1. Regional Accountable Entity Webinar
Orientation for Providers
March 28 & 30, 2018

2. Introducing RAE
Rocky Mountain Health Plans (RMHP) is the Regional Accountability Entity (RAE) for Region 1 (all of Western Colorado and Larimer County).
The RAE is a contract awarded by the Colorado Department of Health Care Policy and Financing (Department) for the Accountable Care Collaborative (ACC) Phase II.
The RAE for Region 1 includes:
The services previously performed by RMHP as the Regional Care Collaborative Organization (RCCO), including the primary care medical provider network and care coordination services.
The services previously performed by the regional Behavioral Health Organization (BHO), including managing covered services under the Medicaid Capitated Behavioral Health Benefit.
The Western Colorado payment reform initiative known as RMHP Prime.
Additional services to support whole person care, including activities to address social determinants of health.
Note: With the transition to the RAE, the terms RCCO and BHO will no longer be used.

3. RMHP PRIME WITH ACC PHASE II
RMHP Prime continues with the Accountable Care Collaborative Phase II.
RMHP Prime counties: Garfield, Gunnison, Mesa, Montrose, Pitkin, and Rio Blanco.
The Department continues to pay RMHP a fixed global payment for physical health services provided to RMHP Prime Members.
RMHP Prime Members are individuals who enroll in RMHP Prime based on county of residence and Health First Colorado eligibility. Eligible adults and children with a disability status are enrolled by the Department into RMHP Prime.
Primary care providers participating in RMHP Prime will continue to receive risk adjusted monthly global payments for attributed RMHP Prime Members.
With the changes to the RAE, for RMHP Prime Members, RMHP is responsible for the physical health services historically covered under RMHP Prime, and the behavioral health services covered under the Capitated Behavioral Health Benefit.

4. CHANGES FOR MEMBERS

5. RAE & RMHP Prime Changes for Members
Process
Current Methods
RAE Changes
RMHP Prime Changes
Mandatory/ Passive
Enrollment
Passive enrollment.
Members can “opt- out”.
Enrollment is mandatory.
All Health First Colorado Members must enroll.
No opt-out.
RMHP Prime continues as passive enrollment. Members can “opt-out” of RMHP Prime to receive physical health benefits through Health First Colorado FFS. Member remains enrolled with the RAE; no opt-out of RAE enrollment.
Enrollment Effective Date
Enrollment is effective first of month after notification period
Enrollment begins upon Member’s Health First Colorado eligibility determination
Enrollment begins upon Member’s Health First Colorado eligibility determination

6. RAE & RMHP Prime Changes for Members
Process
Current Methods
RAE Changes
RMHP Prime Changes
Member Enrollment Region
Member enrollment in the RCCO and BHO is based on Member’s county of residence
Member enrollment in the RAE is based on the region of the Member’s attributed PCMP site, not the Member’s residence
Member enrollment in RMHP Prime continues based on county of residence and Health First Colorado eligibility
Member Attribution
Members are attributed to a PCMP based on claims or patient choice.
Members with no claims or self- selection remain unattributed.
RAE Members are immediately attributed to a PCMP upon being determined eligible for Health First Colorado benefits.
RAE Members are attributed to a PCMP, even when there is no prior claim or patient choice history.
For RAE Members enrolled in RMHP Prime, attribution follows current RMHP attribution methodology and process
Member attribution follows RMHP’s attribution methodology, using claims and Patient Choice.

7. RAE & RMHP Prime Changes for Members
Process
Current Methods
RAE Changes
RMHP Prime Changes
Member
Re-Attribution
On a quarterly basis the Department runs a re-attribution process to identify new Member/PCMP attributions and to change Member/PCMP attributions, based on claims during the most recent 12 months
Every 6 months the Department will run a re-attribution process to attribute RAE Members to PCMPs based on claims during the most recent 18 months.
If the Member’s new attributed PCMP is in a different region, the Member’s RAE will change to the PCMP’s region.
For RAE Members in RMHP Prime, re-attribution follows RMHP’s current process
RMHP determines attribution each month

