Emerging Medicaid Accountable Care Organizations The Role of Managed Care (original) (raw)
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Structuring Medicaid Accountable Care Organizations to Avoid Antitrust Challenges
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Faced with increasingly inefficient, costly, poor quality, fragmented medical care for their citizens, several states are adopting accountable care organization (“ACO”) models of care delivery to improve access to quality health care while trying to bend the cost curve. ACOs are not one-size fits all delivery systems, however, and states are testing different models to see what works best for their needs. Some States are focusing their efforts on developing Medicaid ACOs, which may “offer a useful framework through which payers, providers, and communities can radically restructure care delivery to improve care for low-income patients and reduce system costs.” New Jersey is on the forefront of State efforts to develop safety net ACOs to provide essential health care to their most vulnerable populations. On August 18, 2011, New Jersey enacted the Medicaid Accountable Care Organization Demonstration Project. Although this pilot project shares some features with other ACOs developed at ...
The Policy and Practice Legacy of the New Jersey Medicaid ACO Demonstration Project
Journal of Ambulatory Care Management, 2020
The New Jersey Medicaid Accountable Care Organization (ACO) Demonstration was created with a unique combination of features regarding ACO geography, involvement of managed care organizations (MCOs), and shared savings parameters. Ultimately, the Demonstration did not lead to a sustainable accountable care financing model and shared savings were deemphasized. Instead, the ACOs evolved into community health coalitions focused on coordinating and enhancing a wide range of activities in partnership with state government, private health systems, community leaders, and MCOs. Currently, the state is developing policy parameters to reposition the ACOs as regional partners to implement state-directed population health initiatives.
Accountable care organizations in the USA: types, developments and challenges
Health policy (Amsterdam, Netherlands), 2014
A historically fragmented U.S. health care system, where care has been delivered by multiple providers with little or no coordination, has led to increasing issues with access, cost, and quality. The Affordable Care Act included provisions to use Medicare, the U.S. near universal public coverage program for older adults, to broadly implement Accountable Care Organization (ACO) models with a triple aim of improving the experience of care, the health of populations, and reducing per capita costs. Private payers in the U.S. are also embracing ACO models. Various European countries are experimenting with similar reforms, particularly those in which coordinated (or integrated) care from a network of providers is reimbursed with bundled payments and/or shared savings. The challenges for these reforms remain formidable and include: (1) overcoming incentives for ACOs to engage in rationing and denial of care and taking on too much financial risk, (2) collecting meaningful data that capture ...
Early Performance in Medicaid Accountable Care Organizations: A Comparison of Oregon and Colorado
JAMA internal medicine, 2017
Several state Medicaid reforms are under way, but the relative performance of different approaches is unclear. To compare the performance of Oregon's and Colorado's Medicaid Accountable Care Organization (ACO) models. Oregon initiated its Medicaid transformation in 2012, supported by a $1.9 billion investment from the federal government, moving most Medicaid enrollees into 16 Coordinated Care Organizations, which managed care within a global budget. Colorado initiated its Medicaid Accountable Care Collaborative in 2011, creating 7 Regional Care Collaborative Organizations that received funding to coordinate care with providers and connect Medicaid enrollees with community services. Data spanning July 1, 2010, through December 31, 2014 (18 months before intervention and 24 months after intervention, treating 2012 as a transition year) were analyzed for 452 371 Oregon and 330 511 Colorado Medicaid enrollees, assessing changes in outcomes using difference-in-differences analyse...
Background. The Accountable Care Organization (ACO) model is rapidly being implemented by Medicare, private payers, and states, but little is known about the scope of ACO implementation. Objective. To determine the number of accountable care organizations in the United States, where they are located, and characteristics associated with ACO formation. Study Design, Methods, and Data. Cross-sectional study of all ACOs in the United States as of August 2012. We identified ACOs from multiple sources; documented service locations (practices, clinics, hospitals); and linked service locations to local areas, defined as Dartmouth Atlas hospital service areas. We used multivariate analysis to assess what characteristics were associated with local ACO presence. We examined demographic characteristics (2010 American Community Survey) and health care system characteristics (2010 Medicare fee-for-service claims data). Principal Findings. We identified 227 ACOs located in 27 percent of local areas. Fifty-five percent of the US population resides in these areas. HSA-level characteristics associated with ACO presence include higher performance on quality, higher Medi-care per capita spending, fewer primary care physician groups, greater managed care penetration, lower poverty rates, and urban location. Conclusions. Much of the US population resides in areas where ACOs have been established. ACO formation has taken place where it may be easier to meet quality and cost targets. Wider adoption of the ACO model may require tailoring to local context. Key Words. Accountable care organizations, Medicare, health care reform, incentives in health care, health policy, delivery of health care, health care costs
New Jersey's Medicaid ACO Pilot Program, Past and Future: A Baseline Report
Political Economy: National, 2013
New Jersey’s Medicaid Accountable Care Organization Demonstration Project became law in 2011, representing a broad consensus that accountable care organizations (“ACOs”) could improve the delivery of care in the Medicaid system. ACOs offer the promise of providing “the right care, at the right time, in the right place.” The ACO law reflected a commitment to improve the care experience for Medicaid recipients, strengthen public health outcomes, and responsibly control the cost of care.This Report is the first of two that will examine the past and future of New Jersey’s Medicaid ACO Pilot. This Report sets out the background and current status of the Pilot. The second Report, to be released in April 2014, will reflect further discussions with stakeholders and further research and analysis on the sustainability of New Jersey’s Medicaid ACOs.