CMS and Colorado Partner to Coordinate Care for Medicare-Medicaid Enrollees
Overview
On February 28, 2014, the Department of Health and Human Services announced that the State of Colorado will partner with the Centers for Medicare & Medicaid Services (CMS) to test a new model for providing Medicare-Medicaid enrollees with a more coordinated, person-centered care experience. Under the demonstration, Colorado will work with CMS to provide enhanced care coordination for over 48,000 Medicare-Medicaid enrollees in the state.
Medicare-Medicaid Enrollees
Improving the outcomes and experiences for the nation’s 10 million Medicare-Medicaid enrollees – low-income seniors and people with disabilities enrolled in both programs, sometimes referred to as “dual eligibles” – is a priority for CMS. Currently, Medicare-Medicaid enrollees navigate multiple sets of rules, benefits, insurance cards, and providers (Medicare Parts A and B, Part D, and Medicaid). Many Medicare-Medicaid enrollees suffer from multiple or severe chronic conditions and could benefit from better care coordination and management of health and long-term supports and services.
The Financial Alignment Initiative – Partnerships to Provide Better Care
CMS launched the Medicare-Medicaid Financial Alignment Initiative to more effectively integrate the Medicare and Medicaid programs to improve the overall beneficiary experience, as well as both quality and costs of care. Through this initiative and related work, CMS is partnering with states to test models intended to achieve those goals, including a capitated model and a managed fee-for-service model. Although the approaches differ in each state demonstration, all beneficiaries will receive all the current services and benefits they receive today from Medicare and Medicaid with added care coordination, beneficiary protections, and access to enhanced services.
In July 2011, CMS announced the opportunity for states to partner with CMS through one of two models:
1. Managed Fee-for-Service Model in which a state and CMS enter into an agreement by which the state would be eligible to benefit from savings resulting from initiatives designed to improve quality and reduce costs for both Medicare and Medicaid;
2. Capitated Model in which a state and CMS contract with health plans or other qualified entities that receive a prospective, blended payment to provide enrolled Medicare-Medicaid enrollees with coordinated care.
Colorado’s demonstration is the eleventh to be approved by CMS, and the second managed fee-for-service demonstration. All demonstrations will be evaluated to assess their impact on beneficiary experiences, quality of care, coordination, and costs. CMS continues to work with other states to develop their demonstration models.
The Colorado Demonstration
Under the demonstration, Colorado will make the state’s Accountable Care Collaborative available to 48,000 Medicare-Medicaid enrollees. If the state is successful in lowering costs to Medicare and Medicaid through improved care, CMS will share some of those savings with the state.
Colorado’s Accountable Care Collaborative
Colorado launched the Accountable Care Collaborative (ACC) in 2011 to provide the state’s Medicaid beneficiaries with improved care at lower costs. Under the ACC model, beneficiaries are linked with a primary care medical provider (PCMP), which serves as a medical home. PCMPs are supported by Regional Care Collaborative Organizations (RCCOs), which provide care coordination, medical management, and provider network development and support. The Statewide Data and Analytics Contractor (SDAC) provides analytic support and performance feedback.
Based on the initial ACC results, the state reports improvements in hospital readmissions and lower rates of some exacerbated chronic health conditions like hypertension and diabetes for the enrolled population, while saving approximately $44 million in avoided costs or gross savings in fiscal year 2012-13.
The demonstration extends the benefits of the ACC program to the state’s eligible Medicare-Medicaid enrollees, including expansion of the SDAC to integrate Medicare data.
Additional Information