As of March 2013:698,137Medicaid clients 72,723 children and pregnant women in Child Health Plan Plus (CHP+)60% of Medicaid clients are children 20 and under30% of births in Colorado are paid by Medicaid$5.6 Billion total funds 313 Full Time Employees Approx. 771,000 clients Average per capita spending per client = $4,700 Administration costs approximately 3% Approximately $17 million appropriated for every employee in the Department
•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 Three main componentsRegional Care Collaborative OrganizationsData and AnalyticsPrimary Care Medical ProvidersRegional Care Collaborative Organizations (RCCO) Achieve financial and health outcomes Ensure comprehensive care coordination and a Medical Home level of care for every Member through: NetworkDevelopment/ManagementProvider Support Medical Management and Care Coordination Accountability/ReportingPrimary Care Provider- Serve as a Medical HomeMember/family centeredWhole person orientedCoordinatedPromotes client self-management Care provided in a culturally sensitive and linguistically sensitive mannerAccessibleStatewide Data Analytics Contractor Data Repository Data Analytics & ReportingWeb Portal & Access Accountability & Continuous Improvement
In the ACC’s first year (FY 11-12) we Reduced Medicaid costs by $20 compared to if the ACC were not in placeIn doing so, we returned nearly $3 million to state and federal tax payersWe identified three Key Performance Indicators: Hospital readmissions, ER utilization and High-Cost ImagingWhile ER Utilization increased by .23%, it was much less than the overall Medicaid population not enrolled in the ACC…that group Increased ER utilization by 1%...so we made very good in-roads with the ACC populationOverall, we expect these numbers to improve even more as we get more clients enrolled. These figures were based on ACC enrollment of Approx 150,000 clients about 25% of overall Medicaid population.
Weitzman 2013: State Health Policy Initiatives as Drivers for Improving Care Outcomes: Colorado's Accountable Care Collaborative
Colorado Department of Health Care Policy and FinancingSusan E. Birch, Executive DirectorColorado Department of Health Care Policy and FinancingMay 16, 2013State Health Policy Initiatives as Driversfor Improving Care Outcomes:Colorado’s Accountable Care Collaborative
Colorado Department of Health Care Policy and FinancingMedicaid Expansion Bill Signing2
Colorado Department of Health Care Policy and FinancingWho We Serve3
Colorado Department of Health Care Policy and FinancingThe State of Health: Colorado’s Commitment toBecome the Healthiest State4
Colorado Department of Health Care Policy and FinancingAccountable Care Collaborative
Colorado Department of Health Care Policy and FinancingRCCO Map
Colorado Department of Health Care Policy and FinancingAccountable Care CollaborativeFirst Year Results• FY11-12 Department reduced Medicaid health costs by$20 million• Returned nearly $3 million to state and federaltaxpayers since its inceptionIndicators – ACC Clients• Hospital Readmissions 8.6% reduction• Emergency Room Utilization .23% increase• High-Cost Imaging 3.3% reduction7
Colorado Department of Health Care Policy and FinancingReforming Payment8Graphic Courtesy of Colorado Health Institute
Colorado Department of Health Care Policy and FinancingPCMP & RCCO Payment• FFS reimbursement to PCMPs for medical services• Per Member Per Month (PMPM) payment to PCMPfor medical home services*• PMPM payment to RCCO’s for PCMP support andmember care coordination• Incentive Payments*Children’s Medical Home providers do not receive the PMPM because they are alreadyreceiving the enhanced rate.
Colorado Department of Health Care Policy and FinancingNext Steps•Enhanced Integration•Physical, Behavioral, Dental, Public Health,Long Term Services and Supports•Medicare-Medicaid Enrollees•Payment Reform – HB 12-1281•Shared Savings•Enhanced Data Collection and Sharing
Colorado Department of Health Care Policy and FinancingQuestionsSusan E. BirchExecutive DirectorColorado Department of HealthCare Policy & Financing1570 Grant StreetDenver, CO 80203Susan.Birch@state.co.us