Accountable care organizations (ACOs) represent a fundamentally different way of paying for and delivering health care services, necessitating substantial change for providers and care teams. Providers in Medicaid ACOs must build new connections across health services and social supports, while at the same time assume unprecedented accountability for quality, utilization, and cost. To take on this new role, providers must significantly enhance information technology, workflow, communications, data analytics, quality improvement, and patient and community engagement.
States looking to implement accountable care organizations in Medicaid understand that payment reform alone is not sufficient to transform care delivery at the practice site level. Primary care providers, particularly those serving the health care safety net, require resources and guidance to meet the substantial quality and cost containment aspirations of the accountable care model. 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. Since Medicaid ACOs are a relatively new model, this brief builds largely on lessons learned from states providing supports related to patient-centered medical homes (PCMH), which are foundational to ACOs.
This brief is a product of Advancing Medicaid Accountable Care Organizations: A Learning Collaborative, a CHCS initiative made possible through support from The Commonwealth Fund, and additional funding from the Massachusetts Medicaid Policy Institute, a program of the Blue Cross Blue Shield of Massachusetts Foundation.