Accountable Care Collaborative Program Update to Medical Home Forum Dec. 11, 2012

1. Accountable Care Collaborative Program Update to Medical Home Forum Dec. 11, 2012

2. Hot topics • ACC 101 • Referral Policy Update • First Year Results & Annual Report • ACC Expansion Plans • Payment Reform Initiatives • Shared Savings & 1281 • Comprehensive Primary Care Initiative • Medicare-Medicaid Enrollee Demonstration Project • Children’s Medical Home Program Plans

3. ACC Program Components

4. 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

5. Components of the ACC PCMP serves as a Medical Home Member/family centered Whole person oriented Coordinated care Promotes client self-management Care provided in a culturally sensitive and linguistically sensitive manner Accessible PCMP Responsibilities

6. Components of the ACC SDAC Responsibilities Data Repository Data Analytics & Reporting Web Portal & Access Accountability & Continuous Improvement

7. Client Selection & Enrollment Clients enrolled from FFS and PCPP • Initial ratio of 1/3 children, 2/3 adults • Excluded institutionalized and Medicare-Medicaid enrollees • If possible, clients attached to a provider by claims history Fall 2012, removed cap on children to begin aligning with Medicaid ratio of 1/3 adults, 2/3 children Voluntary (passive) enrollment* • Clients notified by enrollment letter • Call contracted Enrollment Broker to opt out • Clients may also change PCMPs via Enrollment Broker *Adults without Dependent Children are mandatorily enrolled. Approximately 10,000 AwDC members enrolled, and 8,400 waitlisted.

8. Reimbursement • 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* • PMPM to RCCOs was adjusted in November 2012 to account for changes in case mix (more children) • Incentive Payments initiated July 2012 • *Children’s Medical Home providers do not receive the PMPM because they are already receiving the enhanced rate.

9. Referral Policy • The Accountable Care Collaborative Program no longer requires that specialists get an administrative referral from the Primary Care Medical Provider. • The RCCOs and PCMPs are working to develop protocols for a clinical referral process. • The goal is to enhance sharing of clinical data between providers to improve communication and care coordination.

10. First Year Results • Estimated cost reduction of $20 million, but actual savings hard to calculate. • When compared to non-ACC enrollees: • 8.6 percentage point reduction in hospital readmissions • Lower rate of increase in ER visits • Use of MRIs and other high-cost imaging decreased three percentage points • Lower rates of preventable hospitalizations for enrollees with diabetes and asthma • Report to Colorado Joint Budget Committee delivered on Nov. 1st. Report available online at: http://www.colorado.gov/cs/Satellite?c=Page&childpagename=HCPF%2FHCPFLayout&cid=1233759745246&pagename=HCPFWrapper.

11. Expansion Plans • The ACC is Medicaid’s primary delivery system. • ACC enrollment will exceed 200,000 by January 2013. • Expansion populations will include: • CPC initiative (Jan. 2013) • Medicare-Medicaid enrollees (Spring 2013) • Children’s Medical Home • PCPP • Governor has not yet announced decision on Medicaid expansion in 2014 under ACA.

12. Payment Reform Initiatives • Shared Savings • 1281 Payment Reforms • CPC Initiative • Medicare-Medicaid Enrollees Demonstration

13. 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

14. Children’s Medical Homes • Pay for performance for certified medical homes is in HCPF’s budget request for FY13-14. • Forming stakeholder workgroup to help inform decisions regarding medical home certification, pay for performance, timelines, and other key issues. • Department is working closely with CCHAP, AAFP, and AAP to communicate with stakeholders.

15. Questions? Kelly Larsen, ACC Contract Manager Kelly.Larsen@state.co.us (303) 866-4685 Kathryn Jantz, ACC Contract Manager Kathryn.Jantz@state.co.us (303) 866-5972 www.Colorado.gov/HCPF