Accountable Care Collaborative: Medicare-Medicaid Program Webinar for Providers! Medicare & Medicaid working together for your patients!

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1 Accountable Care Collaborative: Medicare-Medicaid Program Webinar for Providers! Medicare & Medicaid working together for your patients! 1

2 Elizabeth Baske. Presenters ACC: Medicare- Medicaid Program Lead Van Wilson ACC: Medicare- Medicaid Project Manager Ma. Vedal & Sophie Thomas ACC: Medicare- Medicaid Program Specialists 2

3 Ques>ons we ll answer What is the Accountable Care Collabora?ve: Medicare- Medicaid Program (ACC:MMP)? Why is the ACC:MMP important and how does it work? Who is eligible and how do pa?ents enroll? How does the ACC improve care across providers? Where can I get more informa?on? 3

4 The ACC program vision Now Tradi>onal, unmanaged Fee- for- Service model Later Regional, outcome- focused, client/family- centered coordinated system of care 4

5 What is the ACC program? The ACC has become the primary Medicaid delivery system! Serving 700,000 Coloradans Managed Fee- For- Service system The ACC allows pa?ents to:! Get help naviga?ng the healthcare system! Keep their doctors and access all their benefits! Receive enhanced care coordina?on! Get access to non- medical services 5

6 How does the ACC program work? 6

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8 How does the ACC help pa>ents? The ACC establishes partnerships and improves communica?on across the con?nuums of care Promotes person- centered care The ACC connects pa?ents with a network of primary care physicians, direct service providers, and social supports 8

9 How does the ACC help providers? Established 7 Regional Care Collabora?ve Organiza?ons (RCCOs) The RCCOs help providers address gaps in care for pa?ents The ACC gives providers a RCCO they can call to get help for pa?ents, including access to social, medical and behavioral health services Refer your pa+ents to the RCCOs! 9

10 The ACC and RCCOs are here to help If you need anything for your pa+ent, ask the RCCOs The RCCOs provide added support through care coordina?on and medical management! Assist with follow- ups, check in on pa?ents, track appointments, help fill prescrip?ons RCCOs link your pa?ents to services and specialists Your pa?ents will get greater care coordina?on 10

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12 Region RCCO Name Phone Number Website Coun>es Served 1 Rocky Mountain Health Plans Colorado Access Archuleta, Delta, Dolores, Eagle, Garfield, Grand, Gunnison, Hinsdale, Jackson, La Plata, Larimer, Mesa, Moffat, Montezuma, Montrose, Ouray, Pitkin, Rio Blanco, Roud, San Juan, San Miguel, Summit Cheyenne, Kit Carson, Lincoln, Logan, Morgan, Phillips, Sedgwick, Washington, Weld, Yuma 3 Colorado Access Integrated Community health Partners om Adams, Arapahoe, Douglas Alamosa, Baca, Bent, Chaffee, Conejos, Cos?lla, Crowley, Custer, Fremont, Huerfano, Kiowa, Lake, Las Animas, Mineral, Otero, Prowers, Pueblo, Rio Grande, Saguache 5 Colorado Access Colorado Community Health Alliance 7 Community Care of Central Colorado Denver Boulder, Broomfield, Clear Creek, Gilpin, Jefferson care.org El Paso, Elbert, Park, Teller 12

13 Why is the ACC:MMP important? The ACC is now expanding to serve individuals with Medicaid and Medicare (MMEs) In the past, MMEs in Fee- For- Service Accountable Care Collabora>ve Fee- For- Service Only, no Coordina>on 700,000+ Members 32,000 MMEs 13

14 Why is the ACC:MMP important? The ACC is now expanding to serve individuals with Medicaid and Medicare (MMEs) In the past, MMEs in Fee- For- Service Accountable Care Collabora>ve Fee- For- Service Only, no Coordina>on 700,000+ Members 32,000 MMEs 14

15 Why is the ACC:MMP important? The ACC is now expanding to serve individuals with Medicaid and Medicare (MMEs) In the past, MMEs in Fee- For- Service Accountable Care Collabora>ve ACC:MMP 32,000 MMEs 700,000+ Members 15

16 Who are MMEs? A popula?on who:! In general, need a higher degree of support! Are a small propor?on of the popula?on, but a large propor?on of spending! Rely almost en?rely on government programs! Have low incomes and are vulnerable! Have great needs, but few resources Na+onal Senior Ci+zens Law Center 16

