A Review of Practices in Six States
Kris Wiitala Program Associate, Margaret Ann Metzger Consultant, Ann Hwang MD Director
A number of states are implementing models for accountable care organizations (ACOs) within their Medicaid programs.1 These models of care delivery are intended to improve the quality of care and health outcomes and contain health care costs. The experience of those states implementing Medicaid ACOs can provide useful insights to other states as they design their programs.
ACOs take on responsibility for providing care to a defined population of patients and are accountable for both the cost and quality of that care. The ACO model offers potential benefits for Medicaid enrollees, but risks as well. On the one hand, the ACO model, in theory, incentivizes better coordination of care and can allow for more flexibility in the types of services provided to members. In the best case scenario, an ACO would provide care that is coordinated and centered on the needs and preferences of the member. However, because ACOs face financial incentives to reduce the total cost of care, there is also potential that ACOs would focus on cost reduction at the expense of providing the level and quality of care that members need.
As states roll out Medicaid ACOs, it is critically important that the members served by these programs have a voice in their design, implementation and ongoing oversight. A strong consumer voice can help ensure that Medicaid ACOs achieve their goal of coordinated, person-centered care.
The Center for Consumer Engagement in Health Innovation at Community Catalyst reviewed the consumer engagement structures of Medicaid ACOs in six states – Colorado, Maine, Minnesota, New Jersey, Oregon and Vermont. This paper summarizes the findings from interviews with consumer advocates in each of the six states and a review of relevant documents and state websites. Our research focused on consumer participation, both at the state policymaking level related to the design, implementation and oversight of each state’s ACO program, and at the ACO level.
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