Medicaid Accountable Care Collaborative (ACC)

1. Medicaid Accountable Care Collaborative (ACC) Larimer County Community Forum September 12, 2013

2. Accountable care collaborative (ACC) BACKGROUND

3. New Medicaid Delivery System • Developed in response to: • 85% of clients in an unmanaged Fee-For-Service (FFS) system • Unprecedented economic situation – highest caseload & expenditures in the State’s history of Medicaid • Objectives: • Triple Aim: Improve quality of care/ensure patient-centered care/reduce costs • Expand access to comprehensive primary care • Provide a higher level of care coordination/integration • Promote Member and provider engagement • Effectively use claims data to support data-sharing and enable more timely monitoring and measurement of health care costs and outcomes

4. Client Population & Enrollment • Serves Medicaid fee-for-service beneficiaries • Includes Adults without Dependent Children waiver population (<10% FPL). • Children currently make up approx. 67% of the membership statewide. • Exclusions to date: • Dual eligible enrollees • Beneficiaries residing in an institutional setting • RMHP Medicaid managed-care enrollees • Enrollment Requirements • Enrollment is mandatory for adult Medicaid beneficiaries without dependent children (AwDC program). • To date, enrollment is voluntary and passive for all other beneficiaries.

5. Achieving the “Triple Aim” Improve Population Health Triple Aim Enhance Patient Experience Control Costs Four Key Performance Indicators, or KPIs, are currently being measured: All Cause 30-Day Hospital Readmissions Emergency Room Usage High Cost Imaging services Well Child Visits (currently being measured but not yet tied to incentive payments) “The best care for the total population and the lowest cost”

6. Three Components of the ACC Regional Care Collaborative Organization Accountable Care Collaborative Primary Care Medical Provider Statewide Data Analytics Contractor

7. Role of Regional Care Collaborative Organizations (RCCOs) • CO divided into seven RCCOs • Responsible for care coordination/practice support • Develop provider networks/contract with Primary Care Medical Providers (PCMP) • Facilitate referral process • Provide network and care coordination data to the Department and/or SDAC • Do not assume risk, pay claims, provide preauthorization RMHP serves as RCCO for Region 1

8. RCCO Regions

9. Role of Primary Care Medical Providers (PCMPs) • Primary Care Medical Providers (PCMPs) are a key part of the success of • the ACC. The PCMP acts as a medical home and coordinates a client's • health needs across specialties and along the continuum of care. • In addition to the fee-for-service payments for the medical services supplied, • PCMPs receive a per-member-per-month (PMPM) for the medical home • services they provide. • Eligible providers can participate as PCMPs in the ACC at any time. PCMPs • sign a contract with the State and with the RCCO.

10. PCMPs in Larimer County • Currently participating PCMPs in Larimer County include: • Associates in Family Medicine • Banner Health (10 clinic locations across the county) • Colorado Health Medical Group • Fort Collins Youth Clinic • Loveland Youth Clinic • Milestone Family Medicine • Miramont Family Medicine • PVHS Family Medicine Center • Rocky Mountain Family Physicians • Salud Family Health Centers – Fort Collins & Estes Park • Sunrise Loveland Community Health Center • Timberline Medical Family Practice

11. Role of State Data and Analytics Contractor(SDAC) • Treo Solutions serves as the statewide Data & Analytics Contractor. The role of the SDAC includes: • Data Repository • Data Analytics & Reporting • Web Portal & Access • Accountability & Continuous Improvement

12. Accountable care collaborative (ACC) CURRENT STATE

13. Current Enrollment • August 2013 Enrollment Summary • Statewide: Approx. 355,000 clients enrolled in the ACC program = 49% of total Medicaid population (729,000) • Region 1: Approx. 42,000 clients enrolled • Larimer County: Approx. 19,000 clients enrolled • 38% adults (age 21 & older) / 62% children (age 20 & under) • 73% attributed to a PCMP / 27% unattributed to a PCMP • 710 Adults without Dependent Children (AwDC) • 561 Children in Foster Care

14. Initial Program Results • In the ACC’s first year, the Department reported that the program returned nearly $3 • million to state & federal taxpayers. • The Departmentidentified three key performance indicators (KPIs) to measure • improvement among those clients enrolled in the ACC, compared to clients not yet enrolled: • Hospital Readmissions: 8.6% greater reduction 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% greater decrease among ACC clients • To-date, three rounds of incentive payments have been issued (February, May, & August 2013). In Region 1, we have met our targets on 2 of the 3 KPIs: 30-Day Readmissions & High Cost Imaging in each of these quarters.

15. Accountable care collaborative (ACC) NEXT STEPS / expansion

16. Current Program Status • In the ACC’s first year, the Department reported that the program returned nearly $3 million to the State General Fund. • Currently, about half of all Medicaid recipients in Colorado are enrolled in the ACC, with plans to enroll entire CO Medicaid population by 2015. • New KPI, Well Child Visits added in July 2013, based upon CMS-416 criteria • Preparations underway to include Full-Benefit Medicare/Medicaid Enrollees in ACC. • Preparing for Medicaid Expansion – January 1, 2014.

17. ACA Medicaid Expansion • SB 13-200 legislation amends the CO Health Care Affordability Act to cover additional low-income Coloradans by changing the Medicaid eligibility level from 100% to 133%* of the FPL. • $30,657 per year for a family of four • $14,856 per year for an individual • Up to 160,000 Coloradans could gain access to care beginning January 1, 2014 • “Colorado Medicaid will soon become the second largest payer in the state because of • the ACA Expansion…. The governor’s State of Health report notes, ‘The ACC infrastructure, • with its focus on client-centered care and regional solutions, is the foundation of the Medicaid • program in Colorado and will be the vehicle for delivery and payment reforms in Colorado • Medicaid.’”** • *Federal law allows for a 5 percent income disregard so those earning up to 138% FPL may be eligible. • **From 5/7/13 Colorado Medical Society article: http://www.cms.org/communications/medicaid-accountable-care-collaborative

18. For More Information… • Jenny Nate, MSW, Senior Community Strategies Leader & RCCO Contract Manager; jenny.nate@rmhp.org; (303) 967-2082 • Carol Ann Hendrikse, RN, BSN, CCM, RCCO Clinical Manager; carolann.hendrikse@rmhp.org; (970) 385-7691 • Nicole Konkoly, RCCO Community Coordinator; nicole.konkoly@rmhp.org; (303) 967-2004

19. Thank you