Abstract
This report describes the results of our two year study of the impact of Colorado’s Accountable Care Collaborative on healthcare utilization, costs, and quality. The quantitate analysis examined claims data between July 2009 and June 2015, a period that spans the introduction and establishment of the Accountable Care Collaborative. The qualitative portion of our mixed evaluation of the Accountable Care Collaborative is focused on experiences and perspectives of provider practices with the program to date. We also have incorporated findings focused on member experience from a companion study conducted by the TriWest Group.
Insights Results
Financial and quality outcomes
The estimates reveal that the Accountable Care Collaborative saved about $60 per member per month (PMPM) in healthcare spending on adults and $20 PMPM in healthcare spending on children
The savings among Medicare and Medicaid eligible (MME) members were estimated to be about $120 PMPM
Results find that contemporaneously funded grants and Center for Medicare and Medicaid Innovation (CMMI) initiatives also contributed to declines in spending. Controlling for these initiatives lowers the estimated savings estimate by about 20%. The Accountable Care Collaborative did not significantly influence official key performance indicators or other recognized indicators of quality and access. Taken together, we interpret these findings as an indication that the Accountable Care Collaborative program increased the value of Health First Colorado services by reducing spending while keeping quality of care constant
The impact of the Accountable Care Collaborative on total spending on adults also varied considerably by Regional Care Collaborative Organization (RCCO): two of seven RCCOs experienced reductions of less than $40 PMPM. In contrast, only one RCCO experienced reductions of less than $20 PMPM on children. Two RCCOs experienced twice the average PMPM savings on MME members
This decrease in spending is likely due in part to practice and RCCO efforts to enhance care coordination through various practice transformation efforts initiatives Many of the practices participating in the Accountable Care Collaborative have only recently implemented care coordination improvements or are in the midst of ongoing quality improvement efforts to enhance care coordination, and RCCOs have helped to support these new initiatives
Future considerations
Many practices noted that members need to play a more active role in the Accountable Care Collaborative program if it is to be successful
Several practices noted that members would benefit from more education, engagement, and accountability, as many lack a fundamental understanding of preventive care and how their Primary Care Medical Providers (PCMP) can help
RCCOs and practices should continue to be supported in their ongoing efforts to enhance the coordination and quality of the care of their members. These supports may include: continued funding to support care coordination; access to timely data; support on how to integrate care coordination efforts into the practice; performance indicators that align with practice specialty and care coordination approach; and member education, engagement and accountability
