High-Performance Health Care for Vulnerable Populations: A Policy Framework for Promoting Accountable Care in Medicaid

Updated: August 22, 2016

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By Deborah Bachrach, JD, William Bernstein, JD, and Anne Karl, JD, The Commonwealth Fund, 2012

commonwealth_fund_logoThrough the Affordable Care Act and other significant healthcare reform policies, there are many new opportunities arising to reengineer healthcare payment and delivery for improved performance. This report explores how state Medicaid agencies might align with and build on the Medicare Shared Savings Program, which rewards groups of providers that meet cost and quality benchmarks by working together to coordinate patients’ care in accountable care organizations (ACOs). While the Shared Savings Program currently applies only to fee-for-service Medicare beneficiaries, federal policymakers recognize that the ACO infrastructure can be leveraged to other populations. ACOs are in fact more likely to succeed if they deploy care management strategies across all patient populations. Medicaid beneficiaries could benefit from payment and delivery system reform initiatives aligned with the Shared Savings Program, and state Medicaid programs could reap considerable savings.