You are on page 1of 14

BRIEF | OCTOBER 2015

Medicaid Accountable Care Organization


Programs: State Profiles
ByJimLloyd,RobHouston,andTriciaMcGinnis,CenterforHealthCareStrategies

INBRIEF

Statesareimplementingaccountablecareorganizations(ACOs)toimprovehealthcarequalityandbetter
managecostsforMedicaidpopulations.CorecomponentsthatdefineMedicaidACOsare:thepayment
model;qualitymeasurementapproach;andthedatastrategy.Thisbriefprovidesanoverviewofthesecore
ACOelementsandprofileshowninestatesColorado,Illinois,Iowa,Maine,Minnesota,NewJersey,
Oregon,Utah,andVermonthavestructuredtheirMedicaidACOs.Foreachstate,itoutlineskeyACO
characteristics;detailsuniquepayment,quality,anddataapproaches;andspotlightsoneofthestates
MedicaidACOs.ThissetofprofilescanhelpinformMedicaidACOdevelopmentinotherstates.

tatesareincreasinglyturningtoMedicaidaccountablecareorganizations(ACOs)toimprove
patientoutcomesandcontrolcostsbyshiftingaccountabilityforriskandqualityto
providers.Todate,ninestateshavelaunchedACOprogramsforallorpartoftheirMedicaid
population,and10moreareactivelypursuingthem.TheseMedicaidACOs,whichcurrentlyserve
overtwomillionMedicaidbeneficiaries,aredesignedtoachievetheTripleAim:(1)enhancing
thepatientexperienceofcare;(2)improvingthehealthofthepopulation;and(3)reducingthe
percapitacostofhealthcare.
ACOsareaninnovativehealthcaredeliverymodeldesignedtoholdprovidersfinancially
accountableforthehealthofthepatientsandpopulationstheyserve,ratherthanbasing
compensationsolelyontheamountofservicestheyprovide.IndesigningMedicaidACOs,core
componentsforstateconsiderationinclude:paymentmodel;qualitymeasurementapproach;
anddatastrategy.Valuebasedpaymentmodels,typicallytiedtoqualitymetrics,areestablished
toensurethatprovidersareaccountableforhighqualitypatientcare.Effectivemonitoringof
ACOactivityrequirestimelydataexchangeatbothapatientandsystemlevel.Assuch,ACOs
musthavethedataanalyticcapacitytoidentifyopportunitiestoimproveperformance.
BelowisabriefdescriptionofthesethreekeyACOcomponentsfollowedbyprofilesofninestate
MedicaidACOprograms,includingpaymentmodels,qualitymeasurementapproaches,anddata
analysisstrategiesforeach.1Theinformationdrawsprimarilyfromthemanystatesthathave
participatedinthenationalMedicaidACOLearningCollaborative,directedbytheCenterfor
HealthCareStrategiesandsupportedbyTheCommonwealthFund.

MadepossiblethroughsupportfromTheCommonwealthFund.


BRIEF | OCTOBER 2015

Payment Model
Inafeeforservicesystem,healthcareprovidershavefinancialincentivestodelivermorecare
thanmaybenecessary.Stateshaveseveraloptionstoshiftthosefinancialincentivestoreward
valueratherthanvolume.SomeACOprogramshaveinitiallybegunwithpayforperformance
systemswhereinprovidersreceivebonuspaymentsbasedonquality.Otherstateshave
establishedsharedsavingsandriskmodels,wherebyparticipatingACOproviderscansharein
savingsiftheirattributedpopulationusesalesscostlysetofhealthcareresourcesthanan
agreeduponbaseline(theupside).Insomecases,providersalsosharetheriskassociatedwith
morecostlyservices(thedownside),wherebytheywouldhavetopaythestatebackifcosts
exceedthebaseline.Somestateshavealsochosentoimplementaglobalbudgetorcapitated
model,similartomanagedcareorganizations,whereACOsreceiveapermemberpermonth
(PMPM)paymentupfronttoprovideservicesandacceptfullfinancialriskforattributedpatients.
Insomecases,theglobalbudgetpaymentgivestheACOtheflexibilitytocovernonmedical
servicesthatcouldresultintheavoidanceofcostlyclinicalinterventions.
Toaccountforthecoststhepatientsincur,ACOswithsharedsavings,sharedsavings/risk,
capitated,orglobalpaymentmodelsarechargedwithmanagingthetotalcostofcare(TCOC)of
eachattributedpatient,andtheirpatientpanelsasawhole.WhileallACOprogramsinclude
physicalhealthservicesintheirTCOCcalculations,someMedicaidACOprogramsaregoing
beyondmedicalservicestoalsoincludebehavioralhealthservices,longtermservicesand
supports(LTSS),pharmaceuticals,dentalservices,andevenothersocialservices,suchas
housing.ThedecisionregardingwhichservicestoincludeinTCOCcalculationsissometimes
madebythestate,andsometimesbytheACO.

Quality Measurement Approach


AcarefullydefinedsetofqualitymetricsisessentialforACOprograms,becauseasharedsavings
orcapitationbasedpaymentwithoutqualitymetricsmaycreateincentivestounderserveto
achievesavings.RequiringanACOtoachievecertainqualitybenchmarks,ortyingtheamountof
sharedsavings,capitation,orperformancepaymenttotheACOsperformanceonidentified
metrics,ensuresthattheACOisdevotedtomaintainingthehealthofthepopulation.
StatesareusingavarietyofmeasurestoassessACOoutcomes,processes,andpatient
experience.Themeasurementsarecomparedtoabaselinestandard,whichcouldbederived
fromtheACOspriorperformance,statewideaveragesofotherhealthcareproviders
performance,ortheperformanceofotherACOs.StatesselectqualitymetricsfortheirMedicaid
ACOprogramsthatreflecttheuniqueneedsoftheirMedicaidpopulations,andoftenalignthese
metricswithotherpayerprograms,suchastheMedicareSharedSavingsProgram(MSSP)where
possible.

