community partner roundtable · 2019-12-16 · community partner roundtable 10.21.14 . today’s...
TRANSCRIPT
Accountable Care Collaborative: Medicare-Medicaid Program Community Partner Roundtable 10.21.14
Today’s Agenda
• HCPF
• ACC
• RCCO
• SDAC
• PCMP
• PMPM
• KPI
• MMP
• SCP
Today’s Agenda
WTH?
The Accountable Care Collaborative
Regional Care Collaborative Organization
Accountable Care
Collaborative Primary
Care Medical Provider
Statewide Data
Analytics Contractor
The RCCO Regions
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
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
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
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
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.
Medicaid and ACC Expansion Data
11
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
Enro
lled
clie
nts
Region 2-7 Total Medicaid
Region 1 ACC Caseload
Region 1 non-ACC Medicaid
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
10000
Archuleta12/13
Archuleta 8/14 La Plata 12/13 La Plata 8/14 Montezuma12/13
Montezuma8/14
Southwest Counties
Medicaid Non-ACC Medicaid ACC
Medicaid and ACC Expansion Data
Medicare-Medicaid Enrollees
Archuleta County 131
La Plata County 368
Montezuma County 425
Contact
Jenny Nate
Senior Community Strategies Leader
Rocky Mountain Health Plans
720.934.4293
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