Health First, Colorado’s Medicaid Program and Community Behavioral Health Services Lenya Robinson, Behavioral Health and Managed Care Section Manager Oct-19

HCPF Mission

Objectives Review the role of Colorado’s Department of Health Care Policy & Financing Understand framework of the Accountable Care Collaborative (ACC) Understand framework of community behavioral health program Understand the Department’s contract standards Understand how to navigate the system Learn how to handle unique or challenging issues

What is HCPF? Colorado’s Department of Health Care Policy and Financing is the designated Single State Agency that administers: Health First Colorado, Colorado’s Medicaid program Child Health Plan Plus (CHP+) Other health care programs for Coloradans who qualify

Colorado Medicaid is now called:

Health First Colorado’s Funding Sources

Health First Colorado Members 42% 45% 7% 3% FY 2015-16 Health First Colorado Caseload

Current Accountable Care Collaborative

Structure of Accountable Care Collaborative Health First Colorado’s primary health care program Administered by 7 Regional Care Collaborative Organizations (RCCOs) RCCOs work to coordinate primary care and other services to improve the overall health of their members

Accountable Care Collaborative Better Health and Life Outcomes Coordinated care means improved health outcomes for everyone enrolled in Health First Colorado. It also means better clarity for and coordination with providers as they interact with the system and wiser use of state resources. Medical Home Improved health and smarter use of state resources requires regional and local coordination that recognizes the need for medical care, behavioral health care and community supports all working together. Regional Coordination Members, providers and the system receive the data needed to make real-time decisions that improve care, increase coordinated services and improve overall efficiencies. Data

Accomplishments Emergency room visits are decreasing Hospital readmissions are dropping Prenatal care has increased High cost imaging has decreased Improve Health Outcomes More Coloradans are connected to a medical home Greater coordination of care Better Coordinated Care Providers are being paid for quality outcomes Smarter Use of Resources

Community Behavioral Health Services Program

Structure of Community Behavioral Health Colorado’s behavioral health “carve out” Administered by 5 regional Behavioral Health Organizations (BHOs) 5 BHOs manage 17 Community Mental Health Centers & 2 specialty clinics

Behavioral Health Organizations Cover and manage comprehensive mental health and substance use disorder (SUD) services* Receive a capitation payment Provide some non-clinical services Do not collect co-pays for services

BHO Networks BHO Community Mental Health Centers Detox Facilities Methadone Clinics Individual Providers Specialists Federally Qualified Health Centers Hospitals Each BHO contracts with their own network of behavioral health providers to ensure members have access to timely services. Provider size and type vary significantly by region.

Service Requirements Members can receive services if they meet the following criteria: Have a covered diagnosis (mental health or substance use disorder) Seek a covered service (individual/group therapy, case management, medication-assisted treatment) Service being sought is medically necessary

Contract Management The BHOs have contract requirements that include: Network Adequacy Timely Access Cultural Competency Evidence-Based and Promising Practices Integrated and Coordinated Care

BHO Accomplishments Cost Savings Integrated Care Trauma-Informed Care Care Coordination Statewide Coordinated Crisis Response System

Behavioral Health Unit Contacts Unit Supervisor Melissa Eddleman 303-866-4025 Contract Manager Troy Peck 303-866-4139

Accountable Care Collaborative Phase II

Goals & Objectives To improve health and life outcomes for Members Join physical and behavioral health under one accountable party Strengthen coordination of services by advancing team-based care and Health Neighborhoods Promote Member choice and engagement Pay providers for the increased value they deliver Ensure greater accountability and transparency To use state resources wisely

From RCCO / BHO to: Regional Accountable Entity Physical Health Care Behavioral Health Care

Stakeholder Engagement & Draft RFP Formulation Procurement Timeline Spring 2014-Fall 2016 Stakeholder Engagement & Draft RFP Formulation Spring 2017 Release of Final RFP Winter 2018 RAE Contracts Signed Now Release Draft RFP Fall 2017 RAE Awards Announced Summer 2018 Phase II Implemented

Thank You!

Questions or Concerns?

Behavioral Health and Managed Care Section Manager Contact Information Lenya Robinson Behavioral Health and Managed Care Section Manager Phone: 303.866.6387  Lenya.Robinson@state.co.us