Data Strategy
ACOsrequiresubstantialdatatomonitoraccountability,andthemanagementofthosedataisa
keyconsiderationforprogramdesigners.Howclinicalandclaimsdatawillbestoredand
exchangedisakeyconsiderationforstatesbuildinganACOprogram,asprivacyregulationssuch
astheHealthInsurancePortabilityandAccountabilityAct(HIPAA)and42CFRPart2mustbe

2BRIEF|MedicaidAccountableCareOrganizationPrograms:StateProfiles

followed,anddatamustbetransmittedinatimelymannertobeuseful.Manystatesare
constructinghealthinformationexchanges(HIEs)toservethispurpose,butstatesmustbe
mindfuloftheinitialcostsofanHIEaswellascostsrelatedtoitsmaintenance.
DataanalyticsarenecessarytocompareanACOsqualitymetricsandcoststoabenchmarkand
tocalculateresultingfinancialincentives.Datacanalsobeminedtoidentifyopportunitiesto
improvecaremanagementefforts.Onequestionallstatesmustansweriswhatentitywill
organizeandanalyzethedata.Thestatecanchoosetohousethedatainthegovernmental
agencyinchargeofMedicaid,useathirdpartycontractor,orrequiretheACOstohandle
reportingandanalyticsthemselves.

Conclusion
Byconnectingprovidersreimbursementtothehealthoutcomesofenrollees,ratherthanjust
theamountofhealthservicesdelivered,ACOprogramscancreateopportunitiestoachievethe
TripleAim.TheninestateswithactiveMedicaidACOprogramsprofiledinthisbriefreflectthe
broaddiversityofemergingstateACOapproaches.Otherstates,includingAlabama,Connecticut,
Maryland,Massachusetts,Michigan,NewYork,Virginia,andWashingtonarepursuingMedicaid
ACOprogramstoaddresstheirownhealthcarereformneeds.WhileMedicaidACOmodels
differ,theyarealldesignedtoprovideagreaterlevelofaccountabilityforimprovinghealth
outcomes.2AnexaminationofthesestatesprogramsshowstherangeofACOmodelsandthe
potentialforACOstoreducecostsandimprovehealthofMedicaidbeneficiaries.

***

State Medicaid ACO Profiles


ThefollowingpagesdetailACOapproachesinninestatesthathaveimplementedthismodelfor
partoralloftheirMedicaidpopulationsColorado,Illinois,Iowa,Maine,Minnesota,New
Jersey,Oregon,Utah,andVermont.Anoverviewmatrixprovidesasidebysidecomparisonof
stateMedicaidACOprogramcomponents.Followingthematrix,onepageprofilesdescribeeach
statesACOprogram,detailingthescopeofservicesaswellasthepaymentarrangements,
qualitymeasurement,anddataanalyticapproachused.AsingleACOisalsohighlightedto
provideanoperationallevelillustrationofeachstatesACOprogram.

3BRIEF|MedicaidAccountableCareOrganizationPrograms:StateProfiles

MedicaidACOModelsOverviewMatrix
State

GovernanceStructure

ScopeofService

PaymentModel

QualityMeasurement
Approach

DataAnalysisStrategy

Colorado

CareCoordination
ManagementEntity
(geographic)

Physicalhealth

Carecoordinationpaymentand
payforperformance

Threequalitymeasurestiedto
payment

StatewideDataAnalyticsContractor
(SDAC)issuesutilizationandcostreports

Illinois

Providerled

Physicalhealth
Behavioralhealth

Carecoordinationpayment
transitioningtosharedsavingsand
thencapitationoverthreeyears

29qualitymeasures,fourtiedto
payment

Historicalclaimsdatafromthestate,
healthinformationexchangerunbystate
withproviderportalandhealthneeds
assessmentfilerunbycontractor

Iowa

Providerled

Physicalhealth

Payforperformance

16measuresderivedfrom3M
ValueIndexScore,alltiedto
payment

Contractormanagesdatarequiredto
operateprogram

Sharedsavingsusingtwotracks:
upsideonlyandupside/downside

17qualitymeasures,including14
coremeasuresandthreeelective
measures;alltiedtopayment

Physicalhealth
Behavioralhealth
Longtermservicesand
supports(LTSS)
(optional)
Dental(optional)

Stateprovidesmonthlymemberlevel
claimsandutilizationmetrics,aswellas
quarterlyreportsoncosts,utilization,
andquality;contractorprovidesanalytics
andreports

Minnesota

Providerled

Physicalhealth
Behavioralhealth
Pharmacy

Sharedsavingsusingtwotracks:
upsideonlyandupside/downside

32qualitymeasuresscoredas9
aggregatemeasures;allmeasures
arereportedinyearone,then
increasinglytiedtopayment

Stateprovidesclaimsbasedanalyticsand
reports;ACOsrequiredtocollectand
reportqualitydata

NewJersey

Communityled
(geographic)

Physicalhealth

Sharedsavingsupsideonly
(recommendedmodel)1

27qualitymeasures,21mandatory
measuresandsixvoluntary
measures,alltiedtopayment

ACOsrequiredtoreportonmeasures;
dataanalyzedbycontractor

Oregon

Payerled
(geographic)

Physicalhealth
Behavioralhealth
Dental

Globalbudgetcappedattwo
percentgrowthrate

33qualitymeasures,17tiedto
payment

CCOsprovidestatewithencounterdata;
statecollectsandreportsdata

Utah

Payerled

Physicalhealth

Capitatedpayment

25qualitymeasures,nottiedto
payment

ACOsrequiredtocollectandreportdata

Physicalhealth
Behavioralhealth
(optional)
LTSS(optional)
Pharmacy(optional)

Sharedsavingsusingtwotracks:
upsideonlyandupside/downside

Coresetof28measures,eighttied
topayment

Stateproducescaresummariesand
utilizationreportsusingallpayerclaims
databaseand/orpayerclaimsdata

Maine

Vermont

Providerled

Providerled

1NewJerseyACOsformtheirowngainsharingarrangementswithmanagedcareorganizations,butarecommendedmodelwasdevelopedbyRutgersUniversitytoguidethesenegotiations.

4BRIEF|MedicaidAccountableCareOrganizationPrograms:StateProfiles

ACO PROFILE:

Colorado

ColoradosAccountableCareCollaborative(ACC)ismadeupof:(1)
RegionalCareCollaborativeOrganizations(RCCOs),ACOlike
entitiesthatcoordinatehealthcareacrossprovidersthatserve
Medicaidenrollees;(2)primarycaremedicalproviders(PCMPs)
thatcontractwithaRCCOtoserveasmedicalhomepractices;and
(3)theStatewideDataAnalyticsContractor(SDAC),an
organizationthatmanagestheACCsdataneeds.3Because
Coloradohasdramaticallydifferentenvironmentsacrossthestate,
therearecurrentlysevenRCCOsassignedgeographically.Foreach
region,theRCCOisresponsiblefor:medicalmanagementandcare
coordination;providernetworkdevelopment;providersupport;
andaccountabilityandreporting.