17 Who is eligible? Medicare- Medicaid pa?ents: Medicare Parts A and B, and eligible for Part D Receive full Medicaid benefits Have no other private/public health insurance or managed care ~32,000 eligible Coloradans 17

18 How are pa>ents enrolled? Passive enrollment process! Pa?ents receive enrollment no?ce 30 days before enrollment! Pa?ents can opt out of the program at any?me! Only pa?ents may opt out of the program, providers are prohibited from encouraging pa?ents to opt out Phased- in approach over 7 months! To op?mize ACC infrastructure! Phasing- in based on level of need! Approximately 5,000 beneficiaries enrolled per month 18

19 Monthly Pa>ent Enrollment by Classifica>on 5000 pa?ents/month maximum Sept Oct Nov Dec Jan Feb Mar MMEs currently in ACC Well Clients in Community who have a PCP in ACC Well Clients in Community who have a PCP in ACC Well Clients in Community who have a PCP NOT in ACC No Enrollment Well Clients in Community who have a PCP NOT in ACC Clients using some waiver services PCP in ACC Clients using some waiver services PCP NOT in ACC Clients using a lot of waiver services PCP in ACC Nursing Facility residents for which CO Medicaid is primary payer 19 (stay >90 days)

20 Pa>ent enrollment materials 33 days before enrollment! Welcome marke?ng leder 30 days before enrollment! An enrollment packet with an enrollment leder and member handbook with RCCO specific informa?on 20

21 What happens when a pa>ent is enrolled? Medicare and Medicaid benefits stay the same Pa+ents can keep same doctors! Pa?ents keep their doctors, even if the provider is not contracted with the ACC! RCCO will contact pa?ent to offer addi?onal supports and a Service Coordina?on Plan 21

22 How does the ACC:MMP improve care across providers? Part 1: Service Coordina?on Plan (SCP) Part 2: Cross- provider communica?on agreements (protocols) Part 3: Appeals and grievances alignment 22

23 Service Coordina>on Plan (SCP) Cornerstone of the program Helps iden?fy gaps in care and duplica>ve services Documents pa?ents short- and long- term goals Blueprint for mee?ng pa?ent goals and improving health outcomes 23

24 Service Coordina>on Plan (SCP) Promotes person- centered coordina?on of services and supports, including:! Coordina?ng physical, behavioral and social health needs for pa?ents! Promo?ng pa?ent engagement 24

25 How does the SCP work with other care plans? Complements other assessments/care plans currently in place Helps to iden?fy gaps in exis?ng services Iden?fies how RCCO care coordinator or delegate can fill in gaps and assist with goal adainment 25

26 How do RCCOs help? RCCOs help pa?ents with:! Primary, specialty and behavioral health care appointments! Medica?ons! Housing! Transporta?on! Food! Job training! Disability accessible and competent care 26

27 How does the ACC:MMP improve care across providers? Part 1: Service Coordina?on Plan (SCP) Part 2: Cross- provider communica?on agreements (protocols) Part 3: Appeals and grievances alignment 27

28 Cross- provider communica>on agreements Help providers: Iden?fy shared pa?ents Share informa?on Coordinate care Improve care delivery Home Health Hospitals SNFs Hospice CCBs Disability Orgs SEPs RCCO BHOs 28

29 When communica>on works 29

30 Coordina>ng case management services Who is the best person to coordinate care? Decide how you and other case managers will work together and receive regular updates. RCCO or delegate care coordinators s?ll responsible for:! Comple?ng and upda?ng SCP regularly! Coordina?ng pa?ent s medical, behavioral and social services and supports 30

31 How does the ACC:MMP improve care across providers? Part 1: Service Coordina?on Plan (SCP) Part 2: Cross- provider communica?on agreements (protocols) Part 3: Appeals and grievances alignment 31

32 Statewide ombudsman Single point of contact for all pa?ent ques?ons, concerns, complaints, appeals related to Medicare and Medicaid benefits and services. Partnership with CDHS and The Legal Center to implement program More informa?on coming soon! 32

33 Other important details! Quality metrics! Claims and reimbursement! Program resources! Regional conferences 33

34 How are we monitoring success? " 16 Program quality metrics " Early indicators reports " Independent CMS evalua?on 34

35 Quality metrics in the office Core Measures! All cause hospital readmissions! Ambulatory Care- Sensi?ve admissions! ED Visits for Ambulatory Care- Sensi?ve Condi?ons! Follow- up aner hospitaliza?on for Mental Illness! Care transi?on record transmission! Depression screening and follow- up care! Screening for fall risk State- Specific Process Measures! SCP completed within?meframe! PCMP training on Disability, Cultural competence! 30 day follow- up aner hospital discharge 35