8. CHANGES FOR PCMPs

9. RAE & RMHP Prime Changes for PCMPs
Process
Current Methods
RAE Changes
RMHP Prime Changes
PCMP Agreement
PCMPs sign an agreement RMHP and the Department
Each PCMP site has an agreement, either directly or via their IPA participation, with the RAE in that site’s region.
The Department will no longer have a unique PCMP contract with providers.
RMHP Prime participating provider agreement
PCMP Payments
The Department pays PCMPs per member per month payments and performance incentive payments
RAE pays at least $2 PMPM to PCMPs for attributed RAE Members.
Additionally, incentive payments are available for higher performing practices.
Payment per terms of RMHP Prime participating agreement

10. RAE & RMHP Prime Changes for PCMPs
Process
Current Methods
RAE Changes
RMHP Prime Changes
Physical Health Reimbursement
PCMPs and physical health providers are paid Health First Colorado fee- for-service by the Department
This remains the same.
Physical health claims for RAE Members are paid FFS rates by the Department.
Physical health claims for RAE Members enrolled in RMHP Prime are paid by RMHP.
No change to RMHP Prime.
PCMPs and physical health claims paid by RMHP.
Six Behavioral Health Sessions at PCMP Practice
Behavioral health services only under the BHO.
Not a benefit under physical health services.
Allows primary care practices to bill up to six behavioral health sessions to the Department, not to the RAE
For RMHP Prime Members, these six primary care behavioral health sessions are billed to RMHP

11. ABOUT PAYMENT

12. Value Based Payment RMHP is dedicated to strengthening primary care.
We reward high-quality, high-value care and reimburse through a payment structure designed to achieve better care, more efficient spending, and healthier communities.
RMHP is committed to supporting and continuing value-based payments.
RMHP recognizes that health care is complex, and resources are limited.
RMHP’s strategy is to provide maximum resources to the practices that assume the highest level of accountability for whole person care and that provide the highest level of access for RMHP Members.

13. RAE Members with RMHP Prime
Payment of Services
Service Type
RAE Members
without RMHP Prime
RAE Members with RMHP Prime
Physical Health Services
Bills sent to and paid by Department following Department claims and authorization methodology
Bills sent to and paid by RMHP following Provider-RMHP agreement
Behavioral Health Services
Bills sent to and paid by RMHP
Bills sent to and paid by RMHP for RAE Members enrolled with RMHP as Region 1 RAE

14. RAE Members with RMHP Prime
Payment of Services
Service Type
RAE Members
without RMHP Prime
RAE Members with RMHP Prime
Six Behavioral Health Sessions at PCMP Practice
PCMPs bill up to 6 sessions to the Department following the Department’s methodology on procedure codes and licensure.
After 6 sessions, these behavioral health sessions must receive RMHP authorization and then bill to RMHP. Paid by RMHP under the RAE behavioral health benefit following RMHP-provider agreement.
All claims are billed to RMHP and paid following RMHP-provider agreement.
PCMPs bill RMHP for the first 6 sessions following Department’s methodology on procedure codes and licensure.
PCMP Medical Home Payments
Paid by RMHP for RMHP RAE Members attributed by the Department to Region 1 PCMP
Paid by RMHP following RMHP attribution methodology and Provider- RMHP Prime agreement

15. ABOUT ATTESTATION

16. RAE Primary Care Attestation
The value-based payment model for PCMPs encompasses clear delineation of provider responsibilities and resources available for different levels of accountability and participation.
These levels of accountabilities, called Tiers, impacts the resources available to the practice and activities the practice must demonstrate through ongoing assessments.
Practices have the option to participate at the highest tier for which they qualify, or may choose to participate at a lower tier. Practices also may opt to identify a higher tier and work towards achieving that tier.
Each practice site must complete the RAE Tier Attestation process.
Complete and submit these documents to the RMHP Practice Transformation Team by April 16, 2018
Practice Information Form
Attestation Tree
Attestation Tree Determination
Submit documents by:
Mail: PO Box Grand Junction, CO 81502
Fax:

