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Today’s Agenda
- HCPF
- ACC
- RCCO
- SDAC
- PCMP
- PMPM
- KPI
- MMP
- SCP
Accountable Care Collaborative: Medicare-Medicaid Program Community - - PowerPoint PPT Presentation
Accountable Care Collaborative: Medicare-Medicaid Program Community - - PowerPoint PPT Presentation
Accountable Care Collaborative: Medicare-Medicaid Program Community Partner Roundtable 10.21.14 Todays Agenda HCPF ACC RCCO SDAC PCMP PMPM KPI MMP SCP Todays Agenda WTH? The Accountable
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Today’s Agenda
WTH?
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The Accountable Care Collaborative
Regional Care Collaborative Organization Accountable Care Collaborative Primary Care Medical Provider Statewide Data Analytics Contractor
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The RCCO Regions
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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
Role of the RCCO
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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
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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
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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
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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.
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Medicaid and ACC Expansion Data
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66,582 [VALUE] 48,014 92,755 658,358 919,054
- 100,000
200,000 300,000 400,000 500,000 600,000 700,000 800,000 900,000 1,000,000 1,100,000 1,200,000 December 2013 August 2014
Enrolled clients
Region 2-7 Total Medicaid Region 1 ACC Caseload Region 1 non-ACC Medicaid
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1000 2000 3000 4000 5000 6000 7000 8000 9000 10000 Archuleta 12/13 Archuleta 8/14 La Plata 12/13 La Plata 8/14 Montezuma 12/13 Montezuma 8/14
Southwest Counties
Medicaid Non-ACC Medicaid ACC
Medicaid and ACC Expansion Data
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Medicare-Medicaid Enrollees
Archuleta County 131 La Plata County 368 Montezuma County 425
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Contact
Jenny Nate Senior Community Strategies Leader Rocky Mountain Health Plans jenny.nate@rmhp.org 720.934.4293
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