Abstract
Many ACOs may be interested in working with state Medicaid programs in accountable care arrangements. There is considerable variability across states in regard to Medicaid payment models. Currently only a handful of states have embraced a substantial commitment to the ACO model or a similar version of an accountable care program for their Medicaid beneficiaries. Many others are pursuing various value-based purchasing strategies, and many rely on Medicaid Managed Care Organization (MCO) contractors to serve their beneficiaries. Below is a working list of states where Medicare-like ACO programs have been implemented for Medicaid beneficiaries. If you do not see your state below and wish to inform us of Medicaid ACO efforts or programs in your state, please contact us at advocacy@naacos.com.
Insights Results
Overview of article/programs
This article describes various state Medicaid ACOs
Colorado – Launched in 2011, Colorado’s Accountable Care Collaborative aims to connect all Medicaid beneficiaries to primary care. Phase 2 of the Collaborative expands and enhances the Collaborative through Regional Accountable Entities, manding coverage for nearly all of the state’s Medicaid beneficiaries. The focus has also been expanded to integrate behavioral health services
Connecticut – Under a State Innovation Model grant, the goal of the ACO program is to consolidate provider purchasing power
Iowa – In this managed care program, Medicaid managed care contractors are required to contract with ACOs in risk-based agreements. Payment is dependent on quality scores
Maine – Main’s Accountable Communities initiative contracts with groups of providers who voluntarily participate in a Medicaid shared savings program
Massachusetts – Massachusetts has 3 ACO models: 1) Accountable care partnership plan; 2) Primary care ACO; and 3) ACO provider organizations. Current priorities include initiating member experience surveys to help establish ACO quality scores, improving data sharing and reporting, and maintaining operational stability
Minnesota – Their Medicaid ACO program, Integrated Health Partnerships, is models after the Medicare Shared Savings Program focusing on shared savings payments for physical, behavioral, and pharmacy care that includes quality measurement. The program has shows accomplishments like decreased length of hospitals stays and decreased use of emergency rooms
New Jersey – The program has a safety-net focus and is based in part on the Camden plan and its population health program. This model will expand and stress population health approaches, including care management and coordination and an emphasis on data collection and matching
New York – Current state policy emphasis involves 25 mostly hospital-led Performing Provider Systems (PPSs) with integration and coordination among providers in each PPS
Oregon – Oregon’s Coordinated Care Organization program for all Medicaid beneficiaries focuses on the provision of physical, behavioral and oral care services. The program has decreased inpatient admissions and ED use while maintaining budget
Rhode Island – RI’s Medicaid Accountable Entities (AE) contract with managed care organizations to deliver more cost-effective, coordinated and population focused care. From shared savings in the first two years of implementation, AEs will progress toward full risk under future contracts
Utah – The Utah Medicaid ACO program includes quality measurement but no payment withhold or downside risk
Vermont – Vermont is moving to a state-wide, single-payer ACO for all citizens, aiming to reduce the growth of healthcare spending, create an integrated delivery system, and prioritize population health. The current program is based on the Medicare Next Gen ACO model with Vermont-specific modifications
