Similar to Oregon, Colorado began moving Medicaid beneficiaries in 2011 into a new Accountable Care Collaborative program, a regional coordinated-care initiative that connects them with healthcare providers as well as social services and community-based assistance.
“We had 85% of our clients in unmanaged fee-for-service, so nobody was really managing or coordinating their care,” said Laurel Karabatsos, the state's deputy Medicaid director. “So we wanted to give a focal point of care to all of our clients, or to create a medical home to make sure they all had a primary-care provider.”
The program consists of seven regional care collaborative organizations composed of healthcare providers that manage care for Medicaid patients enrolled in the program and are responsible for their health outcomes. So far, nearly half of the state's 724,000 Medicaid beneficiaries have enrolled in an RCCO.
In the first year, the program saw hospital readmissions decline among RCCO members by 8.6%, while the rate of high-cost imaging was reduced by 3.3%, Karabatsos said. Also, their rate of emergency-room use slowed compared with ER use by Medicaid patients not in the program. The state estimates the program saved Medicaid $20 million in its first year.
Minnesota also is implementing an accountable care design, but it is applying the model to people covered by Medicare and private insurance as well as Medicaid. Its Accountable Health Model, still in the testing stage, is designed to provide patients with integrated, comprehensive care including coordination of medical, mental, long-term care and social services. It seeks to involve community organizations to create “Accountable Communities for Health.” The state has projected the program will have nearly 3 million enrollees by 2016, and save Minnesota a total of $113 million in overall healthcare costs over three years. That includes more than $90 million in Medicaid savings and $20 million in savings to private payers and Medicare.