Ways of the RAEs: Colorado Access on Engaging Members and Communities
Fifth in a series of interviews with leaders of Colorado's Regional Accountable Entities, or RAEs. Jeff Bontrager, CHI's director of research and evaluation, interviews Gretchen McGinniss, senior vice president of health care systems at Colorado Access.
This episode was recorded before the RAE was launched in July 2018.
Topics covered include Colorado Access's history working with Medicaid and how the state's largest RAE plans to coordinate services and community organizations.
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Jackie Zubrzycki: Hi and welcome to The Checkup, the Colorado Health Institute’s podcast about health in Colorado and the policies that affect it. I’m your host Jackie Zubrzycki, the communications specialist here at CHI.
Health First Colorado the state’s Medicaid program, just launched five new Regional Accountable Entities, or RAEs, as part of an effort to improve care and reduce costs. The RAEs are managing physical and behavioral health together for the first time.
We recently published a paper on the RAEs, which you can find on our website www.coloradohealthinstitute.org.
We wanted to get a sense of what’s going to change now that these new regional organizations are managing care.
Today we’ll be talking with Gretchen McGinnis. She’s the senior vice president of healthcare systems and accountable care at Colorado Access, a nonprofit health insurer in Aurora.
Gretchen McGinnis is leading the biggest RAE in the state, covering metro Denver.
She spoke with Jeff Bontrager, CHI’s director of health coverage and access, about how Colorado Access is trying to get more intentional about engaging members and about why she thinks her region is a “canary in the coal mine” for issues in the Medicaid.
Jeff Bontrager: So Gretchen McGinnis welcome and thank you for being on our podcast today. Can you tell us a little bit about your RAE? ? And also I'm interested in the two regions that you have and what might be some distinguishing characteristics about those regions.
Gretchen: So, Colorado Access was lucky enough to be awarded two of these Regional contracts. So we will be the ray for Regions 5 and regions 3. So, um Region 5 is the City and County of Denver, which is inclusive of the Denver Health managed care plan. I think we'll talk about that in a little bit. Um, and then Region 3 Is often referred to sort of the East metro area. So that's Adams Arapahoe Douglas and Elbert County. So it is a region 3 is a very large geographic area. It has both very Urban parts and very rural parts and it is probably one of the least. I've organized regions in terms of you know, it doesn't have a single system of care. It has a lot of different Health Care Systems within that region. So lots of different neighborhoods. So we go from very rural Elbert County to Douglas County that has a fairly high income level and so Health First Colorado members in Douglas County are there's a significant number of them there, but there's a perception that. Medicaid services in that area aren't as needed. Versus some of the really urban parts of Arapahoe County which look and feel a lot like the metro Denver area. And one of the things we appreciate about having these two contiguous regions is there are a lot of providers and Healthcare systems that span both of these regions.
So the regional boundary for Region 5 is sitting County of Denver, it's invisible frankly for people who are living their lives over example our office where we're sitting today is in Aurora in Arapahoe County, but if I go half a mile down the street to go get a cup of coffee I'm in Denver County. So people cross these Urban boundaries fairly frequently.
So having these two contiguous regions allows us to really interact with the Healthcare systems that exist in a less artificial capacity. Um, so in Colorado access has been around for 24 years now and we've always been in the Medicaid Program.
That was why the company was formed and we have been a long-standing committed partner with the state in serving the Medicaid population through various. One of the other legacies of Colorado access has been our focus on integrated care and that being Behavioral Health Care and physical health care and treating that whole person.
So Colorado access has been a Behavioral Health Organization for the last 17 years. Um, maybe longer but were the only RAE um entity that has experience as both a Medicaid Behavioral Health Organization and a Medicaid physical health provider.
Jeff: What do you think that that experience of being both a regional care collaborative organization or RCCO as well as a Behavioral Health Organization brings to the table in this new role as a regional accountable entity.
Gretchen: A couple of things one is in terms of just being a practical implementation. We're already doing the behavioral health the Behavioral Health Organization. So we have a Statewide Behavioral Health Network already. We are currently paying Behavioral Health claims. We have payment models and structures, you know, utilization management, dedicated behavioral health care coordination services, you know, all kinds of programming in place already.
So there was significantly less for us to build for day one of the RAE and in looking across the state their organizations that came primarily from the RCCO or physical health space and are having to build Behavioral Health capacity and organizations that came primarily from the BHO side and are having to build that physical health capacity.
So because we have been serving both of those contracts under our in our previous contracts. It's it's easier for us to get to move forward into the right world, and I think we're going to be more able to start focusing on those outcomes because we have less to build.
