Policy experts across the country are considering accountable care organizations (ACOs) as a way to rethink the delivery of higher quality and more efficient care. Yet Medicaid, which cares for 60 million patients has been largely absent from the ACO conversation.
To create a Medicaid-focused ACO demonstration, the Centers for Medicare & Medicaid Services (CMS) and states could start by building on the framework developed for the Medicare Shared Savings Program. Structural and population differences between the two programs, however, necessitate many of the underlying provisions of the Medicare ACO rule be reconsidered. This issue brief outlines 10 key issues that CMS and states would need to address in developing a future Medicaid ACO Program.
By providing a stable structure for medical, behavioral health, and social service providers to collaborate, safety-net ACOs offer significant potential for improving care coordination and curbing spending, particularly for Medicaid's highest-risk, highest-cost patients.
An ACO is Born in Camden, But Can it Flourish in Medicaid?
This Health Affairs blog post, coauthored by Jeffrey Brenner, MD, executive director of the Camden Coalition of Healthcare Providers, and Nikki Highsmith, CHCS Senior Vice President, details the opportunities and critical considerations for developing safety net-based accountable care organizations. more >>
NOTE: On a related note, on June 29, the New Jersey legislature nearly unanimously agreed on a "Medicaid Accountable Care Organization Demonstration Project" authorizing the New Jersey Department of Health Services to use community-based ACOs to increase access to primary, behavioral health, and dental care for Medicaid beneficiaries (see Bill S2443). more >>