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Office of MaineCare Services: Maine Accountable Communities Initiative Data Book Walk-Through. May 14, 2014. Agenda. State Update. Claims cap correction Additional 3 mo. (6 mo. total) for claims run out Decision to have interim and final payments State Plan Amendment Rulemaking
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Maine Accountable Communities Initiative
Data Book Walk-Through
May 14, 2014
The initial benchmark, adjusted final benchmark, and the performance PMPM TCOC are key elements in the MaineCare Accountable Communities Program. Below shows the relationship amongst these items.
Relationship of TCOC Elements
Before Performance Period
After Performance Period
The timeline for the shared savings calculation in performance year 1 is discussed below.
Performance Year 1 Timeline:
SFY13 Data with 2-months paid run-out is used for calculation of Initial Benchmark PMPM TCOC
SFY15 Data with 6-months paid run-out is used for calculation of Performance PMPM TCOC
SFY15 Data with 17-months paid run-out is used for calculation of Performance PMPM TCOC
Performance and Adjusted Final Benchmark PMPM TCOC Interim
Performance and Adjusted Final Benchmark PMPM TCOC Final
Initial Benchmark PMPM TCOC Finalized
Shared Savings Calculation Steps
Adjusted Final Benchmark PMPM TCOC Development
Performance PMPM TCOC Development
Shared Savings Calculation
Initial Benchmark PMPM TCOC Development
Goal: Develop Benchmark PMPM TCOC to be Reflective of Performance Period
July 2012 – June 2013
July 2014 – June 2015
Note: Aggregate risk score is documented for each AC in the benchmark period
Initial Benchmark PMPM TCOC = (
) with an adjustment of
After Change Implemented
Before Change Implemented
10% Rate Increase on
Illustrative Policy Adjustments by Service Category
The adjusted final benchmark PMPM TCOC will be further adjusted by policy changes in SFY2015 to be reflective of the performance period policy basis
Illustrative Completion Factor by Service Category
Different completion factors will be developed for the adjusted final benchmark PMPM TCOC based on the additional run-out available
Illustrative PMPM TCOC Trend by Population Group
Prospective trend will be replaced by the actual retrospective trend from the comparison population in the development of the adjusted final benchmark PMPM TCOC
Claim Cap Adjustment
The claim cap adjustment will be refreshed in development of adjusted final benchmark PMPM TCOC after updates are made for completion, policy changes, retrospective trend, and risk
The final data book sent to each accountable community will only contain that community’s data.
Provider to Department:
Department to Provider: