Colorado ACO yields big savings, reduced readmissions

POSTED IN: Quality and Safety, Workforce Management, Financial/Revenue Cycle Management

Colorado’s newest Medicaid program, the Accountable Care Collaborative (ACC), which was established in May 2011, has shown considerable promise in its first year of operations – significantly reducing hospital readmissions, improving patient outcomes and saving the state a potential $30 million, according to a November agency report.  

Released by the Colorado Department of Health Care Policy and Financing, the report makes a convincing case for the ACC, with analysis demonstrating reduced rates for emergency room (ER) visits, hospital readmissions and costly imaging services.

Overall, state officials also observed lower rates for chronic health conditions and lowers costs for enrolled patients.

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“We’re very happy that it’s moving in the right direction,” says Laurel Karabatsos, director of health programs for the Colorado Department of Health Care Policy and Financing, as reported by Health Policy Solutions. “We hope to expand to behavioral health, social services and building a virtual network of specialists and ancillary providers. We anticipate more savings as we integrate."

ACC inpatient readmissions, one of the three key performance indicators, were shown to decrease by 8.6 percent in comparison to the non-enrolled group.

For ACC enrollees, ER utilization, the second of three performance indicators, increased 0.23 percent in comparison to a 1.47 increase for the non-enrolled group. According report findings, officials at one of the seven regional care collaborative organizations (RCCO) recall an enrollee “who visited the emergency department 32 times in one year. The RCCO assisted the client in established a primary care provider and since then the client has only visited the ER once,” the report reads.

Report officials found that utilization of costly imaging services, the last of three performance indicators, fell 3.3 percent among ACC enrollees in comparison to the control group.

Initial overall savings were pegged at $20 million for the fiscal year, but the Department of Health Care Policy and Financing calculated an updated estimate, using more conservative methods. The projected gross savings of the ACC program are now pegged at between $9 million and $30 million for 2011-2012.   

As of June, the ACC program saw total enrollment exceed over 132,227 participants, representing 21 percent of the overall Medicaid population (619,963).

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ACC officials say the program was created in response to a failed fee-for-service system and some of the highest caseload and expenditures in state history.

One of the crucial elements to the ACC program, officials say, is the primary care medical provider, who coordinates patient care along the continuum of care, assists with medical management and contribute provider support with things like referrals and care-coordination. 

Conclusively, the report states, “All indications show that the ACC Program is both reducing costs for clients enrolled in the program and improving client outcomes. As the program continues to expand, the department will utilize lessons learned and best practices identified to further improve the program; the program is iterative and there remain opportunities for improvement.”

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