Section III. Working with Providers, MCOs, and Consumers
ACOs are a new business model and the existing stakeholders in a given environment must be brought on board to help in the change from volume to value. States have the opportunity to create a Medicaid ACO program that complements managed care, and support providers in the transition to the new framework.
Working with Providers
Key Considerations for Supporting Medicaid ACO Providers (June 2013) – This brief outlines the types of technical assistance supports that state Medicaid agencies can potentially offer to help providers in transforming care delivery. It also provides key considerations for planning, implementing, and sustaining such technical assistance.
The New Jersey Medicaid ACO Business Planning Toolkit (June 2013) – This toolkit provides guidance and templates to facilitate ACO planning. It outlines the rationale for developing an ACO, summarizes regulations, walks through a readiness assessment, details steps for ACO development, and guides prospective ACOs in developing business and work plans. While the toolkit is focused on New Jersey, the guidance is generalizable to other states. A webinar is also available, where the authors of this toolkit discussed how it can be used in developing a Medicaid ACO model.
Working with MCOs
Delineating Responsibilities across Accountable Care Organizations and Managed Care Organizations (February 2016) – This technical assistance tool identifies five responsibilities that both ACOs and MCOs may share and outlines which entity may be better suited to perform each function. State Medicaid agencies, as well as ACOs and MCOs, can use the tool as a worksheet to help outline ACO/MCO roles and responsibilities.
The Balancing Act: Integrating Medicaid Accountable Care Organizations into a Managed Care Environment (November 2013) – This brief identifies many of the considerations facing states that are seeking to implement ACOs in a managed care context, including essential operational decisions, potential areas for alignment across payers and delineation of ACO and managed care organization responsibilities to avoid duplication of services.
Working with Consumers
Medicaid ACO Checklist for Advocates (May 2017) – Community Catalyst has published a guide for consumer organizations to evaluate Medicaid ACO programs. The checklist goes through key questions in the design, implementation, and oversight of Medicaid ACO programs, and focuses on the impact that a Medicaid ACO program can have on stakeholders in a health care marketplace.