Though most commonly associated with Medicare, Accountable Care Organizations are now making their way into state Medicaid programs. Providers, of course, are an essential part of the ACO model. But many providers don’t yet have the resources to coordinate care, analyze cost and usage data, and adapt to value-based payments – all necessary to make ACOs successful. A helpful brief from the Center for Health Care Strategies gives states some tips for how to support physicians, hospitals, and other providers participating in new Medicaid ACOs.
Value-Based Health Care Models:
Accountable Care Organizations (ACO) represent one of the most prominent new models to reduce health costs and increase quality. Many models are overlapping and complementary, and combine aspects of payment reform, care coordination, and health information technology. Interest in value-based models has surged the past few years, with both public and private sector health care purchasers eager to replace traditional fee-for-service (FFS) payment with value-based models where payment is driven by the clinical performance and efficiency of providers.
Medicare’s Shared Savings Program, for example, encourages hospitals, physicians and other providers to band together in ACOs to coordinate care and reduce costs. Members of the ACO have the opportunity to earn a substantial part of the cost savings, provided quality standards are also met. Large, innovative health plans are also adopting accountable care models within their provider networks. For example, Cigna has built an impressive, fast growing ACO-like initiative in collaboration with 66 physician practices and health systems in 26 states.
To learn more about payment reform and care delivery reforms in both the public and private sectors, see these previous posts:
Medicaid ACO Provider Capabilities:
ACOs are now poised to make the jump from Medicare to Medicaid. Several states are experimenting with Medicaid ACO models, including Maine, Massachusetts, Minnesota, New Jersey, Oregon, Texas, and Vermont. The Center for Health Care Strategies (CHCS) has been at the forefront of those efforts, supporting states with briefs and advice on best practices for Medicaid ACOs. Last year, CHCS published a brief on the core considerations for implementing Medicaid ACOs. See here for more on that issue brief.
The latest Medicaid ACO brief from CHCS gives states a few tips for supporting providers. Provider support and training is essential to successful ACOs because providers must develop a series of new capabilities and services, including:
Data and analysis on care use, cost, and quality measures – all of which are essential to measuring the value of health care.
Patient engagement and community outreach.
Leadership and management capacity to orchestrate the systematic changes that come with participating in an ACO.
State Supports for Medicaid ACO Providers:
The brief highlights several ways states can help physicians, hospitals, and long-term care providers – who form the backbone of provider networks – develop those capacities. Best practices are based on state experiences with patient-centered medical home (PCMH) models. Some state patient-centered medical home programs, such as Community Care of North Carolina (CCNC), predate the health reform law and have a rich experience from which to draw.
A quick overview of the provider supports CHCS recommends:
1) Tools and Resources
Resources include a variety of different materials to inform providers about issues related to Accountable Care Organizations. A state could use social media, print publications, websites, and email notices to help providers keep up to date on the details of quality measures, ACO governance rules, and legislation. Examples from early innovator states for Medicaid ACOs include Oregon’s Patient-Centered Primary Care Institute and New York’s Health Home Functional Assessment Tools.
Trainings and webinars give providers a chance to ask detailed technical questions and to gain experience in some of the more complex aspects of ACO participation. CHCS suggests quality improvement, data analytics, health IT infrastructure, and payment reform are good topics for training sessions.
3) Learning Collaboratives
Learning collaboratives would allow providers to learn from one another as they implement ACOs. States looking to establish learning collaboratives would need to put a good deal of thought into how to structure and manage them, and which providers to include. Maine’s PCMH Pilot Learning Collaborative and Rhode Island’s Beacon Community Program are two examples.
4) Direct Assistance
States can work directly with staff at physician practices, hospitals, and long-term care providers to help them with technical aspects of managing ACOs. Doing so requires a fair amount of effort on the part of both states and providers.
You can read the full Medicaid ACO provider brief here.