understanding the acc program health programs services and support
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Understanding the ACC Program Health Programs Services and Support. 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 - PowerPoint PPT PresentationTRANSCRIPT
Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing
Understanding the ACC Program
Health Programs Services and Support
Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing
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
Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing
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
Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing
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
Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing
RCCO Map
Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing
• Achieve financial and health outcomes
• Ensure comprehensive care coordination and a Medical Home level of care for every Member
through:
•Network Development/Management
•Provider Support
•Medical Management and Care Coordination
•Accountability/Reporting
Components of the ACC
RCCOResponsibiliti
es
Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing
PCP Responsibilitie
s
• 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
Components of the ACC (cont.)
Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing
8
SDACResponsibilitie
s
• Data Repository
• Data Analytics & Reporting
• Web Portal & Access
• Accountability & Continuous Improvement
Components of the ACC (cont.)
Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing
ACC Process
Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing
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.
Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing
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.
Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing
• 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
Client Selection & Enrollment
Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing
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.
Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing
Next Steps•Enhanced Integration
•Increase Enrollees
•Payment Reform
•Enhanced Data Collection and Sharing
Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing
Questions?Gregory Trollan 303-866-3674
Kathryn Jantz [email protected]
Kelly Larsen [email protected]
Colorado.Gov/HCPF