Colorado Moving Forward with Medicaid Accountable Care Collaborative
December 5, 2010
Posted by chcablogadmin in : ACO Update
Colorado is one of at least three states that preceded the federal government in implementing major health care reforms. The other two are Massachusetts and Utah. Colorado began their Accountable Care Collaborative (ACC) initiative about two years ago and is now proceeding with implementation. According to the Colorado Department of Health Care Policy & Financing in June, 2010, the ACC is part of the Department’s Medicaid reform effort. Its goals are “to create a regional model of accountability for improving health, functioning and self sufficiency of all Medicaid clients while controlling costs, reducing unexplained variation in care, improving timely access to care, enhancing client and provider satisfaction and coordinating care across provider settings and social services.” Key elements include:
- Providing medical homes offering whole-person-centered care, in addition to family-centered care for children;
- Physician leadership in organizing and managing care rather than their being managed by an insurer;
- Provision of care management, data, and other support to providers so that they can focus on patient care;
- Offering coordination assistance regarding clients’ physical, behavioral health, long-term care and psychosocial needs; and
- Aligning incentives for providers to promote and be rewarded for improving health outcomes and reducing duplicate and unnecessary care.
The initial step is creation of 7 Regional Care Collaborative Organizations (RCCOs). The RCCOs will provide care coordination with other programs (e.g., behavioral health, long-term care, social services, food/nutrition, etc.). They will also establish criteria for incentives and make payment to providers/networks that meet certain guidelines and measurements of care. That is underway now as the state reviews proposals received by the October 22, 2010 deadline in response to an RFP issued in August. We understand that most, if not all, of the respondents are managed care plans vs. providers. The plan is to assign 8,000 Medicaid enrollees (including 2900 children) to each RCCO. Awards are to be announced at year end for a three-phase program, beginning with a Start-up Phase that extends from award to “go–live” date (either April 1 or June 1, 2011). The Initial Phase will run from “go-live” date to June 30, 2012, and will then be followed by an Expansion Phase in 2012.
The state has also issued an RFP for a Statewide Data and Analytics Contractor (SDAC) that would provide:
- A web-based health information system that provides business intelligence to identify variation;
- Care management software support for benchmarking and real-time decision-making; and
- Identification of data-driven opportunities to improve care and outcomes.
According to Bruce Harma, Director, Managed Care, The Children’s Hospital, Denver, RCCOs will receive up to the state-budgeted $13 per member per month for the initial phase, with $1 per member per month to serve as incentive payments for reducing the cost of care for treating the panel population by 7%, which, if achieved, will make the program budget neutral to the state. According to Tom Nash, Colorado Hospital Association Vice President of Financial Policy, providers will continue to be paid by the state on a fee-for-service basis as before. Payments to providers from the RCCOs will be based on reaching defined utilization standards, not payments for care. Nash added that the state is probably thinking about incorporating some type of payment reform, but nothing has surfaced on that yet.
Both Nash and Harma indicated that, while the ACC will include children, there is no focus on pediatrics in the RCCO RFP.
The Children’s Hospital Response
The Children’s Hospital plans to establish a non-contractual relationship with the state’s RCCOs and the state on behalf of pediatrics. The hospital will also seek state grant funding to assist in making the program a success for the state. The key to success will be aggressive case management for high cost diseases. Children’s also will rely on several existing components of its infrastructure—outreach programs for children’s safety and prevention, care coordination affiliations, established clinical guidelines, the expanded use of provider extenders, the widely distributed network of EPIC systems across many pediatric practices, an established primary care program for target areas, such as Aurora, CO, and the established Children’s Network of Care to leverage current clinical faculty and staff dedicated to the coordination of children’s care.
Individual hospital governance structures and relationships with primary care providers will help dictate posture and readiness to assume ACO responsibility and risk. The Children’s Hospital’s principle affiliation is with the University of Colorado Denver pursuant to which the hospital is the primary pediatric teaching facility for the School of Medicine (UCD-SOM). This relationship resulted in many of the Children’s community–based medical staff members becoming clinical faculty at UCD-SOM and has resulted in Children’s becoming a significant center for pediatric medical research. The University Physicians Inc., a separate legal entity from The Children’s Hospital, is the UCD-SOM faculty practice group that furnishes the majority of TCH specialty professional services.
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