Among state experiments in Medicaid policy, Colorado’s accountable care collaborative program is showing early successes in coordinating care and curtailing overutilization — and its analytics platform is supporting a good deal of the collaboration, despite a number of hurdles.
Now covering about half the state’s beneficiaries, Colorado’s Medicaid accountable care program saw a 15 percent reduction in hospital admissions and a 25 percent reduction in high-cost imaging in the 2013 fiscal year, contributing to $44 million in savings, the Department of Health Care Policy and Financing announced recently.
Most of that is going to providers as incentive bonuses and $6 million is returning to state coffers.
“Next year at this time, we expect to be talking not only about savings, but also about all the ways the program provides value to our providers, clients and the community,” deputy Medicaid director Laurel Karabatsos said in a media release.
Under the program, primary care providers receive fee-for-service plus $4 per member per month for home-based care, and regional collaborative care organizations that help primary care practices coordinate patient care receive between $8 to $10 per member month, with about $1 from each withheld and then later paid out in quality-based performance incentives.
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Reporting that quality performance to Medicaid officials is a statewide data and analytics contractor, or SDAC, with the contract currently held by Treo Solutions. The SDAC also provides a management platform for primary care practices and regional collaborative organizations that lets them track patients at the individual and population levels.
The data and analytics service “greatly enhances the usefulness of Medicaid data for care management,” as Kaiser Family Foundation researcher Julia Paradise noted in a case study.
“State staff now consider the SDAC essential and say that, without it, it would be impossible to implement” the accountable care collaborative program, Paradise wrote.
The statewide data and analytics contractor emerged as a solution that could use Medicaid managed information system data, and will also be incorporated into a new MMIS Colorado is procuring.
The SDAC takes Medicaid eligibility and claims data, consolidates it in a repository on a monthly basis and gives primary care providers, regional collaborative organizations and Medicaid officials analysis on utilization, spending and other data points through a web portal.
This “centralized approach” ensures that doctors and care managers can access actionable data in one standard, the Kaiser Family Foundation’s Paradise said in the report. Even if it’s not clinical EHR data, the SDAC platform gives providers a window into their Medicaid patient’ history that they largely did not have before.
For primary care practices in the Medicaid accountable care program, the SDAC also fills in some interoperability gaps. Aside from western Colorado, served by the HIE Quality Health Network, “few systems permit the exchange of data among providers who often serve different areas,” Paradise wrote.
There is some interest is possibly incorporating clinical data from the main HIEs, Quality Health Network and the Colorado Regional Health Information Organization, but one challenge to that would be proving its benefits before investing in that integration. As Paradise wrote, some Colorado health stakeholders “wonder how realistic that might prove to be in their region of the state.”
And other challenges remain within the current scope of Colorado’s data-driven Medicaid policy.
Primary care doctors and care managers using the SDAC data portal can only see information for Medicaid beneficiaries currently enrolled in the accountable care program, leaving record gaps if beneficiaries with fluctuating incomes end up “churning” in and out of Medicaid eligibility.
Another challenge that’s common to pretty much every provider, HIE and health data program in every state is integrating behavioral health data — largely being unable to integrate it, that is.
In Colorado, “current efforts to integrate behavioral and physical health data and care take place against a backdrop of separate payment streams and patient accountability for care in these two spheres,” Paradise wrote.
Regional care collaborative organizations usually have to negotiate agreements to obtain behavioral health data directly with providers. And while the SDAC is empowered to incorporate some behavioral health encounters, in most of Colorado Medicaid behavioral health services are “carved out,” paid for and delivered separate from primary care, and federal law also precludes the sharing of data categories, such as substance abuse treatment.
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And then there's the need for federal clarification about behavioral health data. As Kaiser’s Paradise was told by several care managers, “uncertainty and confusion about the kinds of data that may or may not be shared under HIPPA and state law, and with whom, are a barrier.”
Those challenges aside, though, Colorado’s ACO experiment in Medicaid may end up becoming permanent, with all beneficiaries covered under the model, and other states will be looking to the Rocky Mountain state’s experience in crafting their own value-based reimbursement policies in Medicaid.
