Rocky Mountain Health Maintenance Organization Incorporated

COORDINATE THE FINANCE AND DELIVERY OF HIGH QUALITY HEALTH CARE AND RELATED SERVICES THROUGH A COMMUNITY-BASED ORGANIZATIONAL STRUCTURE TO A BROAD CROSS-SECTION OF COLORADANS, FOCUSING ON PREVENTIVE CARE, ACCESS AND QUALITY IMPROVEMENT FOR THE BENEFIT OF MEMBERS AND THE GREATER COMMUNITY.

EMPLOYER GROUP AND INDIVIDUAL PLANSPROVIDED MEDICAL BENEFIT SERVICES AND PROGRAMS TO OVER 31,000 PEOPLE ENROLLED THROUGH EMPLOYER GROUP AND INDIVIDUAL PLANS. OVER 90% OF EMPLOYER GROUPS WERE SMALL BUSINESSES.

MEDICARE PLANSPROVIDED MEDICAL BENEFIT SERVICES AND PROGRAMS TO OVER 24,000 MEDICARE BENEFICIARIES, OVER HALF OF WHOM RESIDE IN RURAL AREAS NOT SERVED BY ANY OTHER MANAGED CARE PLAN. MEMBERS RECEIVED BROAD ACCESS TO MEDICAL CARE AND WELLNESS PROGRAMS.

MEDICAID PLANSUNDER THE MEDICAID ASO AGREEMENT, RMHMO PROVIDED MEDICAL BENEFIT SERVICES AND PROGRAMS TO MEDICAID RECIPIENTS IN 7 RURAL COUNTIES, ENSURING ACCESS TO QUALITY MEDICAL CARE NOT OTHERWISE AVAILABLE, AND SAVING TAXPAYER DOLLARS WHILE EXCEEDING NATIONAL BENCHMARKS FOR QUALITY. THIS PROGRAM CONTRACTUALLY ENDED IN 2014 BUT THE ORGANIZATION HAD RUN-OUT INTO 2016.EXPENSES $ -183,477. INCLUDING GRANTS OF $ 0. REVENUE $ 24,529.EFFECTIVE ON SEPTEMBER 1, 2014, RMHP LAUNCHED A NEW MEDICAID PAYMENT REFORM PILOT KNOWN AS MEDICAID PRIME, WHICH IS AUTHORIZED STATUTORILY BY THE COLORADO GENERAL ASSEMBLY. NEW PAYMENT METHODS AND QUALITY METRICS ARE BEING TESTED TO IMPROVE ACCESS AND VALUE FOR COLORADO MEDICAID RECIPIENTS IN A RIGOROUS, EXTERNALLY EVALUATED DEMONSTRATION. AN AVERAGE OF 34,000 ENROLLEES WERE SERVED BY RMHP IN MEDICAID PRIME DURING 2016.EXPENSES $ 167,150,377. INCLUDING GRANTS OF $ 0. REVENUE $ 186,805,553. CHILDREN'S HEALTH PLAN PLUS:THROUGH THE COLORADO DEPARTMENT OF HEALTH CARE POLICY AND FINANCING, RMHMO PROVIDED MEDICAL BENEFIT SERVICES AND PROGRAMS TO OVER 10,000 CHILDREN IN LOW-INCOME HOUSEHOLDS IN 22 RURAL COUNTIES IN WESTERN COLORADO THROUGH PARTICIPATION IN CHILDREN'S HEALTH PLAN PLUS PROGRAM. THESE CHILDREN GAINED ACCESS TO HIGH-QUALITY MEDICAL CARE THROUGH A MANAGED CARE PROGRAM THAT PROVIDES CASE MANAGEMENT AND CARE COORDINATION.EXPENSES $ 14,808,910. INCLUDING GRANTS OF $ 0. REVENUE $ 18,302,508. REGIONAL CARE COLLABORATIVE:AS PART OF A CONTRACT AWARD RECEIVED FROM THE COLORADO DEPARTMENT OF HEALTH CARE POLICY AND FINANCING, RMHMO PROVIDES SERVICES AS PART OF A REGIONAL CARE COLLABORATIVE ORGANIZATION FOR THE MEDICAID PROGRAM, WHOSE GOALS ARE TO IMPROVE HEALTH OUTCOMES OF MEDICAID RECIPIENTS BY ADDRESSING HEALTH NEEDS AND TO CONTROL COSTS BY REDUCING INAPPROPRIATE USE OF HEALTH CARE RESOURCES. EFFORTS FOCUS ON PROVIDING CARE COORDINATION AND CARE MANAGEMENT SERVICES TO MEDICAID RECIPIENTS; PROVIDING A FOCAL POINT OF CARE; ENSURING POSITIVE PATIENT AND PROVIDER EXPERIENCES; AND APPLYING STATEWIDE DATA TO SUPPORT DATA-DRIVEN QUALITY IMPROVEMENT INTERVENTIONS. THE CONTRACT COVERS 22 COUNTIES IN COLORADO AND SERVES OVER 135,000 MEDICAID CLIENTS.EXPENSES $ 13,438,700. INCLUDING GRANTS OF $ 0. REVENUE $ 14,917,304.

MISCELLANEOUS PROGRAMSCOLLABORATED WITH HEALTH CARE PROVIDERS AND COMMUNITY ORGANIZATIONS TO ADDRESS IDENTIFIED NEEDS, TO SUPPORT IMPROVEMENTS IN MEDICAL MANAGEMENT AND QUALITY OF CARE, TO FUND RESEARCH, HEALTH AND ASSIST THOSE AT-RISK AND VULNERABLE IN OUR COMMUNITIES. THE VALUE OF RMHP WELLNESS EDUCATION, LEADERSHIP, VOLUNTEER TIME, AND IN-KIND SUPPORT HAS NOT BEEN QUANTIFIED.EXPENSES $ 1,835,985. INCLUDING GRANTS OF $ 1,173,409. REVENUE $ 0. TOTAL OTHER PROGRAM SERVICES:CONTRIBUTION & GRANT REVENUE OF $ 1,244,229 WAS USED TO SUPPORT THESE OTHER PROGRAM SERVICE COSTS.