Integration on the Frontlines of Medicaid Accountable Care Organizations and Associations with Perceived Care Quality, Health Equity, and Satisfaction

Michaela Kerrissey
Shirya Jamakandi
Matthew Alcusky
Jay Himmelstein
Meridith Rosenthal
Peer-Reviewed Article
May 2023


Integrated care in MassHealth ACOs varies greatly across primary care practice type and is associated with greater ability to improve care quality and advance health equity. 


Medicaid accountable care organizations (ACO) often encourage interdisciplinary and integrated care. For example, MassHealth (Massachusetts’ Medicaid program) ACOs are required to directly contract with community-based providers to coordinate behavioral health and long-term services and supports (LTSS), with additional incentives to offer other forms of coordinated care.  This study investigated the extent of five measures of care integration — clinical processes, diabetes care, mental/behavioral health services, social services, and LTSS — across primary care practices within MassHealth ACOs, assessing whether care integration is associated with specific practice characteristics, care quality, and health equity. 


By analyzing survey data from over 200 practice sites, selected from a random sample drawn from all 17 Massachusetts Medicaid ACOs (as of August 2018), the authors found notable variations in levels of care integration. Community health centers exhibited lower levels of integration in diabetes care, mental/behavioral health services, and LTSS when compared to group practices. Additionally, physician-owned practices reported higher levels of integration for diabetes care and LTSS than health system and hospital-owned practices.  Across all sites, clinical processes and LTSS integration was associated with a greater perceived ability to enhance quality of care. Similarly, social service integration was positively associated with perceived ability to advance health equity.


The study contains actionable insights for policymakers, such as how some practices may benefit from targeted support in mental/behavioral health service integration, for which there was substantial standard deviation among the sample. Additionally, many practices may benefit from interventions to enhance social service integration, which scored the lowest out of the five integration measures.

Overall, the findings emphasize the importance of tailored resources and support based on the specific characteristics of each practice. They also suggest that increased inclusion of community health centers could be a promising strategy to promote care integration in Medicaid ACOs.

Finally, the perspectives of surveyed administrators on the benefits of care integration for improving care quality and health equity adds to a growing body of research emphasizing the importance of care integration in advancing these policy goals.  

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