Tuesday, January 24, 2012

Sidebar newsletter: Health Care Program a statewide resource as Colorado develops Accountable Care Collaboratives

An article from the winter 2012 edition of Sidebar, CCLP's quarterly newsletter.

CCLP’s Health Care Program is analyzing new mechanisms Colorado is implementing to serve the hundreds of thousands of residents who participate in the Medicaid program for families with low incomes. The state’s Accountable Care Collaborative Program could help contain costs and improve the services Medicaid recipients receive. Without careful implementation, though, the ACC program risks creating new barriers to care, especially for Colorado’s poorest and most vulnerable Medicaid participants.

CCLP lead researcher on the project is Danny Rheiner, who’s working for the Health Care Program under a fellowship funded by the Rice Family Foundation.

ACC program administrators will need to ensure that newly developed health care provider networks are robust enough to meet the needs of people with complex health conditions, Rheiner said. They’ll need to avoid imposing unnecessary administrative hassles on program participants. Consumers will need clear choices or they could become discouraged, confused and less involved in their health care decisions.

“If this is successful, it could lead to real cost savings in the Medicaid program without a cut to services,” Rheiner said. “Given what a large portion of the state budget Medicaid makes up, legislators are looking for every possible way to cut costs, and this seems like a better way to do it than cutting services.”

The ACC program’s potential to improve health care delivery for Medicaid recipients and the risks for vulnerable populations show how vital it is for consumers, advocates, policymakers and providers to help shape the program’s implementation.

In the initial phase of implementing the program, which runs until July 1, the state will enroll Medicaid clients into Regional Care Collaborative Organizations, which will provide a focal point of care (a medical home) for members including coordinated and integrated access to other services. Clients have 30 days to choose whether to participate in the program before they are automatically enrolled. The enrollment goal for the ACC Program during the initial phase is 120,000 Medicaid clients.

An expansion phase begins July 1, when the majority of Medicaid recipients who are not enrolled in a physical health managed care program will be passively enrolled into the ACC program. That includes Colorado’s Medicaid expansion populations (expansion financed through the state’s Health Care Affordability Act) and people who are eligible for both Medicaid and Medicare.

CCLP is watching the process, issuing research papers and weighing in at key points to ensure the interests of people with low incomes are served. The Health Care Program will launch a blog early in 2012 where experts will collect documents, research and other details that will be valuable as the program is implemented.

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