Transcript State Innovations: Changing the Way Care is Delivered and

State-Level Perspectives: Medicaid ACOs
AHRQ CVE Learning Network Webinar
January 13, 2014
1:00 PM-2:30 PM ET
Tricia McGinnis
Director of Delivery System Reform, CHCS
www.chcs.org
Agenda
I.
Overview of Emerging ACO Models in Medicaid
II.
Results to Date
III. Key Issues and Lessons Learned
IV. Key Takeaways for CVEs
V.
Q&A
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A non-profit health policy resource center dedicated
to improving services for Americans receiving publicly
financed care
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Priorities: (1) enhancing access to coverage and services; (2) advancing
quality and delivery system reform; (3) integrating care for people with
complex needs; and (4) building Medicaid leadership and capacity.
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Provides: technical assistance for stakeholders of publicly financed care,
including states, health plans, providers, and consumer groups; and
informs federal and state policymakers regarding payment and delivery
system improvement.
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Funding: philanthropy and the U.S. Department of Health and Human
Services.
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ACO Overview
• Key Medicaid ACO features include:
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On-the-ground care coordination and management
Payment incentives that promote value, not volume
Provider/community collaboration
Robust quality measurement and accountability
Data sharing and integration
Multi-payer opportunities
• Regulatory environment
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States implementing via fee-for-service must get approval
from the Center for Medicaid and CHIP Services
ACOs implemented via managed care organizations do not
need federal approval
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Medicaid ACO Organization Structures Vary
Provider-Driven
ACOs
• Providers establish
collaborative
networks
• Provider network
assumes some level
of financial risk
• Providers oversee
patient stratification
and care
management
• State or MCO pays
claims
• STATES:
Massachusetts,
Minnesota, Vermont
MCO-Driven ACOs
• MCOs assume
greater role
supporting patient
care management
• MCOs retain financial
risk but implement
new payment models
• Providers partner with
the MCO to improve
patient outcomes
• STATES: Oregon, Utah
Regional/Community
Partnership ACOs
• Community orgs
partner to develop
care teams and
manage patients
• Regional/community
org receives payment,
shares in savings
• Providers partner with
regional/community
orgs and form part of
the care team
• MCOs/states retain
financial risk
• STATES: Colorado,
Maine, New Jersey
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Medicaid ACO Activity
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Medicaid ACO Results to Date
• To date, only Colorado’s Accountable Care
Collaborative has published results:
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352,000 Medicaid clients are enrolled
$44 million in cost savings in fiscal year 2012-2013
 State retained $6 million in net savings
 $9 million saved in FY 2011-2012
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Quality results:
 Hospital readmissions declined 15%
 High-cost imaging declined 25%
 No meaningful change in emergency room visits
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Key Issues and Lessons Learned
1. Fostering Widespread Data Sharing and Analytics
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Robust data and analytics are critical to identifying savings
opportunities and targeting care coordination efforts
States are building provider portals fed by all-payer claims databases,
HIE, and Medicaid claims
2. Selecting Appropriate Quality Measures and Value-Based
Purchasing Techniques
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Focus on targeted ACO goals and outcomes
Reflect issues that are unique to complex populations
Link payment methods to quality reporting and
performance/improvement
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Key Issues and Lessons Learned: Examples of
Quality Metrics for Medicaid ACOs
Oregon
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Screening for depression and follow-up plan
Timeliness of prenatal care
Elective delivery
Outpatient and ED utilization
Colorectal screening
PCMH enrollment
Developmental screening for 1st 36 months of
life
Adolescent well-care visits
Controlling high blood pressure
Diabetes: HBa1c poor control
Alcohol or other substance abuse (SBIRT)
Follow-up after hospitalization for mental
illness
CAHPS access to care composite (adults &
kids)
CAHPS satisfaction with care composite
(adults & kids)
EHR adoption
Mental and physical health assessment within
60 days for children in DHS
Minnesota
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Depression remission at six months
Pneumonia appropriate care measure
Heart failure appropriate care measure
Optimal asthma care composite (kids)
Optimal asthma care composite (adults)
Home management asthma care plan
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Optimal vascular care composite
Optimal diabetes composite
CG-CAHPS
HCAHPS
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Key Issues and Lessons Learned (cont.)
3. Building Functional Capacity among ACO Providers
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Many provider systems are not organized well enough to be ACOs
States are investing in training, technical assistance, and learning
collaboratives
4. Aligning with Medicare
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Medicare shared savings methodology can be adapted for Medicaid
beneficiaries
Leveraging Medicare Shared Savings Program (MSSP) promotes multipayer alignment and lightens the lift of program development
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Roles and Opportunities for CVEs
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Neutral third-party data aggregation
Quality measurement/validation
Provider report cards
Provider training, technical assistance, or learning
collaboratives
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Visit CHCS.org to…
 Download practical resources to improve the quality and
cost-effectiveness of Medicaid services
 Subscribe to CHCS e-mail updates to learn about new
programs and resources
 Learn about cutting-edge efforts to transform the way
Medicaid delivers and pays for care
www.chcs.org
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