Payment Model

Colorado:ACOAtaGlance

Programname:AccountableCareCollaborative
Accountableentityname:RegionalCare
CollaborativeOrganizations
YearLaunched:2011
GovernanceModel:CareCoordination
ManagementEntity
NumberofACOs:7
BeneficiariesServed:609,051
PaymentMethodology:Carecoordinationfee
andpayforperformance
NumberofQualityMeasures:3
ScopeofServices:Physicalhealth
Results:Saved$3539Minnetsavingsover
threeyears

Currently,RCCOsreceivecarecoordinationpaymentsofbetween
$8.93and$9.50PMPMforalloftheirresponsibilities.Theyalso
receiveincentivepaymentsbasedonKeyPerformanceIndicators
(KPIs).TheRCCOsagreedtoreducetheirPMPMpaymentsto
ACOSpotlight:RockyMountainHealth
createanincentivepaymentforPCMPsthatmeetfiveofnine
standardsforenhancedpatientcenteredmedicalhomestatus.5 Plan

Quality Measurement Approach


ColoradosRCCOsusedthreeKPIsinitsfirstyear:emergency
department(ED)visits;30dayallcausehospitalreadmissions;
andhighcostimaging.Currently,theKPIsare:EDvisits;wellchild
visits(ages39);andpostpartumcare.

Data Strategy
TheSDACprovidesdatatoidentifyhighneed,highcostutilizersof
healthservicesandotherclientswhomayneedcarecoordination.
Inaddition,theSDACprovidesdataonpopulationstatisticsand
providerperformancetoidentifytrendsandopportunities,and
trackstheKPIsthatColoradousestoevaluatetheperformanceof
theRCCOs.

RockyMountainHealthPlan(RMHP)isaRCCO
thatcoversthewesternmostregionofColorado
andonecountyeastoftheRockies.The
populationservedbyRMHPisheterogeneous,so
thereisnoonesizefitsallsolutiontothehealth
careneedsofitsattributedpopulation.RMHPhas
encouragedcollaborationbetweenprovidersand
publichealthofficesinWesternColorado.The
statealsoselectedRMHPtoserveasapilotfora
fullrisk,capitationpaymentmodel,RMHPPrime.
Themodelisavailabletomostadultsandsome
childrenwithdisabilitiesinsixwesterncounties.4

Results to Date
Coloradoreportedstatewidenetsavingsof$29to$33millionduringFY2014,itsthirdyearofoperation.6Theprogram
alsohadnetsavingsof$6millioninitssecondyearforatotalnetsavingsof$3539millionovertheprogramsthree

years.7

5BRIEF|MedicaidAccountableCareOrganizationPrograms:StateProfiles

ACO PROFILE:

Illinois

In2011,IllinoisenactedanambitiousMedicaidreformlaw
requiring50percentofpublicmedicalassistanceclientstobe
enrolledinriskbasedcarecoordinationprogramsby2015.
IllinoisestablishedAccountableCareEntities(ACEs),thestates
MedicaidACOprogram,asonepartofthiseffort.8IllinoisACEs
willtransitionquicklyfrompayforperformance(P4P)toshared
savingstocapitatedpaymentsover36months
ThegovernancerequirementsforACEsaregenerallyflexible.For
profitornonprofitACEsmaybeprovidergroups,individual
providers,ornonphysicalhealthproviders,buttheymaynotbe
managedcareorganizations(MCOs).EvenifanACEisnotmade
upofprimarycareproviders,allACEsarerequiredtodesignatea
primarycarephysiciannetworkequippedtoserveitsenrollees.

Payment Model
Overathreeyearphasedapproach,ACEswillprogressfromP4P
paymentstosharedsavingstofullaccountability.Duringthefirst
18months,anACEreceivesa$9PMPMpaymentforcare
coordinationofFamilyCareenrolleesand$20PMPMforadult
enrolleeseligibleforMedicaid.Inmonthsseventhrough18,ACEs
mayalsoshareinupto50percentofthesavingsthattheACE
realizes.Frommonths1936oftheACEsoperations,thestatewill
paytheACEonariskadjustedcapitationbasisforallcovered
services,withthestatesharingthedownsiderisk.Inmonths37
andbeyond,theACEwillbeatfullcapitatedrisk.

Quality Measurement Approach

IllinoisACO:AtaGlance

Programname:AccountableCareEntities
Program
Accountableentityname:AccountableCare
Entities
YearLaunched:2014
GovernanceModel:Providerled
NumberofACOs:9
BeneficiariesServed:Notavailable
PaymentMethodology:Payforperformance
transitioningtosharedsavings/risktransitioning
tocapitation
NumberofQualityMeasures:29
ScopeofServices:Physicalhealth;behavioral
health
Results:Pending

ACOSpotlight:MyCareChicago
OneofIllinoissACEsisMyCareChicago,amulti
providerorganizationthatoperateshospitals,
federallyqualifiedhealthcenters(FQHCs),and
othersafetynetprovidersinandaround
Chicago.9Itisownedbyitsmembers:four
hospitals,sixFQHCs,andtwobehavioralhealth
providers.MyCaremaintainsastrongconnection
tothecommunitybyinvitingresidentstobepart
ofitsconsumeradvisoryboardandshare
recommendationsforimprovingACEoperations.

IllinoisrequiresitsACEstoreporton29measures;23arebased
onHEDISqualitymetrics,includingseveralthathavebeen
adaptedbythestatetobetterfitprogramneeds.Themetrics
focusonfiveareas:(1)accesstoandutilizationofcare;(2)
preventionandscreeningservices;(3)appropriatecare;(4)behavioralhealth;and(5)maternalcare.Fourofthe29
ACEmetricsaretiedtopayment.

Data Strategy
Illinoisdatastrategyinvolves:theDepartmentofHealthcareandFamilyServices;IllinoisHealthConnect,acontractor
thatmanagesthestatesPCCMprogram;theIllinoisHealthInformationExchange,thestatewideHIE;andMaximus,a
contractorthatmanagesenrollmentservices.IllinoisHealthConnectprovidesitsACEswithaproviderportalthat
sharesalistofenrolleesonadailybasis,updatedthroughadedicatedtransmittalsystem,whileMaximusprovidesa
monthlyhealthneedsassessmentfile,includinginformationfrommemberenrollmentsurveys.Thestateprovidestwo
yearsofhistoricalclaimsdataandsevenyearsofimmunizationdataonallnewenrolleesonamonthlybasisthroughits
CareCoordinationClaimsDataset,10whichACEscanuseforriskstratificationpurposes.

