State policymakers increasingly recognize that improving health outcomes is as much about addressing the social determinants of poor health as it is about providing high-quality medical care. A number of states are testing payment models that reward good outcomes over greater volume and allow providers to invest in nonmedical interventions that improve health. Medicaid accountable care organizations (ACOs), or other ACO-like models, offer a prime opportunity to meld population health and payment and delivery system reforms.

This brief, made possible through the Milbank Memorial Fund’s Reforming States Group, explores state strategies for promoting population health through Medicaid ACOs. It provides background information on population health approaches and Med­icaid delivery system reforms and describes various state strategies to inform ACO design and governance structures, program components, metrics, and information-sharing mechanisms. It also includes some promising early examples from three states — Minnesota, Oregon, and Vermont — working to embed population health strategies in Medicaid ACO program requirements.