Medicaid Accountable Care Programs: State Profiles

Lloyd J, Houston R, McGinnis T
Publication Year: 2015
Patient Need Addressed: Care Coordination/Management
Population Focus: Medicaid beneficiaries
Intervention Type: Service redesign
Type of Literature: Grey

States are implementing accountable care organizations (ACOs) to improve healthcare quality and better manage costs for Medicaid populations. Core components that define Medicaid ACOs are: the payment model; quality measurement approach; and the data strategy. This brief provides an overview of these core ACO elements and profiles how nine states – Colorado, Illinois, Iowa, Maine, Minnesota, New Jersey, Oregon, Utah, and Vermont – have structured their Medicaid ACOs. For each state, it outlines key ACO characteristics; details unique payment, quality, and data approaches; and spotlights one of the state’s Medicaid ACOs. This set of profiles can help inform Medicaid ACO development in other states.

Insights Results

Overview of model

  • Colorado reported statewide net savings of $29 to $33 million during FY 2014, its third year of operation. The program also had net savings of $6 million in its second year for a total net savings of $35‐39 million over the program’s three years
  • Iowa: In 2014, roughly 51% of Accountable Care Organization (ACO) members achieved at least one healthy behavior, and on average 28% achieved both healthy behaviors. In comparison, for the regular Medicaid population, only five percent completed the wellness exam. Medicaid paid out $430,000 in VIS bonuses in 2014, with Primary Care Physicians (PCPs) in an ACO being 5% more likely to earn a value index score (VIS) bonus than non‐ACO PCPs
  • Minnesota’s Integrated Health Partner (IHP) program saved the state $76.3 million over its first two years ($14.8M in the first year and $61.5M in the second year). All 9 IHPs achieved shared savings in year two and exceeded their quality targets
  • Oregon: since 2011, ED visits decreased by 22% and hospital admissions for short‐term complications from diabetes and chronic obstructive pulmonary disease by 26.9% and 60 %, respectively. Financial data indicate that coordinated care organizations (CCOs) are continuing to hold costs under the 2% capped growth rate mandated by the state’s §1115 waiver
  • Vermont: the program launched in 2014 and reported savings of $14.6 million in its first year