17. Tier 1 Description Comprehensive RMHP Population Health Partner
Profile
CPC+ participant Track 2 or PCMH Level 3/ Recognized
Demonstration
Able to report a minimum of 6 CQMs from RMHP eCQM Measurement Suite from a certified EMR Dashboard (FQHCs may report from the Azara registry)
Meet performance benchmarks on 6/6 measures (See Measurement Suite for benchmarks)
Performs satisfactorily (80%) on RMHP Tier 1 Assessment performed quarterly
Provides current documented Executed Care Compact with at least three major or critical specialties
Open to Medicaid Patients
Medicaid APM/ FQHC APM Score = (at least) %
Use of RMHP designated applications required for Reunion FQHCs and available to others

18. Tier 1 Description Comprehensive RMHP Population Health Partner
Reimbursement Enhancement
RMHP RAE = Estimated $5 to $6 PMPM (contingent upon region-wide attestations and attribution)
Medicaid APM percent FFS Enhancement on the Department FFS = 3 - 4%+ (or as per Medicaid APM Score) or FQHC Value Based APM/ percent FFS reduction
Eligible for Department auto-attribution revenue for potential patients (Member outreach activities may be required)
Eligible for RMHP Community Integration Agreement to fund behavioral health, SDoH and related services.
Incentive Eligibility
Eligible for KPI Pool distributions – relative to TCR
Resource Supplementation
Enhanced RMHP assistance in placing complex, resource intensive patients
Attribution and Feedback Reports
Eligible for Consultative Practice Transformation Resources
Eligible for Health Engagement Team/Community Health Worker resource
Eligible for RMHP designated applications with technical assistance
Eligible for $5 to $10K bonus for AHCM screening participation

19. Tier 1 Assessment Elements Comprehensive RMHP Population Health Partner
Access and Continuity
Care Management
Cohesiveness and Care Coordination
Patient and Caregiver Engagement
Planned Care & Population Health

20. Tier 2 Description Advanced Participation
Profile
Masters 2 Graduate or CPC Classic Graduate or Current CPC+ Track 1 Participant
Demonstration
Able to report minimum of 6 CQMs from the RMHP eCQM Measurement Suite from a certified EMR Dashboard (FQHCs may report from the Azara registry)
Meet benchmark performance (CMS 70th percentile) on 4/6 (See Measurement suite for Benchmarks)
Performs satisfactorily (80%) on RMHP Tier 2 Assessment performed quarterly
Provides current copy of Executed Care Compact with at least one major or critical specialty
Open to Medicaid patients. Equitable panel management processes permitted, with disclosure of tools and protocols to RMHP. Processes subject to review by RMHP. Current Medicaid attribution levels maintained at a minimum.
Medicaid APM/ FQHC APM Score = (at least) %

21. Tier 2 Description Advanced Participation
Reimbursement Enhancement
RMHP RAE = Estimated $4 to $5 PMPM (contingent upon region-wide attestations and attribution)
Medicaid APM percent FFS Enhancement on the Department FFS = 2 - <3%+ (or as per Medicaid APM Score) or FQHC Value Based APM/ percent FFS reduction
Eligible for Department auto-attribution revenue for potential patients (Member outreach activities may be required)
Incentive Eligibility
Eligible for KPI Pool distributions – relative to TCR
Resource Supplementation
Attribution and Feedback Reports
Eligible for Practice Transformation Resources for NCQA PCMH recognition with application fee reimbursement
Eligible for Consultative Practice Transformation Resources
Eligible for Health Engagement Team/Community Health Worker resource
Eligible for RMHP designated applications with technical assistance
Eligible for $5 to $10K bonus for AHCM screening participation

22. Tier 2 Assessment Elements Advanced Participation
Provide Care Management for High Risk Patients
Demonstrate Active Engagement and Care Coordination Across the Medical Neighborhood
Assess and Improve Patient Experience of Care
Implement Patient Shared-Decision-making
Develop a Plan for Sustainability and Spread

