Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing
Bringing Accountable Care To Medicaid
Susan E. Birch, MBA, BSN, RN Executive Director, Colorado Department of Health Care
Policy & Financing 1
Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing
AgendaColorado Overview
Accountable Care Collaborative Program Structure
Regional Care Organizations
Primary Care Providers
Statewide Data and Analytics
Results
2012 Annual Report
2013 Annual Report
Future of the Program
Medicaid Expansion
Expanding coverage & improving value
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Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing
Governor’s State of Health: Four Focus Areas
Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing
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Our mission: Improving health care access and outcomes for people
we
serve while demonstrating sound stewardship of
financial resources
Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing
Administers the
Medicaid and
CHP+* as well as a
variety of other
programs for
Colorado's low‐
income individuals,
families, and
persons with
disabilities.
Supported by OIT.**
Administers
assistance
programs such as
food and cash
assistance that
improve the safety,
independence and
well‐being of
Coloradans. Also
works closely with
HCPF on the
coordination of
behavioral health
and substance
abuse benefits.
Supported by OIT. **
Health Insurance
Marketplace for
individuals,
families and small
employers to
compare health
plan options, apply
for insurance
affordability
programs and to
buy health
insurance and use
new financial help
to reduce the cost
of insurance.
Regulates insurance
industry to ensure
companies follow
the laws and can
afford to pay claims.
Works with
consumers to
answer questions,
help them
understand their
insurance and
ensure they receive
the benefits for
which they have
paid.
Supported by OIT. **
Administers
programs that seek
to improve health
outcomes through
the promotion of
health, wellness
and prevention.
Supported by OIT. **
Working Together for Colorado
*CHP+ is the Child Health Plan Plus **OIT is the Governor's Office of Information Technology
Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing
Colorado Medicaid Expansion & Marketplace
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Marketplace> 400% FPL
Marketplace> 250‐400% FPL*
Marketplace> 250‐400% FPL*
Marketplace> 133‐400% FPL*CHP+
> 133‐250% FPL
CHP+> 185‐250% FPL
Medicaid< 185% FPLMedicaid
< 133% FPLMedicaid< 133% FPL
Children Pregnant Women Adults
* Advanced Premium Tax Credits and Cost Sharing Reductions
Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing
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Historical Model: Before Accountable Care Collaborative
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Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing
Improving health care accessand outcomes for the peoplewe serve while demonstrating sound stewardship of financial resources
Our Mission:
New Model: Accountable Care Collaborative
Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing
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Regional Care
Collaborative
Organizations (RCCOs – 7)
Primary Care Providers(PCPs)
Statewide Data
and Analytics
Contractor(SDAC)
Components
Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing
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Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing
Regional Care Organizations
•• Achieve health & financial
outcomes • Ensure comprehensive care
coordination, Medical Home
level of care • Network
Development/Management • Provider Support • Medical Management &
Care Coordination • Accountability/Reporting
Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing
• Serves as Medical Home
• Member/family centered
• Whole person oriented
• Coordinated
• Promotes client self‐management
• Care provided in a culturally sensitive and linguistically sensitive manner
• Accessible
Primary Care Providers
Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing
Statewide Data and Analytics
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•Data Repository
• Data Analytics & Reporting
• Web Portal & Access
• Accountability & Continuous
Improvement
Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing
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Client Success Story
A diabetic male ACC member was unable to transfer his Food Stamps
from one county to another. As a result the client began dumpster diving
in order to eat. Not only did this new diet exacerbate his diabetes he also
contracted bed bugs from the dumpsters themselves. As a sufferer
of
sleep apnea he was forced to sleep in a recliner, however due to
the bed
bugs the recliner had to be thrown away and the patient had to sleep on
the floor.
With both of his conditions acting up, he often frequented the ER. After
uncovering the needs of the client, the RCCO was able to transfer his
Food Stamps from one county to another and through the help of local
charities they were able to get him a new recliner. He has not gone to the
ER since.
Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing
Enrollment 200,000
Performance Incentives
Medicare‐Medicaid
Enrollees Implementation
with CMS approval
HB12‐1281
Implementation
Accountable Care Collaborative
By June 2013, enrollment at 352,236
$1.1M given to Providers and RCCOs for
meeting performance metrics
Submitted implementation plan in May
2013. Waiting on CMS approval
Rocky Mountain Health Plans pilot project
selected in competitive process. Pilot will
begin in 2014
2013 Results2013 Goals
Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing
What’s Ahead for the ACC?
ACCACC5 Point 5 Point
PlanPlan
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