Results to Date
Theprogramlaunchedin2014andhasnotyetreportedresults.
6BRIEF|MedicaidAccountableCareOrganizationPrograms:StateProfiles

ACO PROFILE:

Iowa

IowasMedicaidAccountableCareOrganizationprogramprovides
valuebasedcareforthestatesnewlyeligibleMedicaidexpansion
population.11Theprogram,whichcurrentlyhasfiveACOs
providingphysicalhealthservicestobeneficiaries,isdesignedto
aligncloselywiththestatesexistingMedicareandcommercial
ACOs.MuchofthestateseffortsthusfarhavesupportedACOsin
developinghealthITinfrastructure.Iowaplanstoextendvalue
basedpaymentmodels,includingitsACOprogram,toallMedicaid
beneficiariesthroughtheimplementationofstatewidemanaged
careanditsRound2SIMTestgrant.

Payment Model
IowaACOscanreceivebonuspaymentsbasedonthe3MValue
IndexScore(VIS),asetofmeasuresdevelopedby3MHealth
InformationSystemsandadaptedfromIowasprivateinsurance
market.InadditiontotheVISbonus,MedicaidoffersACOsthree
potentialbonusesforhelpingmembersachievehealthybehaviors:
1.
2.

3.

$10PMPYifatleast50percentofthePCPspatientshave
receivedanannualphysicalexam;
$4PMPMinyear1or$5PMPMinsubsequentyearsif
theACOmeetsmeasuresfocusedonbroaderdelivery
systemtransformation;and
$4PMPMiftheACOachievesatargetpercentageof
attributedmembersachievingidentifiedhealthy
behaviors.

Quality Measurement Approach

IowaACO:AtaGlance

Programname:MedicaidAccountableCare
Organizations
Accountableentityname:AccountableCare
Organizations
YearLaunched:2014
GovernanceModel:Providerled
NumberofACOs:5
BeneficiariesServed:35,000
PaymentMethodology:Payforperformance
NumberofQualityMeasures:16
ScopeofServices:Physicalhealth
Results:Improvedhealthybehaviors

ACOSpotlight:BroadlawnsMedical
Center
BroadlawnsMedicalCenter(BMC),adesignated
MedicaidACOinIowa,isapubliccommunity
hospitalinDesMoinesthatservesastheprimary
acutecarehospitalandthecoresafetynet
providerincentralIowa.12Broadlawnshasstrong
connectionstothecommunitythroughtheBMC
Academy,anorganizationthatprovidesresources
tostaff,patients,andthebroadercommunity,
includingcontinuingeducationforprofessionals,
acommunityhealthresourceguide,andsupport
programsforpatients.

Iowauses16VISmeasurestoproduceascorefromsixdomains:
(1)memberexperience;(2)primaryandsecondaryprevention;(3)
tertiaryprevention;(4)populationhealthstatus;(5)continuityof
care;and(6)chronicandfollowupcare.In2015,ACOswillalsobeevaluatedontheirabilitytoengageenrolleesin
IowasHealthyBehaviorsPlan.Ifanenrolleereceivesanannualphysicalfromhisorherprimarycareproviderand
completesahealthriskassessment,thatenrolleeisnolongerrequiredtopaythe$5or$10monthlypremiumforIowa
WellnessPlancoverage,asoutlinedinthestates1115waiver.13

Data Strategy
IowasMedicaidACOusesaprivatecontractor,3MHealthInformationSystems,tomanageACOprogramdata.The
systemwasadaptedfromtheapproachusedbythepredominantinsurerinthestate,WellmarkBlueCross/BlueShield,
initscommercialACOprogram.

Results to Date
In2014,roughly51percentofACOmembersachievedatleastonehealthybehavior,andonaverage28percent
achievedbothhealthybehaviors.Incomparison,fortheregularMedicaidpopulation,onlyfivepercentcompletedthe
wellnessexam.Medicaidpaidout$430,000inVISbonusesin2014,withPCPsinanACObeingfivepercentmorelikely
toearnaVISbonusthannonACOPCPs.

7BRIEF|MedicaidAccountableCareOrganizationPrograms:StateProfiles

ACO PROFILE:

Maine

MainesAccountableCommunities(AC)initiativeispartofa
comprehensivevaluebasedpurchasingstrategyacrossthestate.14
AnACrequiresadesignatedleadentitythatmusteitherbea
primarycareproviderorcontractwithone.Therearecurrently
fourACs,whichincludeatotalof28primarycarepractices.Each
ACmusthaveacontractualorotherdocumentedrelationshipto
ensurecoordinationwith:(1)atleastoneproviderineachofthree
categories:chronicconditions,developmentaldisabilities,and
behavioralhealth(iftherearesuchprovidersintheACsservice
area);(2)allhospitalsintheservicearea;and(3)atleastone
publichealthagency.AnACmustalsodirectlyinvolveits
communityindecisionmakingbyrequiringthattheleadentitys
governingbodyincludeatleasttwoMaineCaremembersserved
bytheACortheircaregiversorguardians.
AllACsaremeasuredonthetotalcostofcare(TCOC)forcore
services,whichincludephysicalandbehavioralhealthservices.
ACscanalsochoosetobemeasuredonTCOCforoptional
services,suchaslongtermservicesandsupportsanddental
services(thechoiceofoptionalservicescouldgenerate
opportunitiesforgreatersharedsavings).

Payment Model
Theprogramofferstwosharedsavingsmodels:onethatallows
forupto50percentofsharedsavings(upto10percentof
benchmarkTCOC),withnodownsiderisk;andasecondthat
allowsanorganizationtoshareupto60percentofthesavings,
butalsoholdstheorganizationaccountablefor4060percentof
downsiderisk(cappedatfivepercentofbenchmarkTCOCinthe
firstyear,and10percentinthesecond).Performanceonquality
metricsproportionatelyaffectstheamountofsavingsorlosses.

Quality Measurement

MaineACO:AtaGlance

Programname:AccountableCommunities
Initiative
Accountableentityname:Accountable
Communities
YearLaunched:2014
GovernanceModel:Providerled
NumberofACOs:4
BeneficiariesServed:30,000
PaymentMethodology:Sharedsavings/risk
NumberofQualityMeasures:17(14core,and
ACchooses3of7elective)
ScopeofServices:Physicalhealth;behavioral
health;LTSS(optional);dental(optional)
Results:Pending

ACOSpotlight:PenobscotCommunity
HealthCare
PenobscotCommunityHealthCare(PCHC)isan
FQHCthatservesmorethan60,000patientsin
EasternMaine.15Alsorecognizedasapatient
centeredmedicalhome,PCHCwasthefirsthealth
carefacilityinMainetobenamedatop
performerintheHealthcareEqualityIndex,a
nationalLGBTbenchmarkingtool,andthreeofits
individualpracticesreceivedBetterorBest
designationsbyGetBetterMaine,anorganization
devotedtothequalityofhealthcareinthestate.
PCHCparticipatesinmultiplereformeffortsin
Maine,illustratingthestatesbroadapproachto
healthcarereform.

