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The next iteration of the Accountable Care Collaborative (ACC) began July 1, 2018. As a reminder, the Department has published resources and guidance for providers, members, and other interested parties on
CO.gov/HCPF/ACCPhase2
.
In this issue, you'll find:
- Member Attribution Update
- Common Member Questions
- Submitting Questions
- Resources
- Contact Information
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Member Attribution Update
Since the July 1 launch of the ACC Phase II, the Department has been
working closely with providers, our contractors, and stakeholders to identify and tackle questions and issues related to implementation. These have ranged from payment, benefit, and attribution issues.
As anticipated prior to implementation, the most common issue identified has been related to member attribution to a primary care medical provider (PCMP) and Regional Accountable Entity (RAE). This is a challenge all health plans face, particularly when trying to attribute members to a specific practice. Department staff have been working hard for months to build and implement an attribution process that honors member choice and complies with federal regulation, while also connecting all members to a medical home.
There are a number of factors that have contributed to the challenges of this process, from recent changes in provider enrollment and billing practices to the shift from regional enrollment in a health plan based on member residence to a new model that use the PCMP as the driver of health plan enrollment. This last change was designed in collaboration with providers to reduce the administrative burden of contracting with multiple Health First Colorado health plans and should eventually result in stronger support for providers and improved coordination for members. That said, these factors have increased the complexity of the process and resulted in a number of attribution errors.
Addressing Attribution-related Issues
In order to address attribution-related issues, we started first with identifying and designing system-level solutions. The Department is now running four concurrent streams of work focused on attribution-related issues:
- Closely monitoring and managing system defects and enhancements, and their impacts,
- Executing manual fixes while systemic fixes/changes are being developed and implemented,
- Conducting reattribution of members to more accurately assign members to a PCMP based on their utilization history since July 1, and
- Identifying and analyzing PCMP panel issues with help from the RAEs and individual PCMPs.
Reattribution of Members
In Phase II, the Department plans to conduct a reattribution process to ensure PCMP attributions reflect the member's strongest PCMP relationship every 6 months. The Department will be utilizing the reattribution process more regularly at the beginning of the Phase II program to help ensure proper member attributions.
The reattribution process under ACC Phase II will prioritize attributions made when the member contacted Health First Colorado Enrollment if that contact was within the 18 month look-back. If the member contacted Health First Colorado Enrollment outside of the 18 month look-back, and the client has a stronger claims history with a different provider, the member will be reattributed to the new provider whom they have been seeing.
When a member is reattributed to a new PCMP, they will be notified via a letter from the Health First Colorado Enrollment. If this also triggers a change to the RAE assigned to the member this will be stated on the letter. If a member contacts Health First Colorado Enrollment and selects a new PCMP, they will not get a letter from Health First Colorado Enrollment.
PCMP Panel Analysis
The Department is working with the RAEs to identify, analyze and troubleshoot individual PCMP panel issues. We are taking the following steps:
- Working with the RAEs to compile a list of practices with issues in need of panel analysis,
- Identifying and pooling Department and vendor resources to dedicate to panel analysis,
- Prioritizing PCMP practices for analysis, and then
- Deploying resources to work systematically with the RAEs and individual practices to resolves issues.
At times, a member may be appropriately attributed to another PCMP. The panel analysis process may include identifying members not on a PCMP's panel. This may occur when:
- A member has chosen a new PCMP by contacting Health First Colorado Enrollment,
- A member has more claims utilization history with another PCMP,
- A member's provider was is not contracted as a PCMP at the time of attribution,
- A provider contracted with their RAE using the wrong practice site location or rendering provider number at the time of attribution,
- A member is currently not enrolled in Health First Colorado, and/or
A member is not eligible for enrollment in the ACC (for example, a member is enrolled in Child Health Plan Plus (CHP+) or Program All-Inclusive Care for the Elderly [PACE]).
Though time-consuming work, the Department and RAEs are committed to working through panel issues with PCMPs. We encourage PCMPs to contact their RAE to report the following issues:
- Maximum enrollment/panel size concerns, specifically if a PCMP is concerned about the number of members that have been geographically attributed to their practice site.
- Panel composition concerns, such as the attribution of populations the practice site does not see (for example, children attributed to a practice that does not see children).
- Members not attributed to a practice site that the practice has an established history or relationship with.
If PCMPs have difficulty contacting their RAE, issues can be submitted to the Department using this form.
