Colorado – ACO
Colorado’s Accountable Care Collaborative (ACC) model builds on the state’s medical homes initiatives, active since 2001.
In 2008, Colorado’s Department of Health Care Policy and Financing was initially funded as a “Medicaid Value-Based Care Coordination Initiative” for FY2009-10. The department released a Request for Proposals for seven Regional Care Collaborative Organizations (RCCOs) in 2010, and the program was implemented beginning in spring 2011. The state’s seven RCCOs are responsible for providing medical management, care coordination among providers and services, and support to providers, and are accountable for quality and cost through utilization-based incentive payments and a shared savings program. The ACC Program offers the regular Medicaid benefit package to enrollees who belong to a Regional Care Collaborative Organization (RCCO) through their “Primary Care Medical Provider,” which serves as the enrollee’s medical home.
In an October 2011 brief describing the ACC model, the state discusses similarities and differences between ACCs and accountable care organizations: “Colorado’s Regional Care Collaborative Organizations and the federal ACOs are geared toward outcomes and are focused on reengineering the primary care medical home model. A key difference is that Colorado’s program interfaces directly with clients while the federal ACOs focus on providers.”
To learn more about Colorado’s medical home initiatives, including the ACC program, visit the Colorado page of NASHP’s medical homes map.
Last updated December 2013.
| Project Scope |
Provider Population: Rollout of the Accountable Care Collaborative (ACC) was phased (see slide 15 in link): in the initial phase, Regional Care Collaborative Organizations (RCCOs) chose communities in which to implement the pilot. During the expansion phase, which began in July 2012, implementation is statewide across the program’s seven regions. Each region has one RCCO. RCCOs are expected to work with patients’ Primary Care Medical Providers to coordinate care, ease care transitions between settings, and connect beneficiaries with specialist services as needed.
Patient Population: This program serves Medicaid fee-for-service and Primary Care Physicians Program (a Colorado Medicaid health plan) beneficiaries. Dual eligible and beneficiaries residing in an institutional setting are excluded from the program, as are clients enrolled in Medicaid managed care. The number of children enrolled in the program was initially limited to approximately one-third of the number of total enrollees; the Department plans to remove this limit in October 2012. In addition, beneficiaries are not enrolled if they have a regular provider who is not participating in the ACC program. Enrollment is voluntary and passive for most beneficiaries, though enrollment is mandatory for adult Medicaid beneficiaries without dependent children. In addition to Medicaid beneficiaries, patients with a history of seeing a provider who is participating in the federal Comprehensive Primary Care Initiative will also be enrolled in the ACC program beginning November 1, 2012.
As of June 2013, total program enrollment was 352,236, including 222,862 children. Overall, forty-seven percent of Medicaid beneficiaries in the state are enrolled in the program.
For more information on enrollment and attribution, refer to the ACC Provider Information page and the ACC Client Selection Fact Sheet.
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| Authority |
The program was initially authorized and funded as a budget initiative by the Colorado Legislature in FY2009-2010.
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| Governance |
Under the Accountable Care Collaborative (ACC) Program, primary care medical providers contract with one of seven Regional Care Collaborative Organizations (RCCOs) to provide medical home services to Medicaid enrollees. More information can be found in the RCCO RFP.
The Department of Health Care Policy & Financing has developed an ACC Program Improvement Advisory Committee—representing RCCO staff, Primary Care Medical Providers, other provider groups, clients and families, and Department staff—to provide guidance and make recommendations for improvements in the ACC program.
The ACC Program included stakeholder input through public forums and a formal Request for Information process.
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| Criteria for Participation |
Colorado’s Department of Health Care Financing and Policy selected seven Regional Care Collaborative Organizations (RCCOs) through an RFP process in 2010.
Enrolled Medicaid providers who wish to become Primary Care Medical Providers in the Accountable Care Collaborative (ACC) Program must meet one of the following criteria:
Furthermore, Primary Care Medical Providers must commit to nine additional principles that ensure care is patient/family-centered; whole-person oriented and comprehensive; coordinated and integrated; provided in partnership with the patient and promotes patient self-management; outcomes-focused; consistently provided by the same provider as often as possible so a trusting relationship can develop; and provided in a culturally competent and linguistically sensitive manner.
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| Payment |
Under the Accountable Care Collaborative (ACC) program, 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:
Primary Care Medical Providers will 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. On July 1, 2013, a fourth indicator measuring well child visits was added to this list. 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.
Legislation passed in June 2012, House Bill 12-1281, will also test innovative payment methodologies “that are designed to provide greater value while ensuring good health outcomes and client satisfaction.” In July 2012, RCCOs were invited to submit abstracts outlining proposed innovative payment methodologies to participate in the “Medicaid Payment Reform and Innovation Pilot Program.” Abstracts will be reviewed during the fall of 2012, and the Department plans to release formal proposal criteria by November 1, 2012. HB 12-1281 requires the state to select one or more proposals for piloting by July 1, 2013. See the state’s Payment Reform Initiative fact sheet for a complete timeline.
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| Support for Infrastructure |
Colorado has awarded a Statewide Data and Analytics Contract to Treo Solutions to support its Accountable Care Collaborative. The Statewide Data and Analytics Contractor is responsible for providing secure electronic access to clinically actionable data to the Regional Care Collaborative Organizations (RCCOs) and Primary Care Medical Providers.
Currently, the Statewide Data and Analytics Contractor data repository is storing Medicaid paid claims data, clinical risk group identifiers and predictive risk scores, and Behavioral Health Organization managed care encounter data. Proposals for future data elements to add to the Statewide Data and Analytics Contractor include: clinical data from RCCOs and/or Primary Care Medical Providers (such as data on member care coordination, referrals to non-medial services and medical management activities), disease and immunization registries data, national health survey data, and Colorado Regional Health Information Organization electronic health records data.
The Statewide Data and Analytics Contractor provides RCCOs and Primary Care Medical Providers with access to profiles of individual clients based upon predictive modeling; identification of areas for clinical process improvement at the client, provider, and RCCO levels; and aggregate reporting of cost and utilization performance indicators.
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| Measurement and Evaluation | The primary goals of Colorado’s Accountable Care Collaborative program are to improve health outcomes through a coordinated, client/family-centered system that proactively addresses clients health needs and control costs by reducing avoidable, duplicative, variable and inappropriate utilization. In the program’s first year (slide 13), the state will track utilization measures monthly and do quarterly cost savings analyses to track progress toward these goals. In subsequent years, the state plans to track utilization as well as quality and outcomes measures, and will assess stakeholder participation.According to the Accountable Care Collaborative Annual Report (FY2013-14) released by Colorado’s Department of Healthcare Policy and Financing, analysis of the ACC program to date has shown:
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