Department of Health Care Policy and Financing Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing Disclaimer: There are no conflicts of interest or restrictions (including off-label use disclosure) related to this presentation and/or related materials

Department of Health Care Policy and Financing Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing

Department of Health Care Policy and Financing Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing 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 Financing Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing Created in response to: Unsuccessful attempt at capitated Managed Care in Colorado 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 Financing Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing 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 Financing Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing

Department of Health Care Policy and Financing Colorado 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

Department of Health Care Policy and Financing Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing 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

Department of Health Care Policy and Financing Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing Data Repository Data Analytics & Reporting Web Portal & Access Accountability & Continuous Improvement 10

Department of Health Care Policy and Financing Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing

Department of Health Care Policy and Financing Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing ACC Referral Process The Accountable Care Collaborative Program does not require that specialists get an administrative referral from the Primary Care Medical Provider. The RCCOs and PCMPs are developing protocols for a clinical referral process.

Department of Health Care Policy and Financing Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing 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

Department of Health Care Policy and Financing Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing 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 Financing Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing FFS and Primary Care Physicians Program (PCPP) clients If possible, attached to provider based on claims history Voluntary (passive enrollment) Notified by enrollment letter Call HealthColorado to opt out or

Department of Health Care Policy and Financing Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing Enhanced Integration CPC Initiative Medicare-Medicaid Enrollees 1281 Payment Reforms Shared Savings Enhanced Data Collection and Sharing

Department of Health Care Policy and Financing Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing RCCO 1: Rocky Mountain Health plans RCCO 2: Colorado Access RCCO 3: Colorado Access RCCO 4: Integrated Community Health Partnership RCCO 5: Colorado Access RCCO 6: Colorado Community Health Alliance RCCO 7: Community Care of Central Colorado

Department of Health Care Policy and Financing Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing Kathryn Jantz Catania Jones Gregory Trollan colorado.gov/HCPF