Medicaid collaborative reaches 400,000 members in Colorado

The Accountable Care Collaborative, a Medicaid initiative funded through the Patient Protection and Affordable Care Act, today announced that it has reached 400,000 members in Colorado.

The program is designed to lower health care costs by tending to members’ non-medical needs, such as nutrition, transportation and mental health services.

The collaborative is made up of seven regional care collaborative organizations across Colorado that connect Medicaid clients to Medicaid providers and help the clients find community and social services.

The two regions that encompass Larimer and Weld counties have a combined 85,000 people enrolled, according to data from the Accountable Care Collaborative.

“If a client visits an (emergency room) many times or is readmitted to a hospital over and over again, that’s usually a sign that that person’s health is not stable and he or she may have other unmet needs,´ said Suzanne Brennan, Colorado Medicaid director, in a statement.”

Before the Accountable Care Collaborative, 85 percent of Medicaid clients received care under a “fee for service” model, in which providers are paid based on the number of services they provided each client.

Under the ACC model, providers are paid a “per member, per month” fee, but can receive incentive payments for healthy patient outcomes.

Incentives are given on a tiered basis. Providers who reduce the use of three key services by up to 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.

Through the first three quarters of 2013, hospital readmissions were reduced by 15 to 20 percent, high-cost imaging was reduced by 25 percent, and emergency room use increased by 1.9 percent, compared with a 2.8 percent increase for those not involved in the program.

To read more about how the program has been implemented in Northern Colorado, click here and here.

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