Section V. Payment Structure
An ACO’s payment structure ties provider compensation to health outcomes — unlike the traditional fee-for-service model, which pays providers based on volume of services delivered. This section includes resources on how to use payment strategies to encourage provider accountability.
Shared Savings for Medicaid Accountable Care Organizations: Design Considerations (July 2017) – This technical assistance tool draws from the experiences of states that have successfully implemented shared savings arrangements in their Medicaid ACO programs.
Medicaid Accountable Care Organization Shared Savings Programs: Options for Maximizing Provider Participation and Program Sustainability (July 2017) – This technical assistance brief explores strategies for adjusting shared savings payment methodologies that could help states address concerns about program sustainability.
Lessons from the Camden Coalition of Healthcare Providers’ First Medicaid Shared Savings Performance Evaluation (November 2017) – This article summarizes results and lessons learned from the first year performance evaluation of Camden Coalition of Healthcare Providers’ ACO program, one of three Medicaid ACOs currently operating in New Jersey.
Adapting the Medicare Shared Savings Program (MSSP) to Medicaid ACOs (March 2013) – This technical assistance brief explores how Minnesota and New Jersey have modified the MSSP approach to better incentivize providers to treat medically and socially complex, high-cost patients, align with existing programs, and integrate ACOs into managed care programs.
Using Medicaid Resources to Pay for Health-Related Supportive Services: Early Lessons (December 2015) – This brief provides practical state case studies to help inform supportive service payment strategies within ACOs, health homes, community health teams, accountable communities for health, and other value-based delivery system reforms.