Medicaid Accountable Care Collaborative (ACC) Durango Community Forum, August 27, 2013

Transcription

1 Medicaid Accountable Care Collaborative (ACC) Durango Community Forum, August 27, 2013

2 ACCOUNTABLE CARE COLLABORATIVE (ACC) BACKGROUND 2

3 New Medicaid Delivery System Developed in response to: Failed attempts at capitated Managed Care in Colorado 85% of clients in an unmanaged Fee-For-Service (FFS) system Unprecedented economic situation highest caseload & expenditures in the State s history of Medicaid Objectives: Expand access to comprehensive primary care. Provide a focal point of care / Medical Home for all Members including coordinated and integrated access to other services. Promote Member and provider engagement. Effectively apply an unprecedented level of statewide data and analytics functionality to support transparent, secure data-sharing and enable more timely monitoring and measurement of health care costs and outcomes 3

4 Achieving the Triple Aim The best care for the total population and the lowest cost Enhance Patient Experience Improve Population Health Triple Aim Four Key Performance Indicators, or KPIs, are currently being measured: Day All Cause Hospital Readmissions 2. Emergency Room Usage 3. High cost imaging services 4. Well Child Visits (currently being measured but not yet tied to incentive payments) Control Costs

5 Three Components of the ACC Regional Care Collaborative Organization Primary Care Medical Provider Accountable Care Collaborative Statewide Data Analytics Contractor 5

6 Client Population & Enrollment Serves Medicaid fee-for-service beneficiaries Exclusions to date: Dual eligible enrollees Beneficiaries residing in an institutional setting Medicaid managed care enrollees Enrollment of children was initially limited to approximately one-third of the number of total enrollees; the Department removed this limit in October Children currently makes up approx. 67% of the membership statewide. Adults without Dependent Children June 2012 Individuals age 19-64, at or below 10% of FPL, without dependent children. Initial cap of 10,000 individuals statewide. Expanded in April 2013 to allow 9,250 additional slots. All individuals on wait list will be enrolled on Jan. 1, 2014 when Affordable Care Act Medicaid expansion goes into effect Enrollment Requirements Enrollment is mandatory for adult Medicaid beneficiaries without dependent children (AwDC program). To date, enrollment is voluntary and passive for all other beneficiaries. 6

7 PCMPs in the Southwest Counties Primary Care Medical Providers (PCMPs) are a key part of the success of the ACC. The PCMP acts as a medical home and coordinates a client's health needs across specialties and along the continuum of care. In addition to the fee-for-service payments for the medical services supplied, PCMPs receive a per-member-per-month (PMPM) for the medical home services they provide. Eligible providers can participate as PCMPs in the ACC at any time. PCMPs sign a contract with the State and with the RCCO. Currently participating PCMPs in the SW Counties include: Pagosa Springs Rural Health Center Dove Creek Community Health Center Pediatric Associates of Durango Pediatric Partners of the Southwest Mercy Family Medicine Axis Cortez Integrated Healthcare 7

8 RCCO Regions 8

9 State Data and Analytics Contractor (SDAC) Treo Solutions serves as the statewide SDAC vendor. The role of the SDAC includes: Data Repository Data Analytics & Reporting Web Portal & Access Accountability & Continuous Improvement 9

10 SDAC Dashboard 10

11 ACCOUNTABLE CARE COLLABORATIVE (ACC) CURRENT STATE 11

12 Current Enrollment August 2013 Statewide: Approx. 355,000 clients enrolled in the ACC program = 49% of total Medicaid population (729,000) Region 1: Approx. 42,000 clients enrolled Archuleta County: 1,202 members (31% adults, 69% children) Dolores County: 131 members (38% adults, 62% children) La Plata County: 3,494 members (30% adults, 70% children) Montezuma County: 1,740 members (36% adults, 64% children) San Juan County: 49 members (35% adults, 65% children) SW Counties total membership: 6,616 (16% of Region 1 membership) 12

13 The Three T s of Care Coordination Targeted Aligning resources with patient needs Transdisciplinary Organizing competencies around the patient (care coordinator, educator, BH provider, pharmacist, etc.) Trust Building relationships with clients through in-person contact, consistent and culturally appropriate 13

14 Initial Program Results In the ACC s first year, the Department reported that the program returned nearly $3 million to state & federal taxpayers. The Department identified three key performance indicators (KPIs) to measure improvement among those clients enrolled in the ACC, compared to clients not yet enrolled: Hospital Readmissions: 8.6% greater reduction among ACC clients Emergency Room Utilization Overall, there was a 1% increase among Medicaid clients, but only a.23% increase among ACC enrollees High Cost Imaging 3.3% greater decrease among ACC clients To-date, three rounds of incentive payments have been issued (February, May & August 2013). In Region 1, we have met our targets on 2 of the 3 KPIs: 30-Day Readmissions & High Cost Imaging in each of these quarters. 14

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16 ACCOUNTABLE CARE COLLABORATIVE (ACC) NEXT STEPS / EXPANSION 16

17 New KPI: Well Child Visits Effective July 1, 2013, HCPF began measuring a fourth KPI, Well Child Visits, based on CMS-416 criteria. Beginning in early 2014, HCPF will begin to provide financial incentive payments to RCCOs and PCMPs for this KPI. School sports physicals are not included in the well child visit KPI calculation. Providers are encouraged to expand sports physicals to well child physicals for these adolescent visits to be counted as a well child visit for the KPI. 17

18 Integration of Care for Full Benefit Medicare-Medicaid Enrollees State Demonstration to integrate care for Full Benefit Medicare- Medicaid Enrollees (dual-eligible) Pending approval from Centers for Medicare/Medicaid Svcs state expects to receive more information soon HCPF and RCCOs are completing a readiness review RCCOs and community partners are developing protocols for data sharing and care coordination of shared clients 18

19 ACA Medicaid Expansion From 5/7/13 Colorado Medical Society article: Colorado Medicaid will soon become the second largest payer in the state because of the ACA Expansion. The governor s State of Health report notes, The ACC infrastructure, with its focus on client-centered care and regional solutions, is the foundation of the Medicaid program in Colorado and will be the vehicle for delivery and payment reforms in Colorado Medicaid. Through a number of programs, including the ACC, we will reduce the number of individuals in unmanaged, fee-for-service care to less than 30 percent by SB legislation amends the CO Health Care Affordability Act to cover additional low-income Coloradans by changing the Medicaid eligibility level from 100% to 133%* of the FPL. $30,657 per year for a family of four $14,856 per year for an individual Children are currently covered up to 133% FPL, so the new coverage would impact parents with Medicaid eligible children and other adults without dependent children Many of those impacted are working individuals who had earned too much to qualify for Medicaid in the past, but not enough to afford private insurance HCPF estimates that up to 160,000 Coloradans could gain access to care beginning January 1, 2014 *Federal law allows for a 5 percent income disregard so those earning up to 138% FPL may be eligible. 19

20 For More Information Jenny Nate, MSW, Senior Community Strategies Leader & RCCO Contract Manager; (303) Carol Ann Hendrikse, RN, BSN, CCM, RCCO Clinical Manager; (970) Nicole Konkoly, RCCO Community Coordinator; (303)

21 THANK YOU 21