ACperformanceismeasuredthrough17qualitymetricsinfour
areas:(1)patientexperience;(2)carecoordinationandpatient
safety;(3)preventivehealth;and(4)atriskpopulations.ACsmustreportonall14coremetricsandchoosethreeof
sevenelectivemetrics.Allofthe17metricsaretiedtosharedsavingspayments.

Data Strategy
TheMaineDepartmentofHealthandHumanServices(DHHS)providesparticipatingproviderswithquarterlydata
reportsoncost,utilization,andquality.DHHSprovidesaportalthroughwhichACsandtheirprimarycarepracticescan
downloadclaimsandutilizationmetricsforallattributedmembersandthedataareupdatedmonthly.Mainepartners
withtheMaineHealthManagementCoalitiontoprovidedataanalyticssupporttoparticipatingACs.

Results to Date
Theprogramlaunchedin2014andhasnotyetreportedresults.
8BRIEF|MedicaidAccountableCareOrganizationPrograms:StateProfiles

ACO PROFILE:

Minnesota

MinnesotalauncheditsItsproviderledIntegratedHealth
Partnerships(IHPs)programthroughlegislationin2010.16Six
providersstartedwiththeprogramin2013,andsincethen,10
morehavejoined.
ProvidergroupscanparticipateinoneoftwoIHPtracks:virtual
orintegrated.VirtualIHPsarenotformallyintegratedwitha
hospitalthroughfinancialarrangementsandinformationsystems
andtheyservebetween1,000and1,999attributedmembers.
IntegratedIHPsaredeliverysystemsthatprovideoutpatientand
inpatientcareandserveatleast2,000attributedmembers.

Payment Model
VirtualIHPsareeligibleforaportionofsharedsavings,butshare
nodownsiderisk.IntegratedIHPsphaseinriskoverthreeyears:
(1)upsideriskonlyinthefirstyear;(2)shareinupsidesavingsand
responsiblefordownsideriskequivalenttohalfoftheupsiderisk
potentialinthesecondyear;and(3)symmetricalsavingsandrisk
sharinginthethirdyear.IntegratedIHPscanalsoproposetheir
ownperformancethresholdsforsharedsavings.Boththestate
anditsMCOswillpayportionsofsharedsavingstoIHPsorshare
inlossesfromIHPsthatdonotachievesavings.Thiscreatesan
incentiveforMCOstoworkwithproviderstoachievecostsavings.

Quality Measurement Approach


MinnesotarequiresIHPstoreporton32qualitymetrics,whichare
scoredasnineaggregatemetrics.IHPsareencouragedtopropose
additionalmeasurestailoredtothespecificcommunitiesand
populationsservedbytheIHP.IHPphasesinsharedsavings
distributionstiedtoqualityperformanceoverathreeyearperiod:
(1)inyearone,25percentofsharedsavingsarebasedon
reportingqualitymetrics;(2)inyeartwo,25percentofsavingsare
basedontheoverallqualityscore;and(3)inyearthree,50
percentofsavingsarebasedonoverallqualityperformance.IHP
performanceisassessedforachievementandimprovement.

MinnesotaACO:AtaGlance

Programname:IntegratedHealthPartnerships
Accountableentityname:IntegratedHealth
Partnerships
YearLaunched:2013
GovernanceModel:Providerled
NumberofACOs:16
BeneficiariesServed:175,000
PaymentMethodology:Sharedsavings/risk
NumberofQualityMeasures:32scoredas9
aggregatemeasures
ScopeofServices:Physicalhealth;behavioral
health;pharmacy
Results:Saved$76.3Moverfirsttwoyears

ACOSpotlight:FederallyQualified
HealthCenterUrbanHealthNetwork
TheFederallyQualifiedHealthCenterUrban
HealthNetwork(FUHN)isanIHPcreatedby10
FQHCsintheMinneapolisSt.Paularea.Itservesa
diversegroupofmorethan22,000enrollees.17
PriortotheIHPpartnership,theparticipating
memberorganizationsoftencompetedfor
resources,includinggrantfunding,providers,and
evenpatients.ByjoiningtogetherasanIHP,the
participantshavestrengthenedtheircapacityto
movetowardvaluebasedpayment.Dueto
limitedcapacityatitsmemberFQHCs,FUHN
contractswithOptum,ahealthinformation
technologycompany,tohandlethedataanalytics
requiredforitsACO.Notably,FUHNwasthefirst
FQHConlyMedicaidACOrecognizedbyanystate.

Data Strategy
Byregulation,thehospitalsandphysicianclinicsparticipatingintheprogrammustsendthestatethedatanecessaryto
calculatequalityperformance.Bycontract,MCOsalsosubmitdatatotheMinnesotasDepartmentofHumanServices,
whichmanagesitsclaimsdatainastaterunwarehouse,andprovidesamonthlyriskadjustmentreportstotheIHPs.
ThedatacontainbothfeeforserviceandMCOencounterclaimsdata.

Results to Date
MinnesotasIHPprogramsavedthestate$76.3millionoveritsfirsttwoyears($14.8Minthefirstyearand$61.5Min
thesecondyear).18AllnineIHPsachievedsharedsavingsinyeartwoandexceededtheirqualitytargets.

9BRIEF|MedicaidAccountableCareOrganizationPrograms:StateProfiles

ACO PROFILE:

New Jersey

TheCamdenCoalitionofHealthcareProviders(CCHP),established
morethanadecadeago,gainednationwiderecognitioninthe
pastfewyearsforitscommunitybasedhotspottingeffortsthat
identifyhighcostutilizersofthecityshealthcaresystemand
providepatientcentered,intensiveinterventions.CCHPsefforts
ledtheNewJerseylegislaturetointroduceaMedicaidACO
Demonstration.19NewJerseysthreeactiveACOsareaccountable
forthecareofpatientsinadefinedgeographicarea.Per
legislation,eachorganizationisrequiredtocontractwithall
hospitalsinthedesignatedregion,75percentoftheprimarycare
providers,andatleastfourbehavioralhealthproviders,ensuring
bothlocalstakeholderbuyinandtheresourcesavailablefor
effectivecarecoordination.

