The AHRQ Health Care Innovations Exchange reports that the ACO in Colorado uses a primary care-based model for delivering coordinated care to Medicaid beneficiaries. Under this initiative, the State Medicaid agency contracts with regional organizations serving seven distinct geographic areas.
The regional organizations, in turn, contract with and support primary care-led medical homes in coordinating and managing needed care for enrolled beneficiaries. The State also contracts with an outside vendor to assist with beneficiary assignments to medical homes and with data collection, analysis, and reporting.
The model uses a mixture of payment methodologies, featuring fee-for-service for medical services, capitation for care management and coordination, and financial incentives to promote quality and efficiency.
The use of coordinated care for Medicare beneficiaries has led to fewer admissions and readmissions, less use of high cost imaging services, and a slowdown in the growth of emergency department visits. Collectively, these improvements have yielded an estimated $6 million in cost savings for the State.
The Colorado Department of Health Care Policy and Financing is a funding source for the program. Annual program costs in fiscal year 2012-2013 totaled $36,437,324 covering the costs of care coordination, network development, and practice support services.
Sustaining this innovation will require:
- Disseminating performance data on an ongoing basis to validate provider efforts to improve access and quality and to sustain provider interest in the program
- Continually monitoring the needs of the population and developing new performance measures to reflect those needs
- Working with commercial payers to develop consistent processes and requirements
Go to www.innovations.ahrq.gov/content.aspx?id=4100 for more information and details. To contact the innovators, email kevin.dunley-wilson@state.co.us or email Kathryn.jantz@state.co.us.