ABCs of the ACC

1. ABCs of the ACC February 18, 2015 Targeting High Utilizers Group Meeting, Mile High Health Alliance

2. Colorado Access: Who Are We & What Do We Do?

3. How it all began… Celebrating20 YEARS in 2015

4. Current Structure Regional Care Collaboration Organization (Regions 2,3,5) Access Behavioral Care(Denver, NE) Access Long Term Support Solutions Behavioral Healthcare, Inc. (BHI) Access Medical Enrollment Services Wyoming Access Access Advantage CHP+ HMO CHP+ State Managed Care Network A 501(c)(4) Corporation AccessCare(Telehealth) Access Health Benefit Solutions (Future LLC) Access Management Services LLC Employees work here, supportingALL brands and products. A Colorado C Corporation Access Health Colorado (Commercial Products on health insurance marketplace) A Colorado C Corporation CHP+ Admin Svcs Medicare Employers Commercial Medicaid

5. Accountable Care Collaborative Overview

6. What is the Accountable Care Collaborative (ACC)? The Accountable Care Collaborative (ACC) is a program that gives Medicaid clients their full benefits while emphasizing coordinated care and good health outcomes. ACC members and their PCMPs belong to a Regional Care Collaborative Organization (RCCO). • A Primary Care Medical Provider (PCMP) serves as a medical home that leads the member’s health care team, connecting members to health care and tracking their progress and outcomes. • The RCCO has a network of both medical and non-medical service providers to help ACC members get what they need to be healthy. • RCCOs also work with PCMPs to coordinate the care of ACC members with complex health needs. Care coordinators helps these members find the right health care, learn self-care, and find non-medical services like housing, childcare, food and fuel assistance. There are seven RCCOs in the state.

7. ACC Payment Model • Providers are reimbursed for the services they deliver through “fee-for-service.” • Primary Care Medical Providers (PCMPs) receive a per-member-per-month (PMPM) payment to coordinate and manage the care of ACC members in their practice. • Regional Care Collaborative Organizations (RCCOs) receives a per-member-per-month payment to fulfill their responsibilities of supporting providers and helping members get the health care and services they need. • The Department gives a performance-based payment to RCCOs that meet or exceed targets set for Key Performance Indicators.

8. Client Selection All Medicaid clients are eligible to participate in the ACC, except for those in an inpatient psychiatric care facility or enrolled in a managed care plan. • Clients in a nursing facility are not currently eligible but there are plans to open the ACC to them in the coming year. • Enrollment in the ACC program is voluntary through passive enrollment, which means the client must call HealthColorado to opt out of the ACC program within 30 days. • Clients enrolled in the ACC program must already be enrolled in Medicaid. As of September 1, 2014, the Full Benefit Medicare-Medicaid Enrollees (MMEs) aka Dual-Eligibles, who were previously excluded, were enrolled in the ACC program as part of the ACC: Medicare-Medicaid Program.

9. Client Attribution & Enrollment • Attribution is the method by which ACC clients are assigned to PCMPs within the ACC. • “Attribution” refers only to ACC clients, and your ACC panel will include all clients whom the system has attributed to you or who have chosen you as their PCMP. You will be considered these clients’ medical home and should be the first contact for their medical needs. •  ACC Clients can be attributed to practices in one of three ways: • System Assigned: If an ACC client shows a predominant claims history with your practice over the last 12 months, the system will automatically assign that client to your panel.  • Family Connection: If a client has no predominant claims history with a contracted PCMP, the system looks at whether or not a family member of the client has a claims history with a contracted PCMP—and if one exists, assigns that client to the PCMP with whom the family member has a history. If you have rendered services to a family member of an ACC client, that client may be attributed to you, whether or not you have ever directly rendered services to the client. • Client Choice: Every ACC client has the option of choosing their own PCMP. Often, clients have no stable history with medical providers and rely on location, hours of operation, gender, or other means to choose their PCMP. It is possible that a client may choose your practice without having ever met or received services from you.