36 Claims and reimbursements Process remains the same Submit Fee- For- Service Claims RCCOs and PCMPs receive a per member per month payment for Medicare- Medicaid pa?ents The payments support coordinated care for pa?ents RCCOs can delegate care coordina?on to PCMPs and pass their payment to PCMPs 36

37 The ACC and RCCOs are here to help If you need anything for your pa+ent, ask the RCCOs The RCCOs provide added support through care coordina?on and medical management! Assist with follow- ups, check in on pa?ents, track appointments, help fill prescrip?ons RCCOs can link pa?ents to services and specialists Your pa?ents will get greater care coordina?on 37

38 Program resources for providers New website: hdps:// training! Click Accountable Care Collabora?ve: Medicare- Medicaid Program to expand: Toolkit for providers Trainings- ACC:MMP introduc?on & SCP training Communica?on Protocols Pa?ent outreach materials SCP Materials & Instruc?ons 38

39 Program resources for pa>ents New website: hdp://co.gov/hcpf/mmp Enrollment materials include:! Enrollment leder! Member handbook! Frequently asked ques?ons! RCCO informa?on 39

40 Region RCCO Name Regional Conference Loca>on Mee>ng Date/Time RCCO Contact 1 Rocky Mountain Health Plans Glenwood Springs Durango Fort Collins Poudre Valley Hospital 1024 S. Lemay Avenue, Ft. Collins, Oct 13th 2:00-4:00 Oct 21st 11:00-1:00 Oct 30 th 9:00-1:00 Jenny Nate jenny.nate@rmhpcommunity.org 2 Colorado Access Greeley Island Grove Park 501 N 14th Ave., Greeley, CO Nov 5th 1:00-3:30 Sheeba Ibidunni Sheeba.Ibidunni@coaccess.com 3 Colorado Access Aurora 411 Sable Blvd, Aurora, CO Nov 10th 1:00-3:30 Sheeba Ibidunni Sheeba.Ibidunni@coaccess.com 4 Integrated Community Health Partners Pueblo La Junta Alamosa Buena Vista Best Western 733 HWY 24 N, Buena Vista, CO Oct 8 th 10:00-2:00 Oct 14 th 10:00-2:00 Oct 22 nd 10:00-2:00 Nov 6 th 10:00-2:00 Lori Roberts Lora.Roberts@valueop?ons.com 5 Colorado Access Aurora 411 Sable Blvd, Aurora, CO Nov 10th 1:00-3:30 Sheeba Ibidunni Sheeba.Ibidunni@coaccess.com 6 Colorado Community Health Alliance Lakewood Oct 22nd 5:00-7:00 Adam Bean Adam.Bean@phpmcs.com 7 Community Care of Central Colorado Manitou Springs Garden of the Gods 324 Beckers Lane, Manitou Springs, CO Divide Pikes Peak Community Club US Highway 24 Divide, CO Nov 13th 8:00-10:00 Nov 13th 5:30-7:30 Joe Farr joe@ppchp.org 40

41 Region RCCO Name Phone Number Website Coun>es Served 1 Rocky Mountain Health Plans Colorado Access Archuleta, Delta, Dolores, Eagle, Garfield, Grand, Gunnison, Hinsdale, Jackson, La Plata, Larimer, Mesa, Moffat, Montezuma, Montrose, Ouray, Pitkin, Rio Blanco, Roud, San Juan, San Miguel, Summit Cheyenne, Kit Carson, Lincoln, Logan, Morgan, Phillips, Sedgwick, Washington, Weld, Yuma 3 Colorado Access Integrated Community health Partners om Adams, Arapahoe, Douglas Alamosa, Baca, Bent, Chaffee, Conejos, Cos?lla, Crowley, Custer, Fremont, Huerfano, Kiowa, Lake, Las Animas, Mineral, Otero, Prowers, Pueblo, Rio Grande, Saguache 5 Colorado Access Colorado Community Health Alliance 7 Community Care of Central Colorado Denver Boulder, Broomfield, Clear Creek, Gilpin, Jefferson care.org El Paso, Elbert, Park, Teller 41

42 Ques>ons? 42

43 Contact: Van Wilson, MMP Project Manager Phone:

44 Thank you!" 44

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