23. Tier 3 Description Foundations Participation
Profile
Graduate of RMHP Foundations or SIM
(For Larimer County practices where RMHP practice transformation programs have been unavailable, other structured foundational work will be considered)
Demonstration
Able to report minimum of 6 CQMs from the RMHP eCQM Measurement Suite from a certified EMR Dashboard (FQHCs may report from Azara)
Meet benchmark performance (CMS 70th percentile) on 2/6 (See Measurement suite for Benchmarks)
Performs satisfactorily (80%) on RMHP Tier 3 Assessment performed every 6 months
Open to Medicaid patients. Intermittent or limited availability for new Medicaid Members
Medicaid APM/ FQHC APM Score = (at least) %

24. Tier 3 Description Foundations Participation
Reimbursement Enhancement
RMHP RAE = Estimated $3 to $4 PMPM (contingent upon region-wide attestations and attribution)
Medicaid APM percent FFS Enhancement on the Department FFS = 1% - <2%+ (or as per Medicaid APM Score) or FQHC Value Based APM/ percent FFS reduction
Incentive Eligibility
Eligible for KPI Pool distributions – relative to TCR
Resource Supplementation
Attribution Reports
Feedback Reports upon request
Practice Transformation Resources with $10K incentive for Masters 1 and Masters 2 successful program participation

25. Tier 3 Assessment Elements Foundations Participation
Create a High Functioning QI Team
Population Health, Practice Transformation,
and Process Improvement
Empanelment, Continuity of Care
and Team-Based Care
Implement Patient Shared-Decision-making
Sustainability and Spread

26. Tier 4 Description Basic Participation
Profile
No historical practice transformation work completed; may be engaged in RMHP Foundations or SIM
Demonstration
None, or
Current involvement in Foundations or SIM
Medicaid APM/ FQHC APM Score = (at least) %

27. Tier 4 Description Basic Participation
Reimbursement Enhancement
RMHP RAE = $2 PMPM base program reimbursement.
Medicaid APM percent FFS Enhancement on the Department FFS = <1% or as per Medicaid APM Score or FQHC Value Based APM/ percent FFS reduction
Incentive Eligibility
Eligible for KPI Pool distributions – relative to TCR
Resource Supplementation
Attribution Reports
Feedback Reports upon request
Practice Transformation Resources with $10K incentive for Foundations program participation

28. Attestation Tree Determination
In order to stay in Attested Tier, practice must demonstrate ALL of the following:
Achieve ≥80% on appropriate assessment
Tier 1 Assessment – quarterly
Tier 2 Assessment – quarterly
Tier 3 Assessment – semi-annually
Tier 4 Assessment – none
Achieve Medicaid APM scoring thresholds
Tier 1 – Medicaid APM score of %
Tier 2 – Medicaid APM score of 51-75%
Tier 3 – Medicaid APM score of 26-50%
Tier 4 – Medicaid APM score of 0-25%
Submit 6 CQMs quarterly AND annually meet or exceed the 70th percentile CMS benchmarks
Tier 1 – 6/6 eCQMs must meet or exceed the 70th percentile of the current CMS benchmarks
Tier 2 – 4/6 eCQMs must meet or exceed the 70th percentile of the current CMS benchmarks
Tier 3 – 2/6 eCQMs must meet or exceed the 70th percentile of the current CMS benchmarks
Tier 4 – none
Be open to Medicaid
Tier 1 – Open to new Medicaid
Tier 2 – Open with equitable panel management processes and tools applied in order to maintain current Medicaid attribution numbers (at a minimum). Attach processes and tools.
Tier 3 – Limited, intermittent availability for new Medicaid patients
Tier 4 – Not open to new Medicaid.

29. Attestation Timeline

30. WE ARE HERE TO HELP

31. RESOURCES support@rmhpcommunity.org 888-282-8801
View HCPF-facilitated provider webinars and additional information at colorado.gov/pacific/hcpf/accphase2
Visit RMHP’s community website at rmhpcommunity.org
RMHP Community at
Call RMHP Customer Service at