First Survey of Colorado Accountable Care Collaborative Clients Released

The Colorado Health Institute today released findings from the first consumer experience survey of Medicaid clients participating in the Accountable Care Collaborative (ACC), the state’s signature project to reform the delivery of primary health care.

The report focuses on 10 findings from the survey, the Consumer Assessment of Healthcare Providers and Systems (CAHPS), in which adults enrolled in the ACC rated their health care experiences.

The Colorado Department of Health Care Policy and Financing (HCPF), the state agency overseeing Medicaid, launched the ACC in 2011 to improve the efficiency and effectiveness of primary care, and lower costs. Medicaid clients are enrolled in “medical homes” where their care is coordinated by a team of providers and preventive care is emphasized. The project also institutes new ways of paying for care, including incentives for health care providers who meet targets.

The program is administered through seven Regional Care Collaborative Organizations (RCCOs). About 662,000 of Colorado’s million-plus Medicaid clients are enrolled in the ACC.

To date, the program primarily has been measured by whether costs and the use of certain procedures and services are declining. The new data contribute insights about clients’ perceptions of the value of having a personal doctor, access to preventive care and coordination across health care services.

The survey was a partnership of HCPF, the Colorado Health Foundation, and the Colorado Health Institute. Data were collected in the spring of 2013. The analysis focused on clients in the ACC compared with clients remaining in the traditional fee-for-service (FFS) program.

The key findings include:

• ACC patients rate their care relatively high. For example, on a scale of 0-10, the average rating of personal doctors was 8.2 in the ACC and 8.4 in FFS.
• Many of the experiences reported by both ACC and FFS Medicaid clients in Colorado – such as access to care, coordination between health care providers and rating of their physician - are similar or slightly lower than the national average.  
• Comparisons of the ACC to “traditional” FFS were mixed. On some questions – such as those focused on whether the client had been asked about his or her behavioral health - the ACC scored higher. On others, there was no difference statistically between the two groups.
• ACC clients scored their care lower than traditional FFS on a number of measures – such as care overall and care from their personal doctor.
• The study found no statistical differences between the seven RCCOs after factors such as health, education and age were taken into account.

Jeff Bontrager, the Colorado Health Institute's director of research on coverage and access, who led the survey project, noted that the ACC is in its early stages. Some results could reflect the fact that ACC clients have more health concerns than those who remain in the traditional FFS program or that they are relatively new to their doctors and don’t yet have established relationships. Jeff's blog discusses the results.

Suzanne Brennan, Colorado Medicaid director, said the baseline measurement is critically important as HCPF and the RCCOs look to enhance the ACC and the client experience. “While the data were gathered fairly early in the ACC’s evolution, it establishes a number of client perceptions that we can learn from and build upon in Colorado’s effort to improve health outcomes, and the client experience while lowering costs,” she said.

Added Anne Warhover, president and CEO of the Colorado Health Foundation, which helped to fund the survey:  “The Consumer Assessment of Healthcare Providers and Systems (CAHPS) is a major step toward better understanding the distinct value of having access to preventive and coordinated care, and how we can improve communications between a health care professional and the patient.

"By providing key insights into the patient experience and the ability to measure trends over time, the assessment will guide us toward improved health care systems based on the needs of Coloradans – a component of the Foundation’s vision to make Colorado the healthiest state in the nation.”