Accountable Care Collaborative Phase II Request for Proposals - - PowerPoint PPT Presentation

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Accountable Care Collaborative Phase II Request for Proposals - - PowerPoint PPT Presentation

Feb 07, 2024 142 likes •583 views

Accountable Care Collaborative Phase II Request for Proposals Overview November & December 2016 1 Our Mission Improving health care access and outcomes for the people we serve while demonstrating sound stewardship of financial resources 2

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November & December 2016

Request for Proposals Overview

Accountable Care Collaborative Phase II

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Our Mission

Improving health care access and

  • utcomes for the people we serve

while demonstrating sound stewardship of financial resources

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Purpose of Meeting

  • Share key program features of the draft request for

proposals (RFP)

  • Identify operational concerns and areas of the draft

RFP that need additional clarification

  • Explain how to provide comments on the draft RFP

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Guiding Questions

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  • How well does the draft RFP meet the overall goals of ACC

Phase II?

  • What operational concerns and potential consequences are

there for implementing the requirements in the draft RFP as written?

  • What draft RFP requirements need additional clarification?
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Today

  • Current Accountable Care Collaborative
  • Current Behavioral Health
  • Accountable Care Collaborative Phase II
  • Overview of Key Concepts
  • How to Provide Comments
  • Key Questions & Input Needed

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Current Accountable Care Collaborative

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Health First Colorado Members

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FY 2015-16 Health First Colorado Caseload

7% 3% 42% 45%

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Accountable Care Collaborative

Data

Members, providers and the system receive the data needed to make real-time decisions that improve care, increase coordinated services and improve overall efficiencies.

Regional Coordination

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.

Medical Home

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.

Better Health and Life Outcomes

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Accomplishments

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  • 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

  • f

Resources

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Current Behavioral Health Program

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Behavioral Health

  • Behavioral Health Organizations (BHOs) provide or

arrange for mental health (MH) and substance use disorder (SUD) services for Health First Colorado members

  • Most members are automatically assigned to 1 of 5

Behavioral Health Organizations (BHO)

  • The BHOs are paid a monthly fee, or a capitation to

pay for covered MH and SUD services

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Accomplishments

  • Achieved cost savings for behavioral health services
  • Implemented trauma-informed care practices

across the state

  • Successfully piloted health care integration

projects

  • Participated in the implementation of Colorado’s

statewide behavioral health crisis response system

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Evolving to Meet Needs

Moving toward more coordinated and integrated care that increasingly rewards improved health

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Accountable Care Collaborative Phase II

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Goals & Objectives

To improve health and life outcomes for Members To use state resources wisely

  • Join physical and behavioral health under
  • ne accountable entity
  • 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

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Procurement Timeline

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Spring 2014- Fall 2016 Stakeholder Engagement & Draft RFP Formulation Now Release Draft RFP Fall 2017 RAE Awards Announced Winter 2018 RAE Contracts Signed Summer 2018 Phase II Implemented Spring 2017 Release of Final RFP

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Stakeholder Engagement Contributing to Draft RFP

  • Focused engagement since spring 2014
  • More than 60 meetings
  • Summer 2014: Strategic Vision meetings in all regions
  • Fall 2014: Request for Information had more than 120

respondents with nearly 4,000 pages of feedback

  • Fall 2015: Concept Paper posted with multiple stakeholder

presentations

  • Ongoing engagement of the Accountable Care

Collaborative Program Improvement Advisory Committee

  • Now we are seeking targeted comments from the

community

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Overview of Key Concepts

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Key Concepts

Regional Accountable Entity Member Experience Provider Support Administration

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Regional Accountable Entity

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Regional Accountable Entity

Physical Health Care Behavioral Health Care

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Member Experience

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Mandatory Enrollment Member Attribution Population Health Management Care Coordination

Behavioral Health Services in Primary Care

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Mandatory Enrollment

Full-benefit Health First Colorado Members will be enrolled* Enrollment will be effective on the same day that eligibility is received

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Member Attribution

Attributed based on:

  • Member’s previous choice of a primary care provider
  • Member’s utilization history
  • Appropriate primary care provider located near Member

May select a different primary care provider at any time RAE enrollment is based on the location of the Member’s attributed primary care provider practice site

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Population Health Management

Responsible for health of all of its members Development of Population Health Management Plan Design variety of interventions to support members at all life stages and levels of health Care coordination is one

  • f the interventions that

should be used Additional focus placed

  • n members

transitioning between health care settings and involved in multiple systems

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Behavioral Health Services

  • RAE shall administer behavioral health benefit
  • Services remain the same as in the current behavioral health

benefit

  • Retaining the behavioral health capitation, but modifying

some aspects to increase access

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Provider Support

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Provider Support

Administrative Data Systems & Technology Practice Transformation Financial

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Administration

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Program Monitoring

Pay for Performance Public Reporting Data Analytics

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Transparency

Program Improvement Advisory Committees (PIAC)

  • Provide guidance to improve health, access, cost and

experience of both members and providers

  • Review performance and key deliverables

Financial Reporting

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Payment

Per Member Per Month Behavioral Health Capitation

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Additional Statement of Work Activities

Wraparound Program Pre-Admission Screening and Resident Review (PASRR) Brokering of Case Management Agencies

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Providing Comments

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Considerations & Criteria

  • Does it align with the goals of Phase II?
  • Does it align with the objectives of Phase II?
  • Is there a budget impact, and if so, what is it?
  • Does it meet federal regulations?
  • Does it meet state regulations?
  • Does is align with the implementation timeframe of Phase II?
  • Is the implementation feasible at this time?

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Opportunities for Comments

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Webinar & phone In-person meetings across the state Written input

Go to Colorado.gov/HCPF/ACCPhase2 for a complete list.

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Key Questions & Input Needed

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Questions

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  • What aspects of program are still unclear after today’s

presentation?

  • Are there ways that the Department can ensure that the

written draft RFP is clearer on those points?

  • What program features might be difficult to implement?

How can the Department better ensure success?

  • Are there unforeseen consequences to the approach
  • utlined in the draft RFP?
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Questions or Comments?

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More Information

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Check out our ACC Phase II site for the latest information and sign up for our newsletter at

Colorado.gov/HCPF/ACCPhase2

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Thank You!

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