Accountable care organizations (ACOs) have become increasingly prevalent in the United States. These organizations shift more accountability for health outcomes to providers and many have shown positive results for achieving the “Triple Aim” of better health, improved patient experience, and lowered costs for Medicare, Medicaid, and commercial populations.

This brief, made possible by The Commonwealth Fund, highlights the results of Medicaid ACO programs across the country to date, as well as key themes and lessons from these early adopters. It examines how Medicaid ACO programs have evolved over time by: (1) incorporating downside risk into payment models; (2) maximizing provider participation and program sustainability; (3) expanding services included in the model; and (4) focusing on greater alignment of quality measures. The brief informs state and federal policymakers, researchers, and foundations about key considerations to further the development of effective ACO approaches moving forward.

Key findings are that most early adopter states reported positive results with their Medicaid ACO programs, but designing and operationalizing statewide programs can be a significant undertaking.