Payment Model
TheRutgersCenterforStateHealthPolicy(CSHP)developeda
recommendedsharedsavingsmodelfortheNewJerseyMedicaid
ACOsthatgenerallyfollowstheMSSPmodel,butdepartsfromit
insomekeyareas,suchasnotrequiringACOstomeetaminimum
savingsrate,andnottruncatingcostsforhighcostpatients.ACOs
canchoosetousetheCSHPmodel,modifyittosuittheir
purposes,ordeveloptheirownmodels.Auniquefeatureofthe
programisthatthestatesMedicaidMCOsarenotrequiredto
participateintheprogram,whichmeanstheACOsmustnegotiate
theirownarrangementswiththeMCOs.

Quality Measurement Approach

NewJerseyACO:AtaGlance

Programname:MedicaidAccountableCare
OrganizationDemonstrationProject
Accountableentityname:AccountableCare
Organizations
YearLaunched:2015
GovernanceModel:Communityled
NumberofACOs:3
BeneficiariesServed:122,782
PaymentMethodology:Sharedsavings(upside
only)
NumberofQualityMeasures:27
ScopeofServices:Physicalhealth
Results:Pending

ACOSpotlight:TrentonHealthTeam
TakingtheleadfromCCHP,theTrentonHealth
Team(THT)wasfoundedin2010toprovidecare
coordinationtocityresidentsinneed.The
organizationismadeupofthecityhealth
department,theHenryJ.AustinHealthCenter
(TrentonsonlyFQHC),andthecitystwo
hospitals.20THTdevelopedadetailedcommunity
healthneedsassessmenttodeterminewherethe
organizationsresourcescanbebestdirected.It
hasjustbeguntoimplementaCommunityHealth
ImprovementPlan.THTscaremanagementteam
focusesonhighutilizersofthecitysemergency
rooms,andoffersphysicalhealthcare,behavioral
healthservices,andconnectionstocommunity
basedorganizationsandsocialserviceprograms.

ThestateandCSHPwillevaluatetheACOsperformanceannually
inanumberofbroadcategories,includingscreeningrates,
outcomes,andhospitalizationratesforpatientswithchronic
conditions,andthehospitalizationandreadmissionratesforareas
servedbytheACOs.Themeasuresincludebehavioralhealth
metrics,soeventhoughACOsarenotrequiredtoincludethese
servicesintheirTCOC,theyareultimatelyresponsiblefortheirpatientsbehavioralhealthoutcomes.All27metrics
mustbetiedtopaymentinsomewayviatheACOsgainsharingarrangement.TheACOsmustreport21mandatory
metricsandselectsixmorefromalistofoptions.

Data Strategy
NewJerseysACOprogramisusingCSHPsdataanalyticcapacitytoperformtheevaluationandcostsavings
calculations.NewJerseyiscurrentlytheonlystatetouseauniversityresearchcentertoevaluatehealthcarereform
efforts.

Results to Date
Theprogramlaunchedin2015andhasnotyetreportedresults.

10BRIEF|MedicaidAccountableCareOrganizationPrograms:StateProfiles

ACO PROFILE:

Oregon

OregonsCoordinatedCareOrganizations(CCOs)wereestablished
bytheOregonHealthAuthority(OHA)aspartofanambitious
1115waivertohelpthestatereducehealthcarecostincreases
bytwopercentpermember,peryearfrom20132015.21Eachof
the16regionallybasedCCOsisthesolepayerresponsiblefor
Medicaidpatients.TosupporttheCCOs,Oregonestablisheda
TransformationCenterthatrunslearningcollaborativesforCCOs,
managesaCouncilofClinicalInnovatorsfellowshipprogramto
develophealthsystemtransformationleadersacrossthestate,
andprovidestargetedtechnicalassistancetohelpCCOsmeettheir
outcomegoals.

Payment Model
OregonsCCOshaveaglobalbudgetforallservicesprovidedfor
enrolleesthatgrowsatafixedrate.Additionally,threepercentof
monthlypaymentstoCCOsareheldbackbyOHAandputintoa
qualitypool.Thesefundsaredistributedasanincentivepayment
totheCCOsbasedontheirperformanceonspecifiedquality
metricsattheendofeachyear.Toearntheirfullincentive
payment,CCOshavetomeetbenchmarksorimprovementtargets
onatleast12ofthe17incentivemeasuresandhaveatleast60
percentoftheirmembersenrolledinapatientcenteredprimary
carehome.

Quality Measurement Approach


OHArequiresCCOstoreporton33qualitymetrics,17ofwhich
areusedtodeterminetheincentivepaymentsthatCCOsmayearn
fromthequalitypool.OHAmustalsoreportstateperformance
measurestothefederalgovernmentaspartofthe1115waiver
thatauthorizedtheuseofglobalbudgeting.

Data Strategy

OregonACO:AtaGlance

Programname:CoordinatedCareOrganizations
Accountableentityname:CoordinatedCare
Organizations
YearLaunched:2012
GovernanceModel:Payerled
NumberofACOs:16CCOs
BeneficiariesServed:853,897
PaymentMethodology:Globalpayment
NumberofQualityMeasures:33
ScopeofServices:Physicalhealth;behavioral
health;dental
Results:DecreasedEDandinpatientutilization
andcosts

ACOSpotlight:HealthShareofOregon
HealthShareofOregonisaCCOcoveringthe
Portlandmetropolitanarea,themostpopulous
partofthestate.22Theorganizationincludes
healthplans,hospitals,individualproviders,
healthclinics,andsocialserviceagencies.Health
Sharealsoworkswithcountyhealthdepartments
toaddressnonclinicalcausesofhealthproblems
includingaHealthyHomesprogramtoreduce
asthmarelatedhospitalizationsandasupportive
housinginitiativetohelpenrolleeswithchronic
disease.Theseeffortsappeartobeworkingto
manageenrolleeshealthcarecosts,asHealth
Sharehasreportedsavingsof$32.5Moverthree
years.23

TheCCOsprovideOHAwithregularlysubmittedencounterdata.
OHApublishesamidyearandanannualcomprehensivereportontheprogressthatCCOshavemadetowardidentified
qualitymetrics.TheOHAalsoincludesinformationonCCOsqualityperformanceandfinancesonitspublicwebsite.

