1. 1. Welcome! 2. Objectives of the SNAC Labs 3. Presentation 4. Facilitated discussion Notes from the front lines Critical success factors Implications for the safety net Opportunities for payment reform 5. Next steps Agenda 1

2. April 4, 2012 Where is Colorado Headed? The Medicaid Accountable Care Collaborative

3. Provide a foundation of understanding Share what CHI has learned Ultimately, improve health outcomes among vulnerable Coloradans What’s working Sharing the knowledge Goals of Today’s Presentation 3

4. Key informant interviews with all Regional Care Coordination Organizations (RCCOs), HCPF, providers Monitoring relevant legislation Examination of other state models Legislative roundtable CHI’s Work on the ACC 4

5. The current ACC represents an incremental approach to health system reform Colorado’s safety net providers vary in their ability to be involved New models and new populations will raise the stakes Bonus: Despite challenges, there is a commitment to seeing this through Three Take-Aways 5

6. 6 ACC 101: A High-Level Overview

7. Genesis of ACC: Rising Costs, Rising Caseload Number of Medicaid enrollees and uninsured, Colorado, 2008-2012 Source: Colorado Department of Health Policy & Financing, FY 2011- 12 Budget Request; 2011 Colorado Health Access Survey 7 FY 2008-09 FY 2009-10 FY 2010-11 FY 2011-12 (projected) Number enrolled in Medicaid Number of uninsured

8. Three decades of experience Began in 1980s in a single county, expanded to regional networks covering the state Wide engagement of primary care physicians (92%) $1.5 B in savings attributable 2007-2009 Medicaid Community Care of North Carolina 8 Source: Milliman, Inc. (2011). Analysis of CCNC Cost Savings.

9. Payment Reform under Accountable Care 9

10. A Step in Payment Reform 10

11. 11 How Accountable Care Works

12. Provider leadership Emphasis on primary care Care coordination, medical home Electronic Health Records + data Community-based collaboration Payment reform Principles of Accountable Care 12

13. 13 The ACCs: Up and Running

14. 14 Colorado’s ACC Model

15. 15 ACC Enrollment Source: Colorado Department of Health Care Policy and Financing

16. 16 Colorado’s RCCOs

17. Uniqueness of each RCCO Some are well-established managed care entities, others are new community-driven collaboratives Examples: Rocky Mountain Health Plans, Integrated Community Health Partners Organizational Variability 17

18. Often team-based Delegation between RCCO and provider Medical and non-medical Variability in Care Coordination Approaches 18

19. Culture change Initial investment Attribution process Preserving choice of provider Maintaining pre-existing relationships Real-time health information 19 Accountable Care: Challenges and Opportunities

20. Involvement, experience varies Challenge of making financially feasible Role of rural clinics Integration of behavioral health The Role of Safety Net Providers 20

21. 21 What Does the Future Hold?

22. New populations: Adults without dependent children Dual eligibles New models: HB12-1281 Improve population health? New data sources: All Payer Claims Database Future Directions and Opportunities 22

23. 23 Jeff Bontrager 720.382.7075 bontragerj@coloradohealthinstitute.org Salud Family Health Centers, Commerce City

24. Notes from the front lines: Hearing from you What are some initial success factors and lessons learned? What are the implications and impacts on Colorado’s health care safety net? What are the opportunities for payment reform? Hearing from You 24

25. June 28: The Patient/Consumer Experience Sept. 27: Quality and Care Coordination Jan. 10, 2013: The Data Story All SNAC Labs are from 12:00 – 2:00 pm at CHI 25 Save the Dates! Upcoming SNAC Labs

26. Bonus Slide: Medicaid ACC Implementation 26