News Feature | June 30, 2014

Medicare ACO Lessons For Medicaid

Christine Kern

By Christine Kern, contributing writer

Medicare ACO

Aligning approaches to Accountable Care across Medicare and Medicaid.

The successful deployment of Medicaid accountable care organizations will be dependent upon looking to the Medicare ACO programs underway for guidance, yet still need to be flexible in creating the new delivery systems, according to staff analysts from the Center for Strategic Health Studies.

There is growing interest in leveraging Medicare’s Pioneer accountable care organization (ACO) model to serve Medicaid beneficiaries, with the goal of creating efficiencies by standardizing approaches to accountable care across patient populations and payers. To explore the possibility of extending the model to Medicaid, CMS and CMMI began soliciting input last December on how the Pioneer ACO model might be adapted to serve Medicaid beneficiaries, including those enrolled in both Medicaid and Medicare.

The Center for Health Care Strategies elicited input from the eight states participating in the Medicaid ACO Learning Collaborative, an initiative supported by The Commonwealth Fund. From the states’ perspective, many elements of the Pioneer ACO model may need to be adjusted to serve Medicaid beneficiaries. The Medicare Shared Savings Program (MSSP) model of accountable care, which was developed for a broader range of provider organizations, may prove a more viable option than the Pioneer ACO model given that many states have already incorporated elements of it into their Medicaid ACO programs. CMS should consider granting states flexibility around key parameters of either Medicare ACO program to account for the particular needs of Medicaid beneficiaries.

A recent Commonwealth Fund blog post, by CHCS’ Rob Houston and Tricia McGinnis explored key considerations for adapting Medicare’s Pioneer and Shared Savings Program ACO models to serve Medicaid beneficiaries. The authors presented four key policy considerations including potential adjustments necessary in order for ACOs to effectively serve the Medicaid population, including:

  • the health needs of Medicaid beneficiaries are different than those of Medicare beneficiaries
  • the Medicare models do not include managed care beneficiaries
  • many states have established Medicaid ACO programs
  • Medicaid ACOs may not be able to assume risk immediately

Ultimately, Houston and McGinnis write, "The Medicare Shared Service Program's model of accountable care, which was developed for a broader range of provider organizations, may prove a more viable option than the Pioneer ACO model given that many states have already incorporated elements of it into their Medicaid ACO programs. CMS should consider granting states flexibility around key parameters of either Medicare ACO program to account for the particular needs of Medicaid beneficiaries."