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Judy Zerzan, MD, MPH January 9, 2014

Colorado’s Accountable Care Collaborative. Judy Zerzan, MD, MPH January 9, 2014. Development of the Accountable Care Collaborative Program. Regional model of accountability for: improving health, functioning and self-sufficiency while controlling costs reducing unexplained variation in care

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Judy Zerzan, MD, MPH January 9, 2014

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  1. Colorado’s Accountable Care Collaborative Judy Zerzan, MD, MPH January 9, 2014

  2. Development of the Accountable Care Collaborative Program • Regional model of accountability for: • improving health, functioning and self-sufficiency while controlling costs • reducing unexplained variation in care • improving timely access to care • enhancing client and provider satisfaction • coordinating care across provider settings and social services • Goal: to improve health outcomes for Medicaid clients through a coordinated, client-centered, outcomes-focused system

  3. Who’s Impacted by the ACC As of December 15: 400,000 clients enrolled Approximately 400 provider locations More than 2,100 rendering practitioners

  4. Components of the RCCO Ensure comprehensive care coordination and a Medical Home level of care for every Member through: Network Development/Management Provider Support Medical Management and Care Coordination Accountability/Reporting

  5. RCCO Map

  6. Components of the ACC : PCP PCPs Responsibilities PCP serves as a Medical Home Member/family centered Whole person oriented Coordinated Promotes client self-management Care provided in a culturally sensitive and linguistically sensitive manner Accessible

  7. Components of the ACC: Data SDAC Responsibilities Data Repository Data Analytics & Reporting Web Portal & Access Accountability & Continuous Improvement

  8. ACC DATA ANALYTICS- Opportunities

  9. FFS reimbursement to PCMPs for medical services PMPM payment to PCMP for medical home services - $3 PMPM payment to RCCO’s for PCMP support and care coordination - $9.50 Incentive Payments $1 + $1 PCMP & RCCO Payment

  10. Key Performance Indicators in RCCOs • Re-hospitalizations • ER visits • High cost imaging • Children’s well child visits

  11. ACC Annual Report Highlights 2013 • Reduced High Cost Imaging 25% • Reduced Hospital Readmissions 15% • Slowed growth in ER Visits 0.9% FY2012-13 Total Program Costs: $36.4 Million Total Savings: $44 Million Net Savings: $6 Million

  12. ACC Quality Improvement Subcommittee • Provide guidance to help improve client health, access, cost and satisfaction • Identify measurement gaps and recommend future measures • Meets monthly • Made up of RCCO staff, Department Staff, physicians, community partners and consumers • Align with state and national trends

  13. Helpful Discussions • Developing a new Key Performance Indicator around children • Transition of Children’s Medical Home • Attribution • Rise in ED utilization

  14. Lessons Learned about Committee • Membership needs more consumers • Charter is updated annually • Agendas are planned well in advance so that appropriate attendees and experts are there

  15. Lessons Learned about Measures • Pick easy utilization measures first • Things we really want to measure don’t have good measures • Tension between regional vs. individual reward • Hard to tell what is right reward amount • Alignment with multiple projects

  16. SDAC Quality Dashboard • Using funds from Adult Quality Measure Grant • Started with Diabetes A1C • Easy to create list of clients • Harder • To make quarterly • Interesting and actionable for providers • Match HEDIS especially if hybrid

  17. How should the incentive be structured?

  18. Key Decision Points (1 of 2) • Selecting appropriate measures • How much should the incentive be worth? • How should the incentive be structured? • What entity should receive the incentive? • How should RCCOs/PCMPs earn the incentive? • Should performance against target be valued the same as performance improvement? • Upon which measures should the RCCO/ PCMP be scored? • How should the financial incentive be distributed?

  19. Key Decision Points (2 of 2) • Should all performance measures be worth equivalent value? • Should all performance measures be independent? • Should the algorithm recognize differences in performance among RCCOs/PCMPs? • How should performance improvement be assessed? • Should performance improvement expectations be the same across RCCOs/PCMPS? • Should performance targets be the same across RCCOs/PCMPS? • Should RCCOs/PCMPS only be rewarded through the algorithm?

  20. Thoughts about KPIs Part 2 • More measures • More money at risk • Add population health measures • Option for RCCOs to choose from limited menu • Alignment with other state agencies • Laying out 3-4 year plan of measure development

  21. Thank You! Questions? Judy.Zerzan@state.co.us

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