Population Health-Focused Medicaid ACOs – The New Trend


The term “Population Health” has begun to be widely accepted as the way to describe the combined efforts to improve community health. New initiatives seek to improve population health by focusing on prevention and wellness rather than simply treating illness. In their 2016 Data Quality Strategy, the Centers for Medicaid and Medicare (CMS) outline their vision for improving population health as “providing healthcare that is person-centered, provides incentives for the right outcomes, is sustainable, emphasizes coordinated care and shared decision-making, and relies on the transparency of quality and cost information.” In order to accomplish this goal, the CMS Quality Strategy identifies six priorities:

  1. Make care safer by reducing harm caused in the delivery of care
  2. Ensure that each person and family is engaged as partners in their care
  3. Promote effective communication and coordination of care
  4. Promote the most effective prevention and treatment practices for the leading causes of mortality, starting with cardiovascular disease
  5. Work with communities to promote wide use of best practices to enable healthy living
  6. Make quality care more affordable for individuals, families, employers, governments, and communities by developing and spreading new health care delivery models

In order to achieve these priorities and improve population health, CMS encourages communities to develop innovative programs that address challenges in ways that best meet their needs. States play an important role in helping communities embrace a population-wide focus to deliver high value care and increase provider accountability. This is achieved through value-based payment approaches and a variety of other strategies to maximize resources. Medicaid, public health, and social services representatives work closely, for example, to establish mutually agreed upon population health goals and promote cross-agency health activities. One innovative strategy that is gaining popularity across the country is the Medicaid-funded Accountable Care Organization (ACO).

Medicaid ACO Programs

The goal of these population health-focused Medicaid ACOs is to improve the quality of care for individuals and reduce the overall costs for providers by coordinating a wide variety of needed services. The main components of coordinated care include: value-based payment incentives, provider and community collaboration, quality measurement and accountability, and data sharing and integration.

Each state promoting the ACO model must decide how to structure their own program. While all services provided under Medicaid must be “medically necessary,” the definition of medical necessity varies, allowing states to include some nontraditional support services in their Medicaid plans, including mental health, substance use services, care coordination, long-term services and supports, and social and public health services. A state sets general guidelines for Medicaid ACOs, and then each ACO chooses its covered benefits based on which services will be most cost-effective for its patient population. For example, the Hennepin Health ACO in Minnesota, which has the flexibility to include nonmedical services and providers in its total cost of care calculations, is leasing public housing units to 112 homeless individuals with complex medical conditions in an effort to reduce unnecessary hospitalizations and emergency department visits.

Technology Drives Outcomes

A core focus of the CMS Quality Strategy is to expand the use of health IT in order to help providers deliver higher quality care. ACOs need to provide a comprehensive system which links primary care and community services, incorporates the social determinants of health into healthcare decisions, and coordinates a seamless journey for individuals. In order to measure the health of ACO members, the system must also have robust reporting capabilities which can deliver large amounts of health data to monitor health status and trends among priority populations.

Eccovia Solutions is uniquely positioned to support population health-focused, Medicaid Accountable Care Organizations and their community partners. Our specialized ClientTrack Case Management platform can be tailored to the exact needs of any ACO and enables you to coordinate person-centered healthcare, improve health outcomes, and reduce care costs.

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