Colorado Medicaid Accountable Care Collaborative (ACC)
Program Location:
Denver, CO
Payer Type:
Medicaid
Partner Organizations:
Rocky Mountain Health Plan
Colorado Access
Integrated Community Health Partners
Colorado Community Health Alliance
Community Care of Central Colorado
Payers:
Medicaid
Reported Outcomes
Description:
Colorado is using an Accountable Care Collaborative (ACC) model to expand medical home services for their adult and pediatric Medicaid population. Under this model, primary care medical providers (PCMPs) contract with 7 regional care collaborative organizations (RCCOs) to provide medical home services to Medicaid enrollees.The goal of the ACC is to have every member linked with a primary care medical provider (PCMP) as his or her central point of care, and the PCMPs are directly responsible for ensuring timely access to primary care for ACC members. PCMPs function as medical homes, a model that promotes comprehensive,coordinated, team-based, and client-centered care and enhances client experience and outcomes.
PCMPs are also responsible for assessing members’ nonmedical needs and helping them to access wraparound services such as housing assistance, longterm services and supports, behavioral health care, child care, transportation, food assistance, and other community services. PCMPs may provide this support directly, or it may be provided by Regional Coordinated Care Organization (RCCO) care coordinators. The RCCO helps providers to communicate with Medicaid clients and with each other, so Medicaid clients receive coordinated care. An RCCO will also help Medicaid clients get the right care when they are returning home from the hospital or a nursing facility, by providing the support needed for a quick recovery. An RCCO helps with other care transitions too, such as moving from children's health services to adult health services, or moving from a hospital to nursing care.
The Accountable Care Collaborative (ACC) has transformed Colorado Medicaid. In the ACC, Medicaid members receive coordinated care from a patient-centered medical home and PCMPs have support in order to provide high quality and efficient health care services.
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Payment Model:
According to NASHP, Regional Care Collaborative Organizations (RCCOs), Primary Care Medical Providers and the Statewide Data and Analytics Contractor receive a total of $20 per-member/per-month (PMPM) for medical home services (divided among three entities): Primary Care Medical Provider (PCMP): $4 PMPM, Regional Care Collaborative Organization (RCCO): $13 PMPM, Statewide Data and Analytics Contractor (SDAC): $3 PMPM.
Once an RCCO shows cost neutrality, $1 PMPM is withheld from both the PCMP and RCCO, creating a shared quarterly incentive payment pool. The $1 PMPM can be recouped by each entity by meeting specific performance goals. * Pediatric PCMPs cannot receive enhanced payments from both the Medical Homes for Children and the ACC programs. They are only eligible to receive the Medical Home for Children Program performance payments for their patients.
Primary Care Medical Providers receive fee-for-service reimbursements for medical services rendered to enrolled Medicaid beneficiaries. In the program’s expansion phase, RCCOs and Primary Care Medical Providers are eligible to receive incentive payments: initial incentive payments will be available for RCCOs and Primary Care Medical Providers that reduce emergency room visits, hospital re-admissions, and utilization of medical imaging. PMPM payments to RCCOs and Primary Care Medical Providers will be reduced to $12 and $3 respectively, with $1 from each withheld to support incentive payments based on achievement of performance targets. The state hopes to incorporate a shared savings component at a later date as more beneficiaries enroll in the ACC program.
Fewer ED / Hospital Visits:
ACC 2014 Annual Report (November 2014)
- 8% fewer ER services for adults enrolled in ACC for more than 6 months vs not enrolled
- Fewer readmissions for children and adult ACC members without disabilities vs. non-enrolled
- Use of ER services for ACC members with disabilities was slightly higher than for those not enrolled
- 3% fewer imaging services for ACC members with disabilities (vs. not enrolled)
- 16% fewer imaging services for adult ACC members (vs. not enrolled)
- 12% fewer imaging services for children ACC members (vs. not enrolled)
Colorado Legislative Report (November 2013) outcomes relative to a comparison population prior to program implementation:
- 15-20% reduction for hospital readmissions
- 25% reduction in high cost imaging services
- Reduction in hospital admissions
- 9% among members with diabetes
- 5% among members with hypertension
- 22% among ACC members with COPD who have been enrolled in the program six months or more, compared to those not enrolled
- Emergency room utilization by ACC enrollees increased 0.9 percentage points less than utilization by those not enrolled in the ACC program, or an increase of (1.9%) for ACC enrollees compared to an increase of (2.8%) for those not enrolled
Improved Health:
Colorado Legislative Report (November 2013)
- Lower rates of exacerbated chronic health conditions such as hypertension (5%) and diabetes (9%) relative to clients not enrolled in the ACC Program
Cost Savings:
PCPCC 2018 Evidence Report
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Reduced costs about $60 per member per month (PMPM) on adults and $20 PMPM on children as compared to eligible members who were not enrolled in an ACC over the same time period.
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In dual eligible beneficiaries this cost savings was about $120 PMPM.
ACC 2014 Annual Report (November 2014)
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The ACC program generated approximately $100 million in gross program savings ($31 million in net savings) in FY2013-2014
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In FY2013-2014, approximately $14 million was reinvested into providers by the program (including incentive payments)
Colorado Legislative Report (November 2013)
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$44 million gross, $6 million net reduction in total cost of care (cost avoidance) for clients enrolled in the ACC Program
Increased Preventive Services:
Colorado Legislative Report (November 2013)
- Increased preventive services for individuals with diabetes
Other Outcomes:
PCPCC 2018 Evidence Report
- Well child checks for children ages 3-9 increased from 20.6% for clients who were enrolled less than 6 months to 43% for those enrolled for 7 months or more.
- Follow up care after hospital discharge increased from 41.2% to 49.4% the longer the patient was enrolled in the program. As time enrolled in the program increased, utilization of ER services decreased by 5% and 30 day all-cause readmissions decreased.
ACC 2014 Annual Report (November 2014)
- 50% of all children under age 18 enrolled in the ACC had at least one well-child visit this year
Last updated February 2018
