Planning for Accountability: Emerging Medicaid ACO Models and Key Issues for States

With accountable care organizations (ACOs) being implemented in many state Medicaid programs, additional states are interested in the potential of ACOs to improve health care quality and reduce costs. States must consider many issues in designing ACO approaches, including payment reform structure, quality measurement, reporting requirements, target populations, integration of services, and the policy and regulatory levers that can facilitate program implementation.

This webinar explored emerging Medicaid ACO models, including state trends, best practices, and lessons from the experiences of leading-edge states. Speakers from the Minnesota Health Care Delivery System demonstration and the Massachusetts Primary Care Payment Reform initiative outlined ACO program components and key decision points in their states.

Agenda

I. Introduction and National Overview of Medicaid ACO Activity

Speakers: Tricia McGinnis, Director of Delivery System Reform, CHCS; Pam Riley, MD, Assistant Vice President, Delivery System Reform, The Commonwealth Fund

T. McGinnis welcomed participants and invited P. Riley of The Commonwealth Fund to discuss the promise of Medicaid ACO programs to improve quality of care and lower costs. Ms. McGinnis summarized how states are approaching the development of Medicaid ACO models, including the types of models available and policy and regulatory levers to assist in program implementation.

II. Medicaid ACO Case Studies: The Minnesota HCDS Model and Massachusetts PCPR Initiative

Speakers: Marie Zimmerman, Health Care Policy Director, Minnesota Department of Human Services; Neha Sahni, Program Development Manager, MassHealth

M. Zimmerman described Minnesota’s Health Care Delivery Systems (HCDS) demonstration, focusing on the program’s mandate for managed care organization participation and its payment methodology. N. Sahni provided an overview of Massachusetts’ Primary Care Payment Reform (PCPR) initiative, including considerations related to program design and its ongoing RFP process.