AHRQ CVE Learning Network Webinar January 13, :00 PM-2:30 PM ET Tricia McGinnis Director of Delivery System Reform, CHCS State-Level Perspectives: Medicaid ACOs

I.Overview of Emerging ACO Models in Medicaid II.Results to Date III.Key Issues and Lessons Learned IV.Key Takeaways for CVEs V.Q & A Agenda 2

A non-profit health policy resource center dedicated to improving services for Americans receiving publicly financed care ► Priorities: (1) enhancing access to coverage and services; (2) advancing quality and delivery system reform; (3) integrating care for people with complex needs; and (4) building Medicaid leadership and capacity. ► Provides: technical assistance for stakeholders of publicly financed care, including states, health plans, providers, and consumer groups; and informs federal and state policymakers regarding payment and delivery system improvement. ► Funding: philanthropy and the U.S. Department of Health and Human Services. 3

ACO Overview Key Medicaid ACO features include: ► On-the-ground care coordination and management ► Payment incentives that promote value, not volume ► Provider/community collaboration ► Robust quality measurement and accountability ► Data sharing and integration ► Multi-payer opportunities Regulatory environment ► States implementing via fee-for-service must get approval from the Center for Medicaid and CHIP Services ► ACOs implemented via managed care organizations do not need federal approval 4

Medicaid ACO Organization Structures Vary Provider-Driven ACOs Providers establish collaborative networks Provider network assumes some level of financial risk Providers oversee patient stratification and care management State or MCO pays claims S TATES : Massachusetts, Minnesota, Vermont MCO-Driven ACOs MCOs assume greater role supporting patient care management MCOs retain financial risk but implement new payment models Providers partner with the MCO to improve patient outcomes S TATES : Oregon, Utah Regional/Community Partnership ACOs Community orgs partner to develop care teams and manage patients Regional/community org receives payment, shares in savings Providers partner with regional/community orgs and form part of the care team MCOs/states retain financial risk S TATES : Colorado, Maine, New Jersey 5

Medicaid ACO Activity 6

Medicaid ACO Results to Date To date, only Colorado’s Accountable Care Collaborative has published results: ► 352,000 Medicaid clients are enrolled ► $44 million in cost savings in fiscal year  State retained $6 million in net savings  $9 million saved in FY ► Quality results:  Hospital readmissions declined 15%  High-cost imaging declined 25%  No meaningful change in emergency room visits 7

Key Issues and Lessons Learned 1.Fostering Widespread Data Sharing and Analytics ► Robust data and analytics are critical to identifying savings opportunities and targeting care coordination efforts ► States are building provider portals fed by all-payer claims databases, HIE, and Medicaid claims 2.Selecting Appropriate Quality Measures and Value-Based Purchasing Techniques ► Focus on targeted ACO goals and outcomes ► Reflect issues that are unique to complex populations ► Link payment methods to quality reporting and performance/improvement 8

Key Issues and Lessons Learned: Examples of Quality Metrics for Medicaid ACOs OregonMinnesota  Screening for depression and follow-up plan  Depression remission at six months  Timeliness of prenatal care  Pneumonia appropriate care measure  Elective delivery  Heart failure appropriate care measure  Outpatient and ED utilization  Optimal asthma care composite (kids)  Colorectal screening  Optimal asthma care composite (adults)  PCMH enrollment  Home management asthma care plan  Developmental screening for 1 st 36 months of life  Optimal vascular care composite  Adolescent well-care visits  Optimal diabetes composite  Controlling high blood pressure  CG-CAHPS  Diabetes: HBa1c poor control  HCAHPS  Alcohol or other substance abuse (SBIRT)  Follow-up after hospitalization for mental illness  CAHPS access to care composite (adults & kids)  CAHPS satisfaction with care composite (adults & kids)  EHR adoption  Mental and physical health assessment within 60 days for children in DHS 9

Key Issues and Lessons Learned (cont.) 3.Building Functional Capacity among ACO Providers ► Many provider systems are not organized well enough to be ACOs ► States are investing in training, technical assistance, and learning collaboratives 4.Aligning with Medicare ► Medicare shared savings methodology can be adapted for Medicaid beneficiaries ► Leveraging Medicare Shared Savings Program (MSSP) promotes multi- payer alignment and lightens the lift of program development 10

Roles and Opportunities for CVEs Neutral third-party data aggregation Quality measurement/validation Provider report cards Provider training, technical assistance, or learning collaboratives 11

Visit CHCS.org to…  Download practical resources to improve the quality and cost-effectiveness of Medicaid services  Subscribe to CHCS updates to learn about new programs and resources  Learn about cutting-edge efforts to transform the way Medicaid delivers and pays for care 12