Medicaid Performance & Reimbursement Models For ACOs
An OPEN MINDS Market Intelligence Report
Currently, there are nine state Medicaid programs with Accountable Care Organization (ACO) models, including: Colorado, Iowa, Illinois, Maine, Minnesota, New Jersey, Oregon, Utah, and Vermont. Each ACO model is quite different, as each state’s Medicaid program determines the financing, performance requirements, and structure for their individual ACO programs. Among the nine different programs, the reimbursement model for ACOs generally falls into two different strategies: the traditional shared savings model and the risk-based model. But the differences in ACOs don’t end there. There are a number of different variables that make each Medicaid ACO initiative unique.
The traditional shared savings model builds off the Medicare Shared Savings Program, which state Medicaid programs modify to meet their population-specific needs. For example, a state may change the number of minimum attributed beneficiaries, the percent of shared savings, or the included quality metrics.
The risk-based ACO model is a managed care-ACO hybrid model. Under this model, the ACOs generally act as the payer for health care services and receive a capitated rate to do so. The ACOs are distinct from traditional managed care organizations because the ACOs are often comprised of provider or health plan/provider partnerships, and there is an increased focus on meeting quality metrics.
Additionally, nine states are in the process of exploring or implementing an ACO model: Alabama, California, Connecticut, Massachusetts, Michigan, New York, North Carolina, Rhode Island, and Washington. Many of these states are still in the preliminary planning stages, so details about their models are not well known.
This report defines the differences in Medicaid performance and reimbursement models for ACOs and gives a detailed explanation of the nine states that have implemented an ACO model. The sections of the report are as follows:
Different Medicaid ACO Models
The Key Features Of The Medicaid ACO Models
The Colorado ACO Model
The Illinois ACO Model
The Iowa ACO Model
The Maine ACO Model
The Minnesota ACO Model
The New Jersey ACO Model
The Oregon ACO Model
The Utah ACO Model
The Vermont ACO Model