10. Participants in the ACC The groups below have an active role and a bi-directional relationship in the ACC program. Health Neighborhood Statewide Data Analytics Contractor (SDAC) Regional Care Collaborative Organization (RCCO) Primary Care Medical Provider (PCMP)

11. Statewide Map of the 7 RCCO Regions

12. The ACC Model of Care Delivery

13. RCCO & HCPF Functions Colorado Access does not: • Authorize PARs (Prior Authorization Requests) • Pay Medicaid FFS Claims • Have access to Medicaid Client information before they are enrolled in the ACC program. • Contract with PCMPs that are not enrolled in the Colorado Medicaid Program. • Assign already attributed members to another PCMP • Members must call HealthColorado to switch to a different PCMP HCPF does not: • Update Client Information (i.e. telephone numbers, address changes, etc.) • All client information updates must be done at the local county office.

14. Benefits of Care Management Care Managers outreach and connect with Members in a variety of ways: • Home and/or Community-based • Physician’s Office • Hospital • Telephone • Care Managers connect with Members when there is: • An acute need, • A Complex medical and/or behavioral need and treatment regimen, • Difficulty contacting other physicians or specialties or obtaining medical equipment/supplies or prescription drugs, and/or • A need for adequate social support systems

15. Accountable Care Collaborative: Medicare-Medicaid Program (ACC:MMP) Overview Making Medicare and Medicaid work better together for our clients

16. ACC: MMP Background About 10 million people in the United States are covered by both Medicare and Medicaid, including low-income seniors and younger people with disabilities • These Medicare-Medicaid Enrollees (MMEs) aka “dual eligible beneficiaries” have complex and often costly health care needs. • Fee-for-service (FFS) Medicare & Medicaid is a fragmented delivery system • Affordable Care Act authorized state-led demonstration programs to integrate care for MMEs and processes between Medicare & Medicaid • Colorado is one of 15 participating states to roll MMEs into the existing Accountable Care Collaborative (ACC) program • Further requirements from CMS for the care management of MMEs (enhanced care coordination) • 32,000 eligible clients statewide

17. ACC: Medicare-Medicaid Program Goals • Improve MME health outcomes • Decrease unnecessary and duplicative services • Promote person-centered planning • Improve client experience through enhanced coordination and quality of care

18. What is the Service Coordination Plan? • Cornerstone of Program • Helps identify gaps in care and duplicative services • Documents clients’short- and long-term goals • Blueprint for meeting client goals and improving health outcomes

19. What are Protocols? General protocol requirements exist to formally document how RCCO and other systems of care interact with and work together when coordinating care for the MME population. • Continuously improving • Bi-directional and collaborative • Identification and prioritization of shared clients • Understanding coordination activities • Regular contact and communication • Mutually agreed upon support function

20. Health Neighborhood

21. The Greater Neighborhood • Protocols are a great start to establish documentation of the relationships we’ve all started to build • Other current partners we’re working with include County DHS’, Health Communities Programs, grant funded programs that provide care coordination in the community, housing and day shelters, and countless others, not the least of which includes… • Specialty care providers: Contact Drew Kasper to learn more about and/or join the COA RCCO Specialist Engagement Committee (meets monthly), tackling such topics as: • Mapping and detailing the specialty provider network, and gaps, and connecting members to specialty care providers • Addressing gaps and working toward capacity building • Encouraging communication and education across providers • Spreading awareness of initiatives to address specialty care needs

22. It’s a Beautiful Day in the Neighborhood; Please, Won’t You Be My Neighbor? • An effective health neighborhood relies on: • Communication • Awareness and trust of providers in the neighborhood • Flexibility and willingness to coordinate care across the care continuum • An integrated health neighborhood includes the various provider and support types along the care continuum • Colorado Access is responsible for bringing the health neighborhood together The goal is for the patient and family to experience seamless transitions between providers within the health neighborhood.

23. Glossary of Acronyms ACC Accountable Care Collaborative ACC: MMP Accountable Care Collaborative: Medicare-Medicaid Program BHO Behavioral Health Organization CCB Community-Centered Board CMHC Community Mental Health Center CMS Centers for Medicare and Medicaid Services COA Colorado Access CTP Community Touch Points FFS Fee-for-Service HCBS Home and Community Based Services KPI Key Performance Indicator LTSS Long Term Services and Supports MME Medicare-Medicaid Enrollee PCMP Primary Care Medical Provider PCP Primary Care Provider PMPM Per Member Per Month RCCO Regional Care Collaborative Organization SCP Service Coordination Plan SDAC Statewide Data Analytics Contractor SEP Single Entry Point SNF Skilled Nursing Facility

24. Thank You! Any…