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Health First, Colorado’s Medicaid Program and Community Behavioral Health Services
Lenya Robinson, Behavioral Health and Managed Care Section Manager Oct-19
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HCPF Mission
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Objectives Review the role of Colorado’s Department of Health Care Policy & Financing Understand framework of the Accountable Care Collaborative (ACC) Understand framework of community behavioral health program Understand the Department’s contract standards Understand how to navigate the system Learn how to handle unique or challenging issues
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What is HCPF? Colorado’s Department of Health Care Policy and Financing is the designated Single State Agency that administers: Health First Colorado, Colorado’s Medicaid program Child Health Plan Plus (CHP+) Other health care programs for Coloradans who qualify
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Colorado Medicaid is now called:
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Health First Colorado’s Funding Sources
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Health First Colorado Members
42% 45% 7% 3% FY Health First Colorado Caseload
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Current Accountable Care Collaborative
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Structure of Accountable Care Collaborative
Health First Colorado’s primary health care program Administered by 7 Regional Care Collaborative Organizations (RCCOs) RCCOs work to coordinate primary care and other services to improve the overall health of their members
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Accountable Care Collaborative Better Health and Life Outcomes
Coordinated care means improved health outcomes for everyone enrolled in Health First Colorado. It also means better clarity for and coordination with providers as they interact with the system and wiser use of state resources. Medical Home Improved health and smarter use of state resources requires regional and local coordination that recognizes the need for medical care, behavioral health care and community supports all working together. Regional Coordination Members, providers and the system receive the data needed to make real-time decisions that improve care, increase coordinated services and improve overall efficiencies. Data
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Accomplishments Emergency room visits are decreasing
Hospital readmissions are dropping Prenatal care has increased High cost imaging has decreased Improve Health Outcomes More Coloradans are connected to a medical home Greater coordination of care Better Coordinated Care Providers are being paid for quality outcomes Smarter Use of Resources
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Community Behavioral Health Services Program
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Structure of Community Behavioral Health
Colorado’s behavioral health “carve out” Administered by 5 regional Behavioral Health Organizations (BHOs) 5 BHOs manage 17 Community Mental Health Centers & 2 specialty clinics
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Behavioral Health Organizations
Cover and manage comprehensive mental health and substance use disorder (SUD) services* Receive a capitation payment Provide some non-clinical services Do not collect co-pays for services
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BHO Networks BHO Community Mental Health Centers Detox Facilities Methadone Clinics Individual Providers Specialists Federally Qualified Health Centers Hospitals Each BHO contracts with their own network of behavioral health providers to ensure members have access to timely services. Provider size and type vary significantly by region.
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Service Requirements Members can receive services if they meet the following criteria: Have a covered diagnosis (mental health or substance use disorder) Seek a covered service (individual/group therapy, case management, medication-assisted treatment) Service being sought is medically necessary
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Contract Management The BHOs have contract requirements that include:
Network Adequacy Timely Access Cultural Competency Evidence-Based and Promising Practices Integrated and Coordinated Care
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BHO Accomplishments Cost Savings Integrated Care Trauma-Informed Care
Care Coordination Statewide Coordinated Crisis Response System
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Behavioral Health Unit Contacts
Unit Supervisor Melissa Eddleman Contract Manager Troy Peck
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Accountable Care Collaborative Phase II
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Goals & Objectives To improve health and life outcomes for Members Join physical and behavioral health under one accountable party Strengthen coordination of services by advancing team-based care and Health Neighborhoods Promote Member choice and engagement Pay providers for the increased value they deliver Ensure greater accountability and transparency To use state resources wisely
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From RCCO / BHO to: Regional Accountable Entity
Physical Health Care Behavioral Health Care
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Stakeholder Engagement & Draft RFP Formulation
Procurement Timeline Spring 2014-Fall 2016 Stakeholder Engagement & Draft RFP Formulation Spring 2017 Release of Final RFP Winter 2018 RAE Contracts Signed Now Release Draft RFP Fall 2017 RAE Awards Announced Summer 2018 Phase II Implemented
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Thank You!
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Questions or Concerns?
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Behavioral Health and Managed Care Section Manager
Contact Information Lenya Robinson Behavioral Health and Managed Care Section Manager Phone:
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