Health First Colorado Enrollment
Health First Colorado Enrollment provides assistance directly to Health First Colorado members to change their assigned PCMP. The Department continues work closely with Health First Colorado Enrollment to ensure appropriate wait times to speak with an enrollment counselor. For more about Health First Colorado Enrollment, see our Member FAQs.
For more information on ACC Phase II, including resources for providers, stakeholders, counties, and Health First Colorado members, see CO.gov/HCPF/ACCPhase2.
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Common Member Questions
What is a Health First Colorado regional organization?
Your regional organization manages both your physical and behavioral health care. They support a network of providers to make sure you can access health care for your body, vision, mental health, and substance use in a coordinated way. Every Health First Colorado member belongs to a regional organization. Your regional organization is on your enrollment letter.
How do Denver Health Medicaid Choice and Rocky Mountain Health Plans Prime work with the regional organizations?
Denver Health Medicaid Choice and Rocky Mountain Health Plans Prime are specialized networks of physical health providers that are managed by regional organizations.
Who can be part of Denver Health Medicaid Choice?
Health First Colorado members who live in Adams, Arapahoe, Denver, and Jefferson counties and want to see a Denver Health primary care provider can choose to participate in Denver Health Medicaid Choice.
Who can be part of Rocky Mountain Health Plans Prime?
Health First Colorado members who live in Garfield, Gunnison, Mesa, Montrose, Pitkin, and Rio Blanco counties and want to see a Rocky Mountain Health Plan Prime primary care provider can choose to participate in Rocky Mountain Health Plan Prime. Note that most kids cannot enroll in Rocky Mountain Health Plan Prime.
Additional Health First Colorado member FAQs can be found here.
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Resources
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Submitting Questions
Please submit your questions and issues regarding the Accountable Care Collaborative (ACC) Phase II using this form. We will use questions received to inform future communications regarding Phase II. The Department will not be able to respond directly to all inquiries but will use the questions submitted to tailor upcoming communications and resources. As new information and resources become available we will post them on CO.gov/HCPF/ACCPhase2.
Providers
- First contact the Regional Accountable Entity (RAE) in your area regarding contracting, panel and attribution issues, or other questions about the ACC.
- A second option is to submit panel and attribution issue using the form below.
Health First Colorado Members
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Contact Information
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Region
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Entity Name
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Contact Information for Providers
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Contact Information for Health First Colorado Members
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1
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Rocky Mountain Health Plans
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2
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Northeast Health Partners
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9925 Federal Drive, Suite 100
Colorado Springs, CO 80921
Phone: 1-800-804-5040
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3
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303-368-0037 or 1-855-267-2095 (toll free)
Monday-Friday, 8:00 a.m. to 5:00 p.m.
State Relay: 711 for callers with hearing or speech disabilities
http://www.coaccess.com/
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4
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Health Colorado, Inc.
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9925 Federal Drive, Suite 100
Colorado Springs, CO 80921
Phone: 1-800-804-5040
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1-888-502-4185
Care Coordination Line: 1-888-502-4186
Monday-Friday, 8:00 a.m. to 5:00 p.m.
State Relay: 711 for callers with hearing or speech disabilities
https://www.healthcoloradorae.com/
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5
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Colorado Access
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303-368-0038 (Denver County) or 1-855-384-7926 (toll free) (Denver County)
Monday-Friday, 8:00 a.m. to 5:00 p.m.
State Relay: 711 for callers with hearing or speech disabilities
http://www.coaccess.com/
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6
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Colorado Community Health Alliance
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Phone: 303-256-1717 (Local) or 1-855-627-4685
Contact Us
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303-256-1717 or 1-855-627-4685 (toll free)
Monday-Friday, 8:00 a.m. to 5:00 p.m.
State Relay: 711 for callers with hearing or speech disabilities
http://www.cchacares.com/
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7
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Colorado Community Health Alliance
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Phone: 719-598-1540 (Local) or 1-855-627-4685
Contact Us
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719-598-1540, or 1-855-627-4685 (toll free)
Monday-Friday, 8:00 a.m. to 5:00 p.m.
State Relay: 711 for callers with hearing or speech disabilities
http://www.cchacares.com/
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The Colorado Department of Health Care Policy and Financing complies with applicable federal and state civil rights laws and does not discriminate on the basis of race, color, ethnic or national origin, ancestry, age, sex, gender, sexual orientation, gender identity and expression, religion, creed, political beliefs, or disability. Learn more about our Nondiscrimination Policy.
ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-800-221-3943 (State Relay: 711).
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1-800-221-3943 (State Relay: 711).
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