Results to Date
Since2011,EDvisitsdecreasedby22percentandhospitaladmissionsforshorttermcomplicationsfromdiabetesand
chronicobstructivepulmonarydiseaseby26.9percentand60percent,respectively.FinancialdataindicatethatCCOs
arecontinuingtoholdcostsunderthetwopercentcappedgrowthratemandatedbythestates1115waiver.24

11BRIEF|MedicaidAccountableCareOrganizationPrograms:StateProfiles

ACO PROFILE:

Utah

In2011,theUtahlegislaturepassedSB0180,callingonits
DepartmentofHealthtoreplacetheMedicaidfeeforservice
deliverymodelwithoneormoreriskbaseddeliverymodels.The
statuteestablishedaframeworkthatallowsthestatesMCOled
ACOstoexerciseflexibilityanddevelopsolutionsindependently.25
MedicaidenrolleesinUtahhavetheoptiontoselectanACOas
theirhealthplanuponenrollment,andthemajorityhavedoneso.
IfanenrolleehasnotchosenanACOorahealthplan,thestate
MedicaidagencyassignsthemtoanACObasedontheirmedical
history.

Payment Model
UtahsACOsreceiveacapitatedPMPMpaymentthatisre
adjustedforriskandpopulationeverysixmonths.Though
paymentamountstoACOsmayvaryfromyeartoyear,the
amountsarenottoexceedthegrowthofthestatesgeneral
budget.SomeACOshavenegotiatedsharedsavingsagreements
withlargerclinicsorFQHCs,wherebytheprovidergroupscan
receiveadditionalpaymentsifsavingsaccrue.

Quality Measurement Approach

UtahACO:AtaGlance

Programname:MedicaidAccountableCare
Organizations
Accountableentityname:AccountableCare
Organizations
YearLaunched:2013
GovernanceModel:Payerled
NumberofACOs:4
BeneficiariesServed:238,255
PaymentMethodology:Capitation
NumberofQualityMeasures:25
ScopeofServices:Physicalhealth
Results:Pending

ACOSpotlight:HealthChoiceUtah
HealthChoiceUtahisaproviderownedmanaged
careorganizationthatserves13countiesinthe
state.26Theorganization,asubsidiaryoftheIASIS
Healthcaresystem,wasfoundedin2012to
participateinUtahsMedicaidACOprogram.As
partofitsoutreachefforts,HealthChoiceUtah
hascommissionedaHealthandWellness
EducationVanthattravelstolocationsinits
serviceareatoconducthealtheducation
exerciseswithchildrenandfamilies.

UtahsACOsuse25qualitymeasuresderivedfromthreesources:
(1)theAgencyforHealthcareResearchandQualitysConsumer
AssessmentofHealthcareProvidersandSystems(CAHPS)survey;
(2)theNationalCommitteeforQualityAssuranceHEDIS
measures;and(3)theNationalQualityForum.Themeasures
focusonpreventive,chronic,andacutecareforadultsand
childrenaswellasmaternitycare.Thesemeasuresarenottieddirectlytocapitatedrates.

Data Strategy
UtahalreadyrequiresallhealthplanstorecordCAHPSandHEDISmeasures,andthestateusesthesedataforACO
qualitymeasurement.MostlargeACOsinthestatehavecommerciallinesofbusinessaswell,andcollectthis
informationthemselvesorthroughacontractor.SmallerprogramsinUtahcanopttouseastatecontractedvendor.

Results to Date
Theprogramhasnotyetpublishedresults.

12BRIEF|MedicaidAccountableCareOrganizationPrograms:StateProfiles

ACO PROFILE:

Vermont

VermontdevelopedtheVermontMedicaidSharedSavings
Program(VMSSP)demonstrationusingtheMSSPplatform,which
anumberofACOsinthestatewerealreadysuccessfullyusing.27
TwoofthethreeMedicareACOsinVermontalsoparticipateinthe
statescommercialACOprogramandMedicaidSSPprogram.
VermontisphasingservicesintoitsACOprogramusingan
encourage/incent/requireapproachovertheprogramsfirst
threeyears.Inyearone,ACOsareresponsibleforcorephysical
healthservices.Inyeartwo,theACOshadtheoptiontoinclude
noncoreservicessuchasbehavioralhealth,longtermservices
andsupports,andpharmacybenefitsintheirTCOC,butneither
ACOoptedtoincludenoncoreservicesinyeartwo.Inyearthree,
theACOswillberequiredtoincludespecificnoncoreservices
definedbythestate.

Payment Model
VermontsMedicaidACOsuseadualtrackpaymentstructure:
Track1,inwhichtheACOisnotexposedtodownsiderisk,buthas
anopportunityforsharedsavings;orTrack2,inwhichtheACOis
exposedtodownsideriskwithanopportunityforagreater
percentageofsharedsavingsthaninTrack1.ACOsareableto
selectthetrackinwhichtheywillparticipateandmayparticipate
inthistrackfortheentirethreeyeardemonstration.

Quality Measurement Approach


VermontusestwosetsofmeasuresforitsACOs:(1)acoresetof
28measures,fromwhichACOsmustcollecteightforshared
savingscalculations;and(2)amonitoringandevaluationset
collectedatthestateorhealthplanlevelthatwillnotaffect
sharedsavings.VermontusesaGateandLaddermethodology
forevaluatingtheperformanceofitsACOs.AnACOsperformance
mustreachacertainpointforittobeconsideredforshared
savingstheGateandthentoretainagreaterportionofthe
potentialsavings,theACOmustreachaseriesofhigher
performancelevelstheLadder.

VermontACO:AtaGlance

Programname:VermontMedicaidShared
SavingsProgram
Accountableentityname:AccountableCare
Organizations
YearLaunched:2014
GovernanceModel:Providerled
NumberofACOs:2
BeneficiariesServed:64,515
PaymentMethodology:Sharedsavings/risk
NumberofQualityMeasures:28
ScopeofServices:Physicalhealth;behavioral
health(optional);LTSS(optional);pharmacy
(optional)
Results:Saved$14.6Moverfirstyear

ACOSpotlight:OneCareVermont
OneCareVermontisastatewideACOthat
operatesinMedicare,Medicaid,andcommercial
markets.28Itcontractswithanarrayofproviders
inthestate,includingall14ofVermonts
hospitals,threeFQHCs,andtheDartmouth
HitchcockmedicalcenterinneighboringNew
Hampshire.OneCareisapublic/private
partnershipthatservesnearly100,000attributed
beneficiariesthroughitsmultipayerACO
activities.TheACOillustrateshowasingleentity
canprovidehealthcaretoMedicare,Medicaid,
andcommercialenrolleesthroughasinglemulti
payerACO.OneCareVermontsaved$6,754,568
inMedicaidspendingduringtheprogramsfirst
yearofoperation.29

Data Strategy
VermonthascontractedwithTheLewinGrouptoprovidetheanalyticsforbothcommercialandMedicaidACOsinthe
state.Additionally,Vermonthasdevelopedanallpayerclaimsdatabase,VHCURES,whichcontainsmedicaland
pharmacyclaimsforallMedicaidandMedicareenrollees.ThestatesHIEcanproducecaresummariesanddocuments
oncontinuityofcare,allowingtheACOstobettermanagethecareoftheirpatients.

