Leading-edge state Medicaid agencies across the country are exploring the potential of accountable care organizations (ACOs) to drive improvements in quality, delivery, and cost-effectiveness for Medicaid beneficiaries. Seven states in particular – Maine, Massachusetts, Minnesota, New Jersey, Oregon, Texas, and Vermont – are creating ACO models for Medicaid.

The Center for Health Care Strategies (CHCS) designed Advancing Medicaid Accountable Care Organizations: A Learning Collaborative to help state pioneers launch Medicaid ACO models. Through this effort, CHCS is assisting the seven states in development and implementation of Medicaid ACOs.  The effort is sponsored by the Commonwealth Fund, with additional funding from the Massachusetts Medicaid Policy Institute, a program of the Blue Cross Blue Shield of Massachusetts Foundation.

Drawing from the experiences of these innovator states, a helpful new CHCS policy brief outlines 10 core considerations to help guide the development and implementation of Medicaid ACO approaches:

  1. Obtain the Regulatory Approval to Create Medicaid ACOs
  2. Design a Payment Model Appropriate for Medicaid Populations and Providers
  3. Build ACOs Atop Other Delivery System and Payment Reform Efforts
  4. Facilitate Provider ACO Building Capacity
  5. Determine How to Include High-Cost Populations in ACOs
  6. Select Appropriate Quality Measures, Measurement Strategies, and Value-Based Purchasing Techniques
  7. Define New Roles for Managed Care Organizations
  8. Define the Scope of Services Offered through ACOs
  9. Bring a Wide Set of Stakeholders to the Table
  10. Stimulate Multi-Payer Alignment and Participation

Some of the considerations are unique to the Medicaid program and the challenges inherent in improving care for vulnerable, low-income populations. Other ACO issues are common across all health care purchasers and payors, signaling opportunities for multi-payor collaboration and alignment.

To read Core Considerations for Implementing Medicaid Accountable Care Organizations, click here (PDF).

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Kip Piper is a Medicare, Medicaid, and health reform consultant, speaker, and author.  A senior consultant with Sellers Dorsey and Fleishman-Hillard, Kip advises health plans, hospitals and health systems, states, drug and device manufacturers, and investment firms throughout the U.S.  For more, visit KipPiper.com.  Follow on Twitter at @KipPiper and connect with Kip on LinkedIn.