Start: August 2012

End: June 2018

Funder: The Commonwealth Fund


Medicaid accountable care organizations (ACOs) are becoming increasingly prevalent in state Medicaid delivery systems. ACOs are seen by states as an effective way to improve patient outcomes and control costs by shifting accountability for risk and quality to providers.

Beginning in 2012, the Center for Health Care Strategies’ (CHCS) Medicaid ACO Learning Collaborative (ACO LC) assisted states in developing and launching their Medicaid ACO programs through interactions with federal and state policymakers and subject matter experts, technical assistance, and discussion of common successes and challenges with developing these initiatives.

  • Phase I of the ACO LC included the pioneering states of Massachusetts, Maine, Minnesota, New Jersey, Oregon, Texas, and Vermont. The collaborative focused on laying the initial groundwork for a Medicaid ACO program, concentrating particularly on issues pertaining to payment methodology, data systems and analysis, and quality measurement.
  • Phase II brought together Colorado, Massachusetts, Maine, Minnesota, New York, Oregon, Vermont, and Washington to enhance their Medicaid ACO program designs by including services and populations beyond physical health services for their Medicaid population. Participating states explored ways to integrate behavioral health, long-term supports and services, and social services into their programs, as well as engaging safety net and rural providers in ACO activities. Phase II also explored the participation of Medicare-Medicaid enrollees in Medicaid ACO programs.
  • Phase III included Colorado, Iowa, Massachusetts, North Carolina, Rhode Island, and Washington. This phase aimed to help participating states develop and launch Medicaid ACO programs, focusing on key design elements and lessons from existing Medicaid ACO programs.  These lessons were shared broadly through the development of resources chronicling Medicaid ACO activity.
  • Phase IV assisted Medicaid agencies from the District of Columbia, Louisiana, Massachusetts, Maryland, North Carolina, Rhode Island, Virginia, and Washington in developing payment models, quality measurement strategies, and data and analytic capacity to put their Medicaid ACO programs into place. CHCS also worked with these states to help determine how these models can work in conjunction with a Medicaid managed care environment.

States looking to pursue their own Medicaid ACO models can access resources generated from the collaborative through the Medicaid ACO Resource Center.