Colorado – Medical Homes
Colorado’s medical home efforts began in 2001 with the Colorado Medical Home Initiative (CMHI). This program, administered by the state’s Department of Public Health and Environment (CDPHE), was charged with ensuring that all children receive comprehensive coordinated care within a Medical Home. Chapter 346 of the 2007 Session Laws of Colorado required the Department of Health Care Policy & Financing (HCPF), the state agency that administers the Medicaid and SCHIP programs, to work with CDPHE to maximize the number of children served by medical homes in Medicaid and SCHIP. A non-profit organization known as the Colorado Children’s Healthcare Access Program (CCHAP) also works collaboratively with state agencies in the Medical Homes for Children Program.
Colorado is using an Accountable Care Collaborative (ACC) model to expand medical home services for their adult Medicaid population (it is important to note that children are also included in the ACC program). Under this model, primary care medical providers (PCMPs) will contract with regional care collaborative organizations (RCCOs) to provide medical home services to Medicaid enrollees. More information can be found in the RCCO RFP and on the Colorado page of NASHP’s State Accountable Care Activity Map.
Additionally, with the support of The Commonwealth Fund and The Colorado Trust, HealthTeamWorks (formerly the Colorado Clinical Guidelines Collaborative) convened a multi-state, multi-payer pilot in 16 practices along the Colorado Front Range to implement medical homes for adults with chronic conditions. The pilot, which began in 2009, ended in April 2012. Colorado Medicaid participated in early stakeholders discussions but ultimately did not provide enhanced payment to participating practices.
- Colorado is one of seven markets selected to participate in CMS’s Comprehensive Primary Care Initiative (CPCi). In this multi-payer initiative, Medicare is collaborating with public and private insurers in the selected states or regions with the goal of strengthening primary care. In Colorado, CPCi launched in November 2012, bringing together ten payers including Medicaid, as well as 74 participating primary care practices with 369 providers in the state.
- Colorado has received a duals demonstration grant from the Centers for Medicare & Medicaid Services (CMS) to “coordinate care across primary, acute, behavioral health and long-term supports and services for dual eligible individuals.”
- The Title V Maternal and Child Health Program was integral to the establishment and development of the CMHI.
Last Updated: April 2014
Medical Homes for Children Program: 125-member stakeholder medical home advisory board included provider and family leadership, staffed by Medicaid and included a state-wide survey of providers. Family Voices Colorado has represented parents and families in medical home development since 2000.
|Defining & Recognizing a Medical Home||Definition:
Medical Homes for Children Program: Chapter 346 of the 2007 Session Laws provided a state-developed definition of medical homes for children as follows: “[A]n appropriately qualified medical specialty, developmental, therapeutic, or mental health care practice that verifiably ensures continuous, accessible, and comprehensive access to and coordination of community-based medical care, mental health care, oral health care, and related services for a child. A medical home may also be referred to as a health care home. If a child’s medical home is not a primary medical care provider, the child must have a primary medical care provider to ensure that a child’s primary medical care needs are appropriately addressed. All medical homes shall ensure, at a minimum, the following:
Accountable Care Collaborative (ACC) Program: Under the Accountable Care Collaborative (ACC) Program, practices and providers can become participating Primary Medical Care Providers (PMCPs) if they:
Furthermore, PCMPs 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.
Comprehensive Primary Care Initiative (CPCi): Practices were selected for participation in CMS’s Comprehensive Primary Care Initiative through a competitive application process. Under CPCi, practices are not required to attain formal PCMH recognition; however, formal PCMH recognition through NCQA, AAHCC, the Joint Commissioner, URAC, or a state-based recognition program was viewed favorably in practice selection. Additional criteria included:
HealthTeamWorks Multi-payer Pilot: The HealthTeamWorks multi-payer pilot used National Committee for Quality Assurance Physician Practice Connections – Patient-Centered Medical Home (NCQA PPC-PCMH) recognition standards.
|Aligning Reimbursement & Purchasing||Accountable Care Collaborative (ACC) Program: Under the Accountable Care Collaborative (ACC) Program, a total of $20 per-member/per-month (PMPM) is divided among three entities
Once a RCCO shows cost neutrality, $1 PMPM is withheld from both the PCMP and RCCO, creating a shared quarterly incentive payment pool. The $1 PMPM can be recouped by each entity by meeting Key Performance Indicators: reduced emergency room utilization; reduced hospital readmissions; reduced utilization of medical imaging. A fourth measure, well-child visits, was added in July 2013.
Comprehensive Primary Care Initiative (CPCi): This four-year multi-payer initiative, launched in November 2012, includes ten payers in the Colorado market: Medicare, Anthem Blue Cross Blue Shield of Colorado, Cigna, Colorado Access, Colorado Choice Health Plans, Colorado Medicaid, Humana, Rocky Mountain Health Plans, Teamsters Multi-Employer Taft Hartley Funds, and United Healthcare.
Medicare pays selected practices a per-beneficiary per-month (PBPM) risk-adjusted care management fee, which ranges from $8 to $40. CMS has indicated that it expects care management fees to average $20 PBPM during the first two years of the initiative. In Years 3 and 4, care management fees will average $15 PBPM. Medicare will also introduce a shared savings component beginning in Year 2, calculated at the market level.
The CPCi solicitation for payers indicates that participating payers (non-Medicare) are expected to follow a similar framework, paying per-member per-month (PMPM) care management fees to participating practices on top of fee-for-service and incorporating a shared savings component. Payment amounts will be negotiated individually with participating practices to comply with anti-trust laws.
HealthTeamWorks Multi-payer Pilot: Participating HealthTeamWorks pilot sites received enhanced care management and performance-based payments on top of fee-for-service reimbursement.
|Supporting Practices||Medical Homes for Children Program:
Accountable Care Collaborative (ACC) Program: Under the Accountable Care Collaborative, Regional Care Collaborative Organizations (RCCOs) and the Statewide Data and Analytics Contractor (SDAC) provide support for participating Primary Medical Care Providers (PCMPs). RCCOs provide:
Comprehensive Primary Care Initiative (CPCi): Colorado practices participating in the Comprehensive Primary Care Initiative receive practice coaching services from HealthTeamWorks or Rocky Mountain Health Plan depending on their location.
HealthTeamWorks Multi-payer Pilot: Participating practices received technical assistance provided through on-site quality improvement (QI) coaching, learning community webinars, and a learning collaborative.
|Measuring Results||Medical Homes for Children Program: Outcomes of interest for the Medical Homes for Children Program tracked by the Colorado Department of Healthcare Policy and Financing and Colorado Children’s Healthcare Access Program include:
Accountable Care Collaborative (ACC) Program: 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 controlling costs by reducing avoidable, duplicative, variable and inappropriate utilization.
The program’s 2012 Annual Report to the legislature, published in Nobember 2012, reported reductions in hospital readmissions and utilization of high-cost imaging services for ACC enrollees compared to non-enrollees. Emergency room utilization also increased less for enrollees than for non-enrollees. The report also found that ACC enrollees with asthma and diabetes are less likely to be hospitalized or readmitted. Colorado estimates that the program has saved the state $30 million in its first year, exceeding the state’s initial estimate of $20 million.
The Accountable Care Collaborative 2013 Annual Report, released in November 2013, reported additional positive findings, including additional cost savings: