Colorado’s medical home efforts began in 2001 with the Colorado Medical Home Initiative (CMHI). This program, administered by the state’s Department of Public Health and Environment (CDPHE), was charged with ensuring that all children receive comprehensive coordinated care within a Medical Home. Chapter 346 of the 2007 Session Laws of Colorado required the Department of Health Care Policy & Financing (HCPF), the state agency that administers the Medicaid and SCHIP programs, to work with CDPHE to maximize the number of children served by medical homes in Medicaid and SCHIP. A non-profit organization known as the Colorado Children's Healthcare Access Program (CCHAP) also works collaboratively with state agencies in the Medical Homes for Children Program. As of August 2010, 216,000 Medicaid and Children’s Basic Health Plan children have a medical home.
Colorado is using an Accountable Care Collaborative (ACC) model to expand medical home services for their adult Medicaid population (it is important to note that children are also included in the ACC program). Under this model, primary care medical providers (PCMPs) will contract with regional care collaborative organizations (RCCOs) to provide medical home services to Medicaid enrollees. More information can be found in the RCCO RFP.
| Forming Partnerships |
Medical Homes for Children Program:
125-member stakeholder medical home advisory board included provider and family leadership, staffed by Medicaid and included a state-wide survey of providers. Family Voices Colorado has represented parents and families in medical home development since 2000.
Accountable Care Collaborative (ACC) Program:
The Accountable Care Collaborative Program included stakeholder input through public forums and a formal Request for Information process.
HealthTeamWorks Multi-payer Pilot:
In 2009, HealthTeamWorks, then known as the Colorado Clinical Guidelines Collaborative, convened a public-private multi-payer pilot. |
| Defining & Recognizing a Medical Home |
Medical Homes for Children Program: Definition: Chapter 346 of the 2007 Session Laws provided a state-developed definition of medical homes for children as follows: “[A]n appropriately qualified medical specialty, developmental, therapeutic, or mental health care practice that verifiably ensures continuous, accessible, and comprehensive access to and coordination of community-based medical care, mental health care, oral health care, and related services for a child. A medical home may also be referred to as a health care home. If a child's medical home is not a primary medical care provider, the child must have a primary medical care provider to ensure that a child's primary medical care needs are appropriately addressed. All medical homes shall ensure, at a minimum, the following:
Recognition: Certification using the Medical Home Index; Eleven state-developed qualification standards across eight domains (Accessible; Family-Centered; Comprehensive; Culturally Competent; Compassionate; Coordinated; Continuous; and Community-based). See the following for more information.
Accountable Care Collaborative (ACC) Program:
Definition: No specific definition of “Medical Home” within the Accountable Care Collaborative program.
Recognition: Under the Accountable Care Collaborative (ACC) Program, practices and providers can become participating Primary Medical Care Providers (PMCPs) if they:
Furthermore, PCMPs must commit to nine additional principles that ensure care is patient/family-centered; whole-person oriented and comprehensive; coordinated and integrated; provided in partnership with the patient and promotes patient self-management; outcomes-focused; consistently provided by the same provider as often as possible so a trusting relationship can develop; and provided in a culturally competent and linguistically sensitive manner.
HealthTeamWorks Multi-payer Pilot:
Definition: The HealthTeamWorks multi-payer pilot uses the Joint Principles of a Patient Centered Medical Home.
Recognition: The HealthTeamWorks multi-payer pilot uses National Committee for Quality Assurance Physician Practice Connections - Patient-Centered Medical Home (NCQA PPC-PCMH) recognition standards. |
| Aligning Reimbursement & Purchasing |
Medical Homes for Children Program: Certified providers receive pay-for-performance enhanced reimbursement for EPSDT/well-child visits.
Accountable Care Collaborative (ACC) Program:
Under the Accountable Care Collaborative (ACC) Program, a total of $20 per-member/per-month (PMPM) is divided among three entities
Once a RCCO shows cost neutrality, $1 PMPM is withheld from both the PCMP and RCCO, creating a shared quarterly incentive payment pool. The $1 PMPM can be recouped by each entity by meeting specific performance goals. * Pediatric PCMPs cannot receive enhanced payments from both the Medical Homes for Children and the ACC programs. They are only eligible to receive the Medical Home for Children Program performance payments for their patients.
HealthTeamWorks Multi-payer Pilot:
Participating HealthTeamWorks pilot sites receive enhanced
care management and performance-based payments on top of fee for service reimbursement. Multi-payer pilot sites may also participate in the ACC, but individual patients may only be attributed to one program at any given time. |
| Supporting Practices |
Medical Homes for Children Program:
Accountable Care Collaborative (ACC) Program:
Under the Accountable Care Collaborative, Regional Care Collaborative Organizations (RCCOs) and the Statewide Data and Analytics Contractor (SDAC) provide support for participating Primary Medical Care Providers (PCMPs). RCCOs provide:
HealthTeamWorks Multi-payer Pilot:
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| Measuring Results |
Medical Homes for Children Program: Outcomes of interest for the Medical Homes for Children Program tracked by the Colorado Department of Healthcare Policy and Financing and Colorado Children's Healthcare Access Program include:
Accountable Care Collaborative (ACC) Program:
The primary goals of Colorado’s Accountable Care Collaborative program is to improve health outcomes through a coordinated, client/family-centered system that proactively addresses clients health needs and controlling costs by reducing avoidable, duplicative, variable and inappropriate utilization.
HealthTeamWorks Multi-payer Pilot:
The HealthTeamWorks multi-payer pilot evaluation, which is being prepared by the Harvard School of Public Health, will include quality, cost, and patient/provider satisfaction measures. |
