Weitzman 2013: State Health Policy Initiatives as Drivers for Improving Care Outcomes: Colorado's Accountable Care Collaborative

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Susan E. Birch, Executive DirectorColorado Department of Health Care Policy and Financing

May 16, 2013

State Health Policy Initiatives as Drivers for Improving Care Outcomes: Colorados Accountable Care Collaborative

Colorado Department of Health Care Policy and Financing

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Medicaid Expansion Bill Signing2

Colorado Department of Health Care Policy and Financing

Who We Serve

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Colorado Department of Health Care Policy and Financing

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 under

30% 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

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The State of Health: Colorados Commitment to Become the Healthiest State4

Colorado Department of Health Care Policy and Financing

Accountable Care Collaborative

Colorado Department of Health Care Policy and Financing

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 Providers

Regional Care Collaborative Organizations (RCCO) 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

Primary Care Provider - Serve as a Medical Home

Member/family centeredWhole person oriented CoordinatedPromotes client self-management Care provided in a culturally sensitive and linguistically sensitive mannerAccessible

Statewide Data Analytics Contractor Data Repository Data Analytics & ReportingWeb Portal & Access Accountability & Continuous Improvement

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RCCO Map

Colorado Department of Health Care Policy and Financing

Accountable Care CollaborativeFirst Year ResultsFY11-12 Department reduced Medicaid health costs by $20 million Returned nearly $3 million to state and federal taxpayers since its inception

Indicators ACC ClientsHospital Readmissions 8.6% reductionEmergency Room Utilization.23% increaseHigh-Cost Imaging3.3% reduction

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Colorado Department of Health Care Policy and Financing

In the ACCs first year (FY 11-12) we Reduced Medicaid costs by $20 compared to if the ACC were not in place

In doing so, we returned nearly $3 million to state and federal tax payers

We identified three Key Performance Indicators: Hospital readmissions, ER utilization and High-Cost Imaging

While ER Utilization increased by .23%, it was much less than the overall Medicaid population not enrolled in the ACCthat group Increased ER utilization by 1%...so we made very good in-roads with the ACC population

Overall, 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.7

Reforming Payment8

Graphic Courtesy of Colorado Health Institute

Colorado 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 *Childrens Medical Home providers do not receive the PMPM because they are already receiving the enhanced rate.

Colorado Department of Health Care Policy and Financing

Next StepsEnhanced IntegrationPhysical, Behavioral, Dental, Public Health, Long Term Services and SupportsMedicare-Medicaid EnrolleesPayment Reform HB 12-1281Shared SavingsEnhanced Data Collection and Sharing

Colorado Department of Health Care Policy and Financing

Questions

Susan E. BirchExecutive DirectorColorado Department of Health Care Policy & Financing 1570 Grant Street Denver, CO 80203 Susan.Birch@state.co.us

Colorado Department of Health Care Policy and Financing

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