Medicaid Reform Is Working For Colorado Kids
The good news in Colorado is that the Colorado Department of Health Care Policy and Financing (HCPF), which administers Medicaid and CHP+, has set up an innovative system designed to reduce the cost to the state of providing care for Medicaid recipients and improve certain health outcomes. This program, the Accountable Care Collaborative (ACC), can also help address some of the causes of health disparities. CCHAP is instrumental in helping medical homes serving children adapt to the ACC, meet key performance indicators, and maintain medical home certification for children on Medicaid.
HCPF has divided the state into 7 regions and contracted with non-profit Regional Care Coordination Organizations (RCCOs) for each region to address a variety of issues. The highest priority of the RCCOs is to reduce the cost of Medicaid services. Other objectives include improving the patient experience, improving the health of patients covered by Medicaid, addressing the socioeconomic issues and meeting the care coordination needs of Medicaid recipients.
The RCCO connects Medicaid clients to Medicaid providers and also helps Medicaid clients find community and social services in their area. The RCCO helps providers to communicate with Medicaid clients and with each other, so Medicaid clients receive coordinated care. A 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. A RCCO helps with other care transitions too, like moving from children’s health services to adult health services, or moving from a hospital to nursing care.
Providers And The ACC
Providers who contract with the ACC are paid fee for service based on the current Medicaid fee schedule and an additional $3.00 per member per month (PMPM) by Medicaid for each Medicaid patient enrolled in the ACC and attributed to the provider (PCMP). An addition incentive of $1.00 PMPM is available if certain Key Performance Indicators (KPI) are met by the RCCO and the individual provider.
The Statewide Data and Analytics Contract (SDAC) is responsible for providing secure electronic access to clinically actionable data to the Regional Care Collaborative Organizations (RCCOs) and Primary Care Medical Providers (PCMPs) to help them meet the goals of the Accountable Care Collaborative (ACC) – to improve client health and reduce costs.