Community Partner Roundtable · 2019-12-16 · Community Partner Roundtable 10.21.14 . Today’s...
Transcript of Community Partner Roundtable · 2019-12-16 · Community Partner Roundtable 10.21.14 . Today’s...
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Accountable Care Collaborative: Medicare-Medicaid Program Community Partner Roundtable 10.21.14
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Today’s Agenda
• HCPF
• ACC
• RCCO
• SDAC
• PCMP
• PMPM
• KPI
• MMP
• SCP
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Today’s Agenda
WTH?
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The Accountable Care Collaborative
Regional Care Collaborative Organization
Accountable Care
Collaborative Primary
Care Medical Provider
Statewide Data
Analytics Contractor
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The RCCO Regions
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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
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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
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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
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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
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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.
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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
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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
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Medicare-Medicaid Enrollees
Archuleta County 131
La Plata County 368
Montezuma County 425
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Contact
Jenny Nate
Senior Community Strategies Leader
Rocky Mountain Health Plans
720.934.4293
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