AHRQ CVE Learning Network Webinar January 13, 2014 1:00 PM-2:30 PM ET Tricia McGinnis

1. State-Level Perspectives: Medicaid ACOs AHRQ CVE Learning Network Webinar January 13, 2014 1:00 PM-2:30 PM ET Tricia McGinnis Director of Delivery System Reform, CHCS

2. Agenda

3. 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

4. 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

5. Medicaid ACO Organization Structures Vary

6. Medicaid ACO Activity

7. 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 2012-2013 • State retained $6 million in net savings • $9 million saved in FY 2011-2012 • Quality results: • Hospital readmissions declined 15% • High-cost imaging declined 25% • No meaningful change in emergency room visits

8. Key Issues and Lessons Learned • 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 • 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

9. Key Issues and Lessons Learned: Examples of Quality Metrics for Medicaid ACOs

10. Key Issues and Lessons Learned (cont.) • 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 • 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

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

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