The need to foster integrated care delivery and address social determinants of health has led to the development of accountable care organizations (ACOs) in Medicaid. The common goal of Medicaid ACO initiatives is to coordinate a wide array of needed services to improve the quality of care and to curb costly and avoidable hospitalizations of Medicaid beneficiaries, particularly those with multiple chronic conditions and behavioral health needs. Given these extensive transformation efforts, states are leveraging existing investments in managed care and primary care to guide the development of their Medicaid ACO programs.
With support from The Commonwealth Fund, the Center for Health Care Strategies (CHCS) has been working with leading-edge states to accelerate ACO program implementation. The following matrix presents key features and requirements for ACO programs in seven of the states participating in the Medicaid ACO Learning Collaborative: Colorado, Maine, Massachusetts, Minnesota, New Jersey, Oregon, and Vermont.
The matrix outlines how each state has configured key ACO program features including: governance; provider eligibility; covered populations; scope of accountable services; required functions; payment models; and quality measures. The details from these seven ACO programs should inform additional states as they consider their own ACO approaches.