Um, so it'll be it'll be an interesting challenge.
I think we because Access is so large. We currently have the largest Medicaid enrollment in the three RCCO programs that we have and then we expect to have about 38 to 40 percent of the Health First Colorado memberships in our to RAE regions going forward. We often think of ourselves as kind of the canary in the coal mine.
So, um, you know when there are challenges with um eligibility files or questions about enrollment or changes in health care is being delivered, we often see those things bubble up first because we have such a high volume and so we we really appreciate our partnership and collaboration with Health Care Policy and Finance (HCPF) to be able to say hey, we're seeing something here that looks a little um, that looks a little odd, you know, how can we provide data and information to the department that might help identify early on, you know, a problem that is likely affecting the rest of the region.
Jeff: So I'd like to shift gears and talk a little bit about how you see this new phase of Colorado's Medicaid Program Health First Colorado affecting individual members Medicaid members who are living in the state or in your region specifically.
Gretchen: So I think there will be a couple of differences state-wide and a couple of differences within the you know, the our region specifically, um, as as I mentioned before in Region 5, which is the City and County of Denver, we have been the Behavioral Health Organization and the RCCO for the last seven years.
So for members in that region, they're not really going to see I think a lot of different. They already called the same Colorado Access customer service line, whether they need help with their Behavioral Health Care or their physical health care. We have the same providers that we have partnered with in the community, you know, Denver Health, MCPN, Doctor's Care, Children's Hospital that we'll have seen so it's not new providers.
One of the things though that we really are focusing on in our new RAE program is creating this this Collective impact model. And so one of the goals of the is to really look at the health of the system of care, so certainly to impact the health of individual members but to think about how the Health Care system works together in a way that delivers care to those members. And so one of the unique things that we're doing with in Region 3 and Region 5 is to create a set of collaborative, um governing groups that bring together the providers in the region at a big table to really have those those conversations about how the work that they are all doing individually impacts the health of the region and how they may conflict with each other in some instances or how they may be able to be strengthened by coming alongside each other.
Knowing even that this program is happening in the system over here this similar, but you know fundamentally different in this one area program. is happening as other part of the system. So bringing that that big table of of providers together and really working on that kind of trust and transparency and collaboration to say how do we all work together with our various tools in our toolbox to make the region better and look at data across the region and have those. those moments of wrestling with how do we decide where to invest resources in this area that area and then how do we decide together what we're going to work on.
So within the RAE there are a lot of key performance indicators. There are a lot of Behavioral Health performance metrics. There are a lot of additional metrics that are going to be reported publicly, even though there aren't incentives tied to them.
And so as a region, we believe that we really need to prioritize and we don't think that that is Colorado Access's role alone to prioritize we want to work collaboratively with our partners and say, okay, what do we think we can achieve first and how do we put our focus on these these achievable metrics first and how we get that in place. How do we draw down those incentive dollars? How do we invest those dollars to achieve those next metrics the ones that are a little bit harder and continue that cycle.
So we really are trying to transform the way the system works together in a different way.
Jeff: Have there been challenges and doing that,?
Gretchen: Sure and and there will continue to be challenges in doing that. I mean, these are these are entities that don't always play nicely in the sandbox together. Um, sometimes they do sometimes they have shared grants, but to the best of our knowledge, you know, this is this is the first time that these groups will be in the same space with really the same goal. And one of the things that Colorado Access has committed to is really being very transparent about what our contracts are with the state what decisions we have to make um, you know, where um where the money goes what we have to invest how we have to do all of these various contractual obligations and how they these groups play a part of that and this group is is augmented and supported by a very robust member advisory Council. Where we have a number of members who were very actively engaged in looking at materials giving us information about how they like to what challenges they have with getting their own care what they hear in the community, you know empower them to get out and talk to their fellow folks and be that kind of ambassador spokesperson, you know, so we get that information back and then we're very excited to be seating our regional performance Improvement advisory committees or PACs the summer which will bring together community partners, advocacy groups, providers who might not be at that governance council table and really making sure that we're mirroring these these ideas and we're all really working together in this shared model.
Jeff: So you mentioned the member engagement and I'm wondering if you could say a little bit more about that.
Gretchen: So member engagement is a it's a huge topic and it's not there's not one way to kind of do that and so we have a number of different areas in which we work with members today, and a number of different ways that we're going to work with members, you know in the future as we build - remember these RAEs are seven year contracts, so everything is not going to be magically different on July 2nd - but uh where we are on July 2nd, you know, 2020 or 2022 should look different than where we are today.
