Health systems and public sector officials who hope to successfully deploy Medicaid accountable care organizations will have to draw lessons from the Medicare ACO programs underway, yet be flexible in creating the new delivery systems, according to staff analysts from the Center for Strategic Health Studies.
In a Commonwealth Fund blog post, CHCS Rob Houston and Tricia McGinnis explore key considerations for adapting Medicares Pioneer and Shared Savings Program ACO models to serve Medicaid beneficiaries.
Drawing on input from the eight states participating in the Medicaid ACO Learning Collaborative, a project supported by The Commonwealth Fund, the authors present four key policy considerations including potential adjustments necessary in order for ACOs to effectively serve the Medicaid population.
Those considerations include:
* 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."
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