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Giving incentives to providers is part of the system’s approach to reforming the way health care is paid for, according to Laurel Karabatsos, deputy Medicaid director with the Colorado Department of Health Care Policy and Financing.
Rather than being reimbursed based on treatments provided, physicians and other health care providers are seeing a shift to payment for outcomes.
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Incentives in this Medicaid program are awarded on a per-patient, per-month basis, and are given based upon the level of improvement on three different metrics: reducing 30-day readmissions, emergency room visits and high-cost imaging.
Those providers that are able to reduce the occurrence of these three elements by less than 5 percent are awarded incentives of 22 cents per patient, per month. Providers who improve these metrics by more than 5 percent are awarded 33 cents per patient, per month.
The Accountable Care Collaborative began enrolling members in May 2011 with the goal of improving the stability of the payment model for Medicaid patients and making the system less confusing for patients.
The collaborative aims to provide patients with a “focal point of care,” according to Karabatsos, which means that a patient’s primary care provider becomes a “medical home” for that patient, where comprehensive care is received and referrals to specialists are made.
Colorado is split into seven different regions, all of which have regional care collaborative organizations, which serve as hubs for the various affordable care organizations in a given region.
Also part of the collaborative is a statewide data and analytics contractor, Karabatsos said.
As of July 1, just under 350,000 clients had enrolled in the Accountable Care Collective statewide.
In November, the Department of Health Care Policy and Financing announced that the Accountable Care Collaborative program had reduced Medicaid health expenditures by $20 million in Colorado.
Two of the three metrics that are part of the incentive program were reduced statewide in the first year of the program, according to the department.
As of November, for Accountable Care Collaborative members, hospital readmissions were reduced by 8.6 percent and high cost imaging was reduced by 3.3 percent.
Emergency room visits, though, increased slightly, by .23 percent.
New data for these statistics will be available later this year.