@state.co.us • Kelly Larsen 303-866-4685 • Kelly.Larsen@state.co.us • Colorado.Gov/HCPF