Accountable Care Organizations in Medicaid: An Overview

Transcription

1 Accountable Care Organizations in Medicaid: An Overview Friday, December 11, 2015 National Health Policy Forum Tricia McGinnis Vice President

2 About the Center for Health Care Strategies A non-profit policy center dedicated to improving the health of lowincome Americans

3 State Representation in CHCS Projects Effective 10/15

4 CHCS Medicaid Accountable Care Organization Initiatives Medicaid ACO Learning Collaborative, The Commonwealth Fund Participants: CO, IA, MA, NC, RI, WA Graduates: MN, ME, NJ, OR, and VT State Innovation Model (SIM), Center for Medicare and Medicaid Innovation (CMMI) ACOs and Super Utilizers, CMMI Health Care Innovation Award spreading Camden s model Issue Briefs and Tools: New Jersey Medicaid ACO Toolkit, The Nicholson Foundation ACO and Future Directions, Robert Wood Johnson Foundation, Forthcoming Leverage Medicaid ACOs to Promote Population Health, Milbank Memorial Fund 4

5 What are Accountable Care Organizations? Accountable Care Organizations (ACOs) are designed to hold providers accountable for improving health outcomes and controlling costs Key features: On the ground care coordination and management Payment incentives that promote value, not volume Provider/community collaboration and data sharing Robust quality measurement and accountability 5

6 Medicaid Accountable Care Organizations by State 6

7 Policy Context for Medicaid ACOs State pressure to achieve significant cost savings Provider participation in Medicare ACO models ACOs are viewed as the next step along the continuum of advanced care delivery models The CMMI State Innovation Model provides funding to explore and invest in the models No national Medicaid ACO standards Early results are promising: Savings in CO, MN, OR, and VT have generated interest and credibility 7

8 What are Key Attributes of ACO Models? Governance structure Provider-, payer-, or regional ACOs Value-based payment with provider risk Shared savings models Capitated or global payments Quality measurement Reporting and performance evaluation Ties to payment Scope of services Physical health services + Behavioral health? Dental? LTSS? Pharmacy? Social services? Data exchange and analysis Health IT and EHRs 8

9 Common Medicaid ACO Attributes Mix of governance models Payment Shared savings transitioning to shared risk Global payment Quality metrics Pay for reporting shifting to pay for performance Chronic care, behavioral health, efficiency/utilization Scope of services Physical health only Physical health and behavioral health Claims data sharing 9

10 Promoting Population Health in Medicaid ACOs GOVERNANCE STRUCTURE AND PAYMENT ACOs are geographically defined Partnerships with public health, social services and community agencies Value-based payment approaches DELIVERY SYSTEM ENHANCEMENTS Comprehensive preventive and social services Community health workers and nontraditional providers POPULATION HEALTH METRICS Metrics incorporate short-term processes and longer-term outcomes Initial metrics focus on welldefined categories: e.g., tobacco use, asthma, obesity DATA SHARING ACROSS SECTORS Data-sharing arrangements between Medicaid and other state agencies Electronic records as a reservoir for population health measures New processes for secure information sharing 10

11 Medicaid ACO Program Results to Date Colorado: $35-39 million in net savings over three years for 600,000 beneficiaries Minnesota: $76.1 million cost savings over two years for 200,000 beneficiaries Oregon: ED visits declined 17% in two years Decreased hospitalizations: 27% for CHF, 32% for COPD, and 18% for adult asthma Vermont: $14.6 million cost savings over one year for 65,000 beneficiaries 11

12 Future Issues Medicaid launch of ACO programs will continue Programs will expand and become more complex Integration of mental health, substance abuse, long-term care, and supportive services Increase in financial accountability and risk Accountability for health outcomes, population health, and community needs Inclusion of more diverse providers (e.g., safety net, rural providers, etc.) Alignment with other payers and new models 12

13 Visit CHCS.org to Download practical resources to improve the quality and cost-effectiveness of Medicaid services Subscribe to CHCS updates to learn about new programs and resources Learn about cutting-edge efforts to transform the way Medicaid delivers and pays for care 13