www.chcs.org

AHRQ CVE Learning Network Webinar January 13, 2014

1:00 PM-2:30 PM ET

Tricia McGinnisDirector of Delivery System Reform, CHCS

State-Level Perspectives: Medicaid ACOs

I. Overview of Emerging ACO Models in MedicaidII. Results to DateIII. Key Issues and Lessons LearnedIV. Key Takeaways for CVEsV. Q & A

Agenda

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A non-profit health policy resource center dedicated to improving services for Americans receiving publicly financed care

► 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.

► 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.

► Funding: philanthropy and the U.S. Department of Health and Human Services.

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ACO Overview• Key Medicaid ACO features include:

► 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► 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 approval4

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:

► 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

► 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► 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 ► 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 ACOsOregon Minnesota Screening for depression and follow-up plan Depression remission at six months Timeliness of prenatal care Pneumonia appropriate care measure Elective delivery Heart failure appropriate care measure Outpatient and ED utilization Optimal asthma care composite (kids) Colorectal screening Optimal asthma care composite (adults) PCMH enrollment Home management asthma care plan Developmental screening for 1st 36 months of

life Optimal vascular care composite Adolescent well-care visits Optimal diabetes composite Controlling high blood pressure CG-CAHPS Diabetes: HBa1c poor control HCAHPS 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  

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Key Issues and Lessons Learned (cont.)

3. Building Functional Capacity among ACO Providers► 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► Medicare shared savings methodology can be adapted for Medicaid

beneficiaries► Leveraging Medicare Shared Savings Program (MSSP) promotes multi-

payer alignment and lightens the lift of program development

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Roles and Opportunities for CVEs

• 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…

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Learn about cutting-edge efforts to transform the way Medicaid delivers and pays for care

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www.chcs.org