RMHP’s 2-year program to examine how Medicaid is paid

A pilot program designed by Rocky Mountain Health Plans seeks to reform the way Medicaid pays doctors, hospitals and other health care providers by basing reimbursement on “value instead of volume,” Colorado Department of Health Care Policy and Financing Communications Director Rachel Reiter said.

Health care providers who treat Medicaid patients enrolled in the Regional Collaborative Care Organization covering Delta, Garfield, Gunnison, Mesa, Pitkin and Rio Blanco counties will participate in the two-year program, Reiter said.

“Traditionally in health care, payment is referred to as a fee for service model. Providers are paid for each service or service procedure rather than being paid based on outcomes,” she said.

The pilot is expected to innovate programs and systems that ensure providers have time to treat the “whole person,” she said.

That means coordinating health care by and between primary care doctors, specialists, behavioral health professionals and social service organizations to make sure all of a patient’s health care needs are addressed.

For example, levels of reimbursement under the pilot might depend on the ability of participating health care providers to ensure a homeless client suffering from cancer and depression receives treatment from an oncologist, mental health counselor and social worker, all of whom would be expected to consult and coordinate their treatments.

“Whole person care means we are not just looking at one individual payment for one thing. It’s the whole person. Can they be connected to a community partner that helps them?” Reiter said.

If successful, the pilot will make it easier for patients and families to see specialists and access resources beyond primary medical care.

Providers who successfully integrate care could be eligible for incentive payments under the program, she said.

“Colorado Medicaid is focused on transforming our care delivery and payment systems to focus on paying for value instead of volume,” department executive director Sue Birch said in a news release.

Rocky Mountain Health Plans, Colorado West Regional Mental Health Center, Midwestern Colorado Mental Health Center, independent physician groups, hospital and health systems, federal health centers, primary care providers and public health and human services agencies are sponsoring the program.

The department selected the pilot proposed by Rocky Mountain Health Plans, a Regional Collaborative Care Organization, from among 10 other proposals submitted by the state’s seven RCCOs.

Only six of the 22 counties involved in the Rocky Mountain Health Plans RCCO will participate in the program.

Regional Collaborative Care Organizations were created by the department in 2011 to reduce the costs of the Medicaid program in Colorado. Roughly 132,000 Medicaid clients receive services through these organizations, according to the department’s November 2012 report.

The report credits RCCOs with a nearly 9 percent reduction in the number of hospital readmissions and a 3 percent decrease in high cost imaging during their first year of operation.

As more patients enroll in RCCOs, health care costs for Medicaid recipients are expected to decrease even further, according to the report.


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