Results to Date
Theprogramlaunchedin2014andreportedsavingsof$14.6millioninitsfirstyear.30

13BRIEF|MedicaidAccountableCareOrganizationPrograms:StateProfiles

ENDNOTES

1
FormoreinformationabouttheMedicaidAccountableCareOrganizationLearningCollaborative,madepossiblebyTheCommonwealthFund,see
http://www.chcs.org/project/medicaidaccountablecareorganizationlearningcollaborativephaseiii/.
2
D.Hervey,L.Summers,andM.Inama.TheRiseandFutureofMedicaidACOs.LeavittPartnerswhitepaper,September2015.Availableat
http://leavittpartners.com/2015/09/theriseandfutureofmedicaidacos2/.
3
FormoreinformationaboutColoradosACCprogram,pleaseseethestatewebsite:https://www.colorado.gov/pacific/hcpf/regionalcare
collaborativeorganizations.
4
RockyMountainHealthPlan,2014IssueBrief.Availableat:https://www.rmhpcommunity.org/sites/default/files/resource/FinalRMHP
September2014WEB.v3.pdf.
5
ColoradoAccountableCareCollaborative,2014AnnualReport.Availableat:
https://www.colorado.gov/pacific/sites/default/files/Accountable%20Care%20Collaborative%202014%20Annual%20Report.pdf.
6
Ibid.
7
ColoradoAccountableCareCollaborative,2013AnnualReport.Availableat:
https://www.colorado.gov/pacific/sites/default/files/Accountable%20Care%20Collaborative%20Annual%20Report%202013.pdf.
8
FormoreinformationaboutIllinoisACEprogram,pleaseseethestatewebsite:
http://www2.illinois.gov/hfs/publicinvolvement/cc/ace/Pages/default.aspx.
9
MyCareChicagowebsite.Availableat:http://www.mycarechicago.org/#ac7.
10
IllinoisCareCoordinationClaimsDatawebsite.Availableat:http://www2.illinois.gov/hfs/PublicInvolvement/cc/Pages/ClaimsData.aspx.
11
FormoreinformationaboutIowasACOprogram,pleaseseethestatewebsite:http://dhs.iowa.gov/ime/about/iowahealthandwellness
plan/ACOVIS.
12
BroadlawnsMedicalCenterwebsite.Availableat:http://www.broadlawns.org/.
13
IowaHealthandWellnessPlanWaiverApproval:FrequentlyAskedQuestions.Availableat:
http://dhs.iowa.gov/sites/default/files/IHAWP_WaiverApproval_FAQ_01022014.pdf.
14
FormoreinformationaboutMainesAccountableCommunitiesInitiative,pleaseseethestatewebsite:
http://www.maine.gov/dhhs/oms/vbp/accountable.html.
15
PenobscotCommunityHealthCarewebsite.Availableat:https://pchc.com/.
16
FormoreinformationaboutMinnesotasIHPProgram,pleaseseethestatewebsite:
http://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMethod=LatestReleased&dDocName=dhs16_
161441.
17
FUHNwebsite.Availableat:http://www.nhcn.org/.
18
MinnesotasMedicaidreforminitiativesaves$61.5millionin2ndyear.MinnesotaDepartmentofHumanServices.June19,2015.Availableat:
http://mn.gov/dhs/images/IHP%2520second%2520year%2520results%2520NR.pdf.
19
FormoreinformationaboutNewJerseysACOprogram,pleaseseethestatewebsite:http://www.nj.gov/humanservices/dmahs/info/aco.html.
20
http://www.trentonhealthteam.org/tht/index.php.
21
FormoreinformationaboutOregonsCCOprogram,pleaseseethestatewebsite:https://cco.health.oregon.gov/Pages/Home.aspx.
22
HealthShareofOregonwebsite.Availableat:http://www.healthshareoregon.org/.
23
D.LundMuzikant.HealthShareReducesCostsbyCreatingPatientCenteredSystem,TheLundReport,July2015.Availableat:
https://www.thelundreport.org/content/healthsharereducescostscreatingpatientcenteredsystem?elq_cid=1268993&x_id.
24
OregonHealthAuthority.OregonsHealthSystemTransformation,2014AnnualReport.Availableat:
http://www.oregon.gov/oha/Metrics/Documents/2014%20Final%20Report%20%20June%202015.pdf.
25
FormoreinformationaboutUtahsACOProgram,pleaseseethestatewebsite:https://medicaid.utah.gov/accountablecareorganizations.
26
HealthChoiceUtahwebsite.Availableat:http://www.healthchoiceutah.com/.
27
FormoreinformationaboutVermontsSharedSavingsProgram,pleaseseethestatesoverviewdocument:
http://healthcareinnovation.vermont.gov/sites/hcinnovation/files/SSP_and_ACO_FAQ_and_Chart_7.8.14.pdf.
28
OneCareVermontwebsite.Availableat:https://www.onecarevt.org/.
29
MedicaidSharedSavingsProgramsHelpedAvoid14.6MillioninCostsin2014.VermontGovernorsOffice.September8,2015.Avaliableat:
http://governor.vermont.gov/node/2474.
30
Ibid.

ABOUT THE CENTER FOR HEALTH CARE STRATEGIES


TheCenterforHealthCareStrategies(CHCS)isanonprofitpolicycenterdedicatedtoimprovingthehealthof
lowincomeAmericans.ThisbriefwasdevelopedthroughCHCSMedicaidAccountableCareOrganization(ACO)
LearningCollaborative,anationalinitiativemadepossiblebyTheCommonwealthFund.TheCollaborativeis
helpingstatesadvancenewACOmodelsdesignedtoimprovepatientoutcomesandcontrolcostsbyshifting
accountabilityforriskandqualitytoproviders.Formoreinformation,visitwww.chcs.org.

14BRIEF|MedicaidAccountableCareOrganizationPrograms:StateProfiles