www.chcs.org
Friday, December 11, 2015
National Health Policy Forum
Tricia McGinnis Vice President
Accountable Care Organizations in Medicaid: An Overview
About the Center for Health Care Strategies
A non-profit policy
center dedicated
to improving the
health of low-
income Americans
State Representation in CHCS Projects Effective 10/15
CHCS Medicaid Accountable Care Organization Initiatives • Medicaid ACO Learning Collaborative, The Commonwealth Fund
► Participants: CO, IA, MA, NC, RI, WA
► Graduates: MN, ME, NJ, OR, and VT
• State Innovation Model (SIM), Center for Medicare and Medicaid Innovation (CMMI)
• ACOs and Super Utilizers, CMMI Health Care Innovation Award spreading Camden’s model
• Issue Briefs and Tools: ► New Jersey Medicaid ACO Toolkit, The Nicholson Foundation
► ACO and Future Directions, Robert Wood Johnson Foundation, Forthcoming
► Leverage Medicaid ACOs to Promote Population Health, Milbank Memorial Fund
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What are Accountable Care Organizations?
• Accountable Care Organizations (ACOs) are designed to hold providers accountable for improving health outcomes and controlling costs
• Key features: On the ground care coordination and management Payment incentives that promote value, not volume Provider/community collaboration and data sharing Robust quality measurement and accountability
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Medicaid Accountable Care Organizations by State
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Policy Context for Medicaid ACOs
• State pressure to achieve significant cost savings • Provider participation in Medicare ACO models • ACOs are viewed as the next step along the
continuum of advanced care delivery models • The CMMI State Innovation Model provides funding
to explore and invest in the models • No national Medicaid ACO standards • Early results are promising: Savings in CO, MN, OR,
and VT have generated interest and credibility
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What are Key Attributes of ACO Models?
• Governance structure ► Provider-, payer-, or regional ACOs
• Value-based payment with provider risk ► Shared savings models ► Capitated or global payments
• Quality measurement ► Reporting and performance evaluation ► Ties to payment
• Scope of services ► Physical health services ► + Behavioral health? Dental? LTSS? Pharmacy? Social services?
• Data exchange and analysis ► Health IT and EHRs
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Common Medicaid ACO Attributes
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• Mix of governance models
• Payment ► Shared savings transitioning to shared risk
► Global payment
• Quality metrics ► Pay for reporting shifting to pay for performance
► Chronic care, behavioral health, efficiency/utilization
• Scope of services ► Physical health only
► Physical health and behavioral health
• Claims data sharing
Promoting Population Health in Medicaid ACOs
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GOVERNANCE STRUCTURE AND
PAYMENT
DELIVERY SYSTEM ENHANCEMENTS
POPULATION HEALTH METRICS
DATA SHARING ACROSS SECTORS
• ACOs are geographically defined
• Partnerships with public health, social services and community agencies
• Value-based payment approaches
• Comprehensive preventive and social services
• Community health workers and nontraditional providers
• Metrics incorporate short-term processes and longer-term outcomes
• Initial metrics focus on well-defined categories: e.g., tobacco use, asthma, obesity
• Data-sharing arrangements between Medicaid and other state agencies
• Electronic records as a reservoir for population health measures
• New processes for secure information sharing
Medicaid ACO Program Results to Date
Colorado: $35-39 million in net savings over three years for 600,000 beneficiaries
Minnesota: $76.1 million cost savings over two years for 200,000 beneficiaries
Oregon: ► ED visits declined 17% in two years
► Decreased hospitalizations: 27% for CHF, 32% for COPD, and 18% for adult asthma
Vermont: $14.6 million cost savings over one year for 65,000 beneficiaries
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Future Issues
• Medicaid launch of ACO programs will continue • Programs will expand and become more complex
► Integration of mental health, substance abuse, long-term care, and supportive services
► Increase in financial accountability and risk ► Accountability for health outcomes, population health,
and community needs ► Inclusion of more diverse providers (e.g., safety net, rural
providers, etc.) ► Alignment with other payers and new models
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