accountable organizations in medicaid: an overvie · chcs medicaid accountable care organization...

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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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