Colorado Medical Society

http://www.cms.org/articles/medicaid-accountable-care-collaborative/

Medicaid Accountable Care Collaborative

Tuesday, May 07, 2013 01:21 PM

Physicians work to accelerate local innovations

Chet Seward, Senior Director, Health Care Policy

The Medicaid expansion in Colorado under the Affordable Care Act is moving forward, and Governor Hickenlooper just pledged his support for not only maintaining but also growing the Accountable Care Collaborative (ACC) in Medicaid.

Colorado Medicaid will soon become the second largest payer in the state because of the ACA expansion and the program is in the midst of a serious upgrade thanks to the ACC using local care innovations through Regional Care Collaboratives (RCCOs), sophisticated data analytics, alternative payment models to encourage patient-centered care, and perhaps most importantly physician engagement.

Governor Hickenlooper has laid out an ambitious plan to help make Colorado the healthiest state in the nation and a central component to his strategy focuses on expanding and enhancing the ACC. The governor’s State of Health report notes, “The ACC infrastructure, with its focus on client-centered care and regional solutions, is the foundation of the Medicaid program in Colorado and will be the vehicle for delivery and payment reforms in Colorado Medicaid. Through a number of programs, including the ACC, we will reduce the number of individuals in unmanaged, fee-for-service care to less than 30 percent by 2018.”

All in on the ACC
Anticipating the growing importance of the ACC, the Colorado Medical Society convened a professionally facilitated retreat for RCCO medical directors and other ACC leadership in February. The meeting focused on utilizing the expertise of the RCCO medical directors, practicing physicians and operational leaders to identify what’s working, what’s not and what’s missing in the RCCO program.

“We may not see another opportunity in our lifetimes to close the coverage gap, and to reinvent Medicaid in innovative ways that guarantee a meaningful return on this substantial investment by the federal and state government,” said CMS President Jan Kief, MD, emphasizing the importance of the ACC and its RCCO components.

Nearly 20 medical directors, practicing physicians and operation staff attended the day and a half long meeting. The group leveraged the excellent work done by physicians, health plans, the state and many others over the past few years as the ACC was conceptualized and is now being operationalized. Importantly, the meeting focused physician leadership from across the state on fleshing out the “exam-room view” of the program.

The group raised a number of topics and then prioritized nine key issues that can and should be addressed to accelerate the progress being made by the ACC.

Top priorities include:

  1. Attribution of patients
  2. Behavioral health integration with physical health and social services
  3. Data analytics
  4. Access to specialty care
  5. Payment reform/gainsharing
  6. Continuous eligibility
  7. Care coordination/flexibility in models and regions
  8. Resident training
  9. Colorado Client Assessment Record

Next steps
More work remains to flesh out these priorities and develop and implement proposed solutions. Results of the facilitation will be compiled into a white paper that CMS will publish and use in a concerted and collaborative push to help state officials get this historic opportunity right for taxpayers, patients and providers. RCCO medical directors will reconvene at the CMS spring conference in May to prioritize and synchronize next steps. Watch for more information on this important initiative in the future.

“Local is the way to go,” Kief said. “We support the ACC because it represents a real partnership with the state, that focuses on local empowerment, innovation, data sharing, patient-centered care and coordination across medical specialties and through the system. This is health care reform – locally operated, locally led and locally delivered.”