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States mimicking Medicare – experimenting with Accountable Care Models for Medicaid

February 09, 2012

Accountable Care Organizations (ACO) model’s popularity is growing and mirroring Medicare almost 11 states are trying ACO models for their Medicaid programs by adding initiatives resembling ACO’s to their programs, moreover various providers who initially were vary of Medicare ACO models are showing interest in the state versions as well.

With the exact number of states experimenting with ACO model programs unknown, 13 states have already submitted Medicaid amendments to the CMS to implement the new medical home model including aspects of ACOs, with four amendments already approved as reported by Federal officials. According to health policy experts, state interest has evolved in the past two years, to control spending due to their increasingly costly Medicaid programs; moreover part of the increased interest could be an outcome of the national attention the federal Medicare ACO programs received.

In North Carolina one Medicaid program is building an ACO-like structure off a longstanding medical home model. Other states are modifying their Medicaid managed-care programs into ACO-type pilots- in January, Minnesota, launched a two-year expansion of its managed-care program that will provide extra provider payments for up to 10,000 Medicaid beneficiaries. In another initiative viewed as an ACO-like model, a Colorado Medicaid program launched in mid-2011 gives providers regular bonus payments for offering extra care to patients, with plans to add bonus payments to practitioners whose patient’s outcomes improve.

Various states are still implementing their ACO-like Medicaid changes but are expected to complete their plans soon. The Cambridge Health Alliance, Massachusetts, already considers itself an ACO and has begun moving some of its Medicaid patients into a global payment model through the managed-care plan under which it operates.

High potential to improve health while saving money, practitioners eventually expect the state and federal efforts to result in widespread ACO adoption within Medicaid programs. As the ACO model transforms the system from the current fee for service system to pay for value system – physicians would benefit from seeking help from medical billing companies, who can provide consultancy for integrating this system of healthcare delivery. Medicalbillersandcoders.com having capability of providing operational and revenue management to various specialties and being equipped with an insider-knowledge of the Healthcare Industry can help make the choice of transitioning to the ACO model easier.


Category : ACA / HIPAA / Reforms