Researchers and policymakers increasingly recognize the impact of factors beyond physical health on health outcomes — including housing, social supports, and behavioral health needs. Some ACO programs are beginning to expand the types of services included in the calculated costs of patient care, making providers more broadly accountable for their patients’ health. The resources in this section provide information on how states are including additional services in Medicaid ACO 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.

Integrating MassHealth Long-Term Services and Supports: Considerations for ACOs and MCOs (November 2017) – This brief, from Blue Cross Blue Shield of Massachusetts Foundation, prioritizes issues for consideration as ACOs and MCOs prepare to integrate and fully manage comprehensive long-term services and supports over the course of Massachusetts’ five year 1115 waiver extension.

State Approaches for Integrating Behavioral Health into Medicaid ACOs (September 2015) – This technical assistance tool examines four broad strategies states can use to integrate behavioral health services into ACO payment models, reporting metrics, provider networks, and support services.

Exploring the Feasibility of Including Medicare-Medicaid Enrollees in Medicaid ACOs (April 2015) – This brief describes the challenges of incorporating Medicare-Medicaid enrollees in Medicaid ACO programs, reviews state considerations of these barriers, and presents emerging thinking on the potential of using this model for achieving better care for Medicare-Medicaid enrollees at lower costs.

Population Health in Medicaid Delivery System Reforms (March 2015) – This brief explores state strategies for promoting population health through Medicaid ACOs, providing background information on population health approaches and Med­icaid delivery system reforms and describes various state strategies to inform ACO design and governance structures, program components, metrics, and information-sharing mechanisms.

Supporting Social Service Delivery through Medicaid ACOs: Early State Efforts (February 2015) – This brief highlights the initial efforts of seven states that have sought to incorporate social services into their existing or emerging Medicaid ACO models. The brief outlines key themes and considerations to help additional states build collaboration between ACO and social service providers.

Considerations for Integrating Behavioral Health Services within Medicaid ACOs (July 2014) – This brief outlines considerations to guide state Medicaid agencies in successfully integrating behavioral health services within ACOs — addressing decisions around financial strategies, data sharing, and quality measurement. It also identifies policy levers for promoting alignment with existing behavioral health initiatives.

Introducing Totally Accountable Care Organizations (TACOs) (January 2014) – This fact sheet introduces CHCS’ vision of a health care system where all physical health, behavioral health, long-term services and supports, social services, and elements of public health are integrated for targeted high-need population.