This document discusses community-based accountable care organizations (ACOs) for Medicaid patients. It outlines that ACOs coordinate care across providers to improve quality and reduce costs. For Medicaid ACOs specifically, it is important to address social determinants of health through partnerships with community organizations. The document then discusses key components of Medicaid ACOs including payment models, quality measurement, and data analysis strategies. It provides examples from Colorado and Minnesota that have achieved cost savings and quality improvements. Finally, it argues that integrated care coordination platforms can help ACOs collect and share patient data to direct resources and invest in programs.

1. Establishing
aCommunity-
based
Framework
forACOs

2. What is an ACO?
Source: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ACO/index.html?redirect=/aco/
Accountable Care Organizations are groups of
doctors, hospitals, and other health care
providers, who come together voluntarily to
give coordinated, high quality care to their
patients.
Post-acute Alignment
Hospital
Specialists
Disease Management
Programs
Population
Health Analytics
Payer Partners
Primary Care
Physician
Patient Activation

3. What is an ACO?
Accountable Care Organizations provide the
environment ideally suited to coordinate care
across multiple providers who each share
responsibility for patient health.
Whole Person Care
Coordination
Primary Care
Behavioral HealthCommunity-Based
Organizations

4. What is an ACO?
The ACO organizational structure typically incorporates three characteristics
that define the ACO model:
2process-level mechanisms to
help achieve desired
outcomes
a structural realignment
to enable process-level
change
31organizational goals to
reduce costs and improve
health care quality

5. History of ACO Movement
The term “Accountable Care
Organization” was coined by
Dr. Elliott Fisher during a
2006 public meeting with the
Medicare Payment Advisory
Committee (MedPAC).

6. What is an ACO?
In order to improve quality and reduce costs, accountability for a patient’s
care should be shared among all providers along the health care continuum
HospitalsHospitals Workforce
Services
Clinics Intellectual
and Developmental
Disabilities
Chronic Disease
Management
Housing
Services
Behavioral
Health
Youth and
Family Services

7. Growth of ACOs
Source: Muhlestein, McClellan. Accountable Care Organizations In 2016: Private And Public-Sector Growth And Dispersion.
Health Affairs Blog. 2016, Apr 21
ACOs
2012 2016
838
157
Lives Covered
2012 2016
7MILLION
28MILLION

8. Community-based
Medicaid ACOs

9. Community-based
Medicaid ACOs
Community-based Medicaid ACOs combine
primary and behavioral healthcare with
community-based providers who address the
social determinants of health for vulnerable
populations
Whole Person Care
Coordination
Behavioral HealthCommunity-Based
Organizations

10. The social determinants of health (SDH) are the conditions in which people
are born, grow, work, live, and age, and the wider set of forces and systems
shaping the conditions of daily life.
Source: World Health Organization
Social Determinants of Health

11. Social
Determinants
of Health and
Accountable Care
Understanding the social determinants of health
are crucial to healthcare delivery that seeks to
both improve outcomes and reduce cost.
Housing/
Homeless
Service
Safety Youth and
Family Services
Disaster
Recovery
Intellectual and
Development
Disabilities
Behavioral
Health
Long-term Support
and Services
Chronic Disease
Management

12. Three key components
of a community-based ACO
Payment
Model
Quality
Measurement
Data Analysis
Strategies

13. Payment
Model
MEDICAID ACO PROVIDERS
• Share financial risk through a shared savings
plan
• Are compensated with financial reward for
achievements based on quality measurement
and improvement

14. Quality
Measurement
ACOs must carefully define a set of quality
metrics that reflect the unique needs of their
Medicaid population
Reduced
ED UTILIZATION
Decreased
HOSPITAL READMISSIONS
Improved
MANAGEMENT OF
CHRONIC DISEASES
COMMON QUALITY INDICATORS
MEDICAID ACOs MONITOR IN THEIR
PATIENT POPULATIONS

15. Quality
Measurement
• States use a variety of quality metrics to
access ACO outcomes, including:
– Statewide averages of other healthcare
providers' performance
– Performance of other ACOs
– Performance of other programs, such as
the Medicare Shared Savings Program
• Provider payments are tied to these quality
metrics
• Providers typically will not receive a portion
of shared savings if they exceed or do not
meet quality benchmarks

16. Data Analysis
Strategies
• Medicaid ACO’s require substantial data to
track patient utilization data and costs
• Timely and accurate collection and analysis
are essential to operation
• Data can also be mined to identify
opportunities to improve care management
efforts

17. State Medicaid
ACOs

18. • Individual states develop
state-specific ACO models
based on each state’s
healthcare landscape
• As of September 2016, ten
states have launched
Medicaid ACO programs

19. According to the Center for Healthcare
Strategies, “States have been actively
pursuing innovative care delivery and
payment models in order to improve
the capacity of the health system to
deliver high-value care and increase
provider accountability, particularly for
high- need populations facing multiple
health challenges.”

20. Although state and regional Medicaid
ACOs are a relatively new development,
they have already demonstrated some
impressive results

21. COLORADO’S REGIONAL CARE COLLABORATIVE ORGANIZATIONS REPORTED
$
139MILLION
net savings for
Colorado Medicaid
since FY 2011-12
$
205MILLION
avoided
medical costs
in FY 2015-16
RCCOs have demonstrated lower rates of:
emergency
department
(ED) visits
high-cost
imaging
hospital
readmissions for
adult patients
for adult patients who have been enrolled in
the program for more than six months

22. MINNESOTA’S INTEGRATED HEALTH PROVIDER PROGRAM
$
76.3MILLION
Within it’s first
two years
achieved
shared
savings
exceeded
quality
targets
reduced
inpatient and
ED utilization
among patients served during the
program’s second year
Integrated Health Providers have

23. The Role of Care Coordination
Software in ACOs

24. Community-based
ACO Framework
In order to collect, analyze, and use patient
information for optimal impact, information
from the following systems must be readily
available within the accountable care
organization:
ACO
Provider Electronic
Health Record (EHR)
Behavioral
health systems
Population
health analytics
Health Information
Exchanges (HIE)
Care coordination
systems

25. • Connects multiple providers and systems of
care across a common platform
• Unites medical health behavioral health, and
community-based providers
Integrated Care
Coordination
Platform
Medical
Providers
Mental Health
Providers
Intellectual and Developmental
Disabilities Providers
Homeless Service
Providers
Care Coordination
& Reporting

26. Integrated Care
Coordination
Platform

27. Integrated Care
Coordination
Platform
Data can help the
ACO determine:
Where to direct
its outreach
efforts
Where to add
resources
Where to invest in
new programs,
departments,
facilities, equipment,
or staff
Where to
cut costs

28. Integrated Care Coordination Platform
Cloud-based care
coordination
platforms exist
on the market
today that are:
Configurable,
whole-person care
coordination
Mobile ready
Care team
management
Secure,
compliant,
SaaS
Quality measures
and reporting
Prioritization and
risk stratification
Effective data
exchange
Patient and
stakeholder
engagement

29. Conclusion
Post-acute Alignment
Hospital
Specialists
Disease Management
Programs
Population
Health Analytics
Payer Partners
Primary Care
Physician
Patient Activation
With the rapid growth
of state Medicaid,
Medicare, and
commercial ACOs,
now is the time to
establish best
practices for
addressing the full
spectrum of patient
needs within an
accountable care
setting

30. Conclusion
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