So we have we've always had a member a very active member advisory, um group and lots of participation. What we didn't have was a sort of deeper and more meaningful connection with a group of well-informed members who were really willing to put in time kind of at the at the system level so, you know really being willing to dig into materials and education and you know, if we're trying to educate, you know, send care Mmnagement information to somebody and you got this what would you think so not just showing up at a meeting and you know giving some input but a group of members who really are interested in doing a deeper level of work.
Um, but that isn't the only member engagement activity that we're doing. So we do a lot of work in the community at community events at health fairs, you know, really engaging both current members and people who um could be members whose uh, neighbors are members who, you know are just interested in healthcare and trying to understand.
What are the common challenges that people are facing? What do people want out of their health care? What do they want out of their health plan, how do we help? What language we should be using to describe services? And then certainly we have lots of um deep relationships with advocacy groups and people who speak on behalf of specific populations whether that be you know, children or folks with brain injuries or other disabilities, so we think it's a multi-faceted approach and then certainly for the members that we serve and that we work with on an individual basis, we are always trying to understand what is there that individuals motivation? So what what is the most important thing to them about their health care? Um, and it may not be the most important thing to us. But our our job is to help that member achieve their definition of a healthy life.
Jeff: What is one way that you know that these efforts will be successful.
Gretchen: Well, the easy answer to that is we will have achieved hopefully all but at least the majority of these key performance metrics at the measuring.
Gretchen: So, welness visits for all ages across the population, reduced emergency room visits, reduced costs overall, compacts between providers and specialists that dictate how care is going to be managed.
Jeff: So these are all things that the RAE is kind of graded on.
Gretchen: Yes and there are actual dollars tied to the achievement of these goals. So if the the region meets the goal then there is um, there's a financial reward that is paid. To the ride with the expectation that that those um, those dollars are shared with the folks in the region who contributed to that metric so that might be different depending on whether it's a primary care based metric or whether it's their metrics around Behavioral Health Services. So, um screening for depression in Primary Care, increased access to Behavioral Health Services overall. So they're ways for the state to really see are we improving the care for the members that we serve and can we demonstrate that and then also I think to make sure that care for these folks are isn't getting worse.
And so they're you know, there's sort of a monitoring aspect of that and then on the less tangible side of success.
I think as we've talked about before having these new structurse in terms of governing, I think in a couple of years one of my goals is to really see the conversations at those tables take on a different tone. You know one that really is first focused on the region. You know, what what are we achieving as a region? What are our goals? You know, whether they be kpi specific or you know, how are we moving forward in terms of you know, efficient moving of patients between the various systems or communicating between um, the Denver Health Medicaid Plus Choice plan member and how that system interacts with the rest of the primary care system. So are we really our folks at those tables having those challenging conversations have they built that level of trust and respect and knowledge about the the system that we're all living and working in and can we move are we moving that that process forward?
Jeff: So is there anything that I haven't asked that you would like people to know?
Gretchen: All sorts of things probably. We're really excited about the the evolution of the ACC 2.0 model and the RAE model. We think there's a lot to be gained by bringing together the physical health and the behavioral health systems and treating members as sort of one person and working with the provider community in a more in a more coordinated way, but we're also looking at what's the you know, what is ACC 3.0 going to look like?
You know, what is the next evolution of this model? And it could go, you know more towards global budget model it could go towards, you know, the continued evolution of this managed fee-for-service kind of model and what are the pros and cons of both of those? So from Colorado Access's unique past in the Medicaid system we have experience with both of those models. We know what works well in that in one system what doesn't work? What needs to be shored up if this model is going forward.
So we're focused on ACC 2.0 but we're interested in partnering with the community and the state and uh, the legislature and the new Administration to think about what does the next phase look like and how do we continue to to keep Colorado in the forefront of Medicaid innovation and success?
Jeff: Well Gretchen McGinnis. Thank you so much for joining us on our podcast today and best wishes is the ACC Phase 2 rolls out.
Gretchen: My pleasure. Thank you for having me.
Jackie: That’s all for today. Thanks to Gretchen McGinnis from Colorado Access for joining us. She’s leading the new Regional Accountable Entity for Regions 3 and 4, which cover metro Denver.
You can listen to our interviews with other regional leaders on our website, . There, you can also read our new report on the RAEs and how they work and more of our work on other health policy issues.
Make sure to follow us on Twitter and instagram @cohealthinst, and follow us on Facebook. Thanks for listening! I’m Jackie Zubrzycki at CHI.
Italicized questions were cut from the audio recording for length.