Accountable Care Collaborative: Medicare-Medicaid Program Community - PowerPoint PPT Presentation

Accountable Care Collaborative: Medicare-Medicaid Program Community Partner Roundtable 10.21.14

Today’s Agenda • HCPF • ACC • RCCO • SDAC • PCMP • PMPM • KPI • MMP • SCP

Today’s Agenda WTH?

The Accountable Care Collaborative Regional Care Collaborative Organization Accountable Care Collaborative Primary Statewide Care Data Medical Analytics Provider Contractor

The RCCO Regions

Role of the RCCO The seven Regional Care Collaborative Organizations do the following: • Responsible for care coordination/practice support • Develop provider networks/contract with Primary Care Medical Providers (PCMP) • Facilitate referral process • Provide network and care coordination data to the Department and/or SDAC • Do not assume risk, pay claims, or provide preauthorization RMHP serves as RCCO for Region 1

Our approach to care: Community Care Teams North Larimer County • Care Team: SW, NP, beh. health specialist, community navigator South Larimer County • Care Team: RN care coordinator Routt/Moffat Counties • Care Team: RN care coordinator, SW, beh. health specialist La Plata/Archuleta Counties • Care Team: RN nurse navigators (pediatric, adult, geriatric) and promotora Eagle/Pitkin/Garfield Counties • Care Team: RN care coordinator

Additional Care Coordination Support RMHP Clinical Care Coordination: • ACC members not served by a CCT ACC members served by a CCT, but requiring a lower level of intervention • ACC members who have not yet been attributed to a PCMP • Care Coordination Levels: Level 1 - Preventive care, wellness care • • Level 2 – Single, well-managed chronic disease • Level 3a - Moderately well-managed Disease Process (specialists not required) Level 3b – Moderately managed Disease Process (specialists required) • Level 4 – Complex outpatient care coordination – Poorly controlled disease • process Level 5 – Transitions of Care •

ACC Payment Model • Fee-for-service • Prospective payment for care management • PCMP - $3/PMPM • RCCO - $9.50/PMPM • Quarterly incentive payments received if Key Performance Indicator targets are met (up to $1 PMPM for providers). • Key Performance Indicators: • ER utilization • Well-child visits (ages 3-9) • Postpartum visits

Current Program Status • In the ACC’s first year, the Department reported that the program returned nearly $3 million to the State General Fund, and $6 million in its second year. • Currently, over half of all Medicaid clients in Colorado are enrolled in the ACC, with plans to enroll entire CO Medicaid population by 2015. • Statewide Medicaid enrollment is over one million • In Region 1, over 98,000 Medicaid clients are currently enrolled.

Medicaid and ACC Expansion Data 1,200,000 1,100,000 1,000,000 900,000 800,000 Region 2-7 Total Medicaid Enrolled clients 700,000 Region 1 ACC Caseload Region 1 non-ACC Medicaid 919,054 600,000 500,000 658,358 400,000 300,000 200,000 92,755 100,000 48,014 [VALUE] 66,582 - 11 December 2013 August 2014

Medicaid and ACC Expansion Data Southwest Counties 10000 9000 8000 7000 6000 5000 4000 3000 2000 1000 0 Archuleta Archuleta 8/14 La Plata 12/13 La Plata 8/14 Montezuma Montezuma 12/13 12/13 8/14 Medicaid Non-ACC Medicaid ACC

Medicare-Medicaid Enrollees Archuleta County 131 La Plata County 368 Montezuma County 425

Contact Jenny Nate Senior Community Strategies Leader Rocky Mountain Health Plans jenny.nate@rmhp.org 720.934.4293 14