Table 1.
Characteristics of Oregon and Colorado Reform Models
| Coverage Model | CCO (Oregon) | ACC/RCCO (Colorado) |
|---|---|---|
| Regional Focus | Regional and community resources support the coordination of care across programs (16 CCOs covering entire state) | Same as Oregon (7 RCCOs cover entire state) |
| Enrollment of beneficiaries | Automatic enrollment with exceptions primarily for individuals with special health needs. Approximately 90% of Medicaid population enrolled in CCOs in June 2013. | Automatic enrollment based on primary care provider attribution†; primary care providers could opt in to ACC program. Approximately 47% of Medicaid population enrolled in RCCOs in June 2013; 58% by June 2014. |
| Primary Care Medical Homes | Beneficiaries are assigned a primary care medical home, which serves as the primary agency for coordinating care | Same as Oregon |
| Incentive Measures | 17 “Incentive Measures”; CCOs eligible for bonus payments of up to 3% of global budget in 2014. | 3–4 core measures, updated annually; RCCs eligible for bonus payments of up to $1.00 PMPM |
| Cost Savings | Requirement to slow spending growth rate to 4.4% in 2014 and 3.4% in 2015 | Incremental reductions anticipated but not required |
| Financing | Global budget: risk adjusted, per capita, with CCOs at financial risk | FFS, with RCCOs and primary care providers receiving per-member payment to support care coordination |
| Examples of delivery system initiatives | High utilizer programs Programs to reduce ED utilization Hospital-to-home transition programs Support for social services Alternative payment models designed to move away from fee-for-service and decrease incentives for high-volume, high-intensity care Integration of oral and mental health |
High utilizer programs Programs to reduce ED utilization Support for social services Centralized data repository to track and report clinic performance |
| Investments | CMS provided approximately $1.92B over 5 years from (2012–2017) | State-based investment of approximately $155M between 2011–2014 |
†
Most Medicaid enrollees were in Colorado were covered by the traditional fee-for-service Medicaid program; individuals in Colorado Medicaid Managed Care Organizations were generally required to opt out of Managed Care in order to be enrolled in the ACC program.