Colorado Medicaid has initiated a new program, the Accountable Care Collaborative (ACC), to connect Medicaid beneficiaries* to primary care physicians providing medical home services. The ACC has now enrolled over 222,862 children, accounting for over 63% of the total population served by the ACC.

More Information about Colorado's Accountable Care Collaborative can be found on the National Academy for State Health Policy Web site.

* The ACC program serves Medicaid fee-for-service and Primary Care Physicians Program (a Colorado Medicaid health plan) beneficiaries.

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Program Components

  • Regional Care Collaborative Organizations (RCCOs): The state is divided into seven RCCOs that have the responsibility to provide support for the primary care providers by overseeing accountability and reporting, and providing medical management, care coordination and support to practices.
  • Statewide data and analytics contractor (SDAC): Through SDAC, participating providers and RCCOs have access to actionable, web-based data on both patient- and population-level to improve the delivery of care to patients.
  • Primary care medical providers (PCMPs): The PCMPs continue to serve as the medical home using the services and information provided though the RCCOs and SDAC. Children with special health care needs, for example, still may receive their services in their actual medical home with access to additional support provided through the RCCO.

 

Payment Model

The primary Care medical providers receive a fee for service reimbursement for medical services and a $3.00 per member per month payment for enrolled Accountable Care Collaborative Medicaid clients. Providers may receive an additional $1.00 per member per month incentive payment based on their Regional Care Collaborative Organizations's performance on key performance indicators (KPI). These incentive payments are calculated regionally based on four KPI including hospital readmissions, emergency room visits and high cost imaging services, beginning in July 2013, well child visits.

 

Outcomes

Findings in the Accountable Care Collaborative's (ACC) 2013 Annual Report indicate that children diagnosed with diabetes who are enrolled in the ACC are receiving services at a substantially higher rate than those who are not enrolled in the ACC. Such increased access to early and appropriate childhood diabetes management has been shown to result in both improved health outcomes and lower costs over the long-term.

 

Fast Facts

  • 611,051: Children enrolled in Medicaid and CHIP in Colorado in FY 2012 (484,882 Medicaid; 129,169 CHIP)
  • 81.3%: The participation rate for those eligible for the Colorado CHIP program
  • 87.2%: The national participation rate for those eligible for the CHIP program
Last Updated

05/31/2022

Source

American Academy of Pediatrics