Headline
Findings from a literature review and state interviews share experiences and outcomes of implementing Medicaid accountable care organization (ACO) programs.
Background
ACOs for people enrolled in Medicaid are available in over a dozen states. However, limited information is available on the impacts of Medicaid ACOs on health care utilization, costs, and quality. This brief reviews findings from published ACO evaluations and interviews with leaders from eight states — with and without Medicaid ACOs — to summarize outcomes and implementation barriers.
Findings
The authors found mostly positive impacts of Medicaid ACOs following a review of 30 published studies. The most common findings showed enhancements in at least one process measure of quality (e.g., financial incentives for achieving patient outcomes) and decreased avoidable utilization (e.g., emergency department visits). Six studies showed cost savings and, of the four studies that examined racial/ethnic equity, three studies showed improvements in racial and ethnic disparities after Medicaid ACO adoption.
From the interviews, factors that helped states adopt Medicaid ACOs included leadership buy-in, experience with value-based payment and primary care, and a robust state data infrastructure. Additionally, factors that ensure ACO programs are successful include community engagement and larger shares of Medicare and commercial insurance populations also receiving care from an ACO. Common barriers to adoption included difficulty interpreting federal requirements, competing priorities, and pushback from stakeholders.
Policy/Program Takeaways
Medicaid ACOs have demonstrated positive outcomes when it comes to cost, utilization, and quality. States can reference the outcomes and considerations shared in this brief to adopt or adapt the ACO model for their Medicaid program.