Realizing the Potential of Accountable Care in Medicaid.

Issue: Accountable care organizations (ACOs), designed to hold health care providers responsible for the quality and overall cost of patient care, have played a leading role in U.S. efforts to improve health system performance. While much of the experimentation with ACOs has focused on the Medicare program, Medicaid ACOs have been established in more than a dozen states. Much less is known, however, about the design of Medicaid ACOs and their impact on patients and costs. Goals: Evaluate the impact of Medicaid ACOs on health care costs, quality, and access, and analyze the building blocks and barriers to their success. Methods: Synthesis of findings from 30 empirical studies and 16 interviews with Medicaid agency leaders and safety-net providers in eight states — four with and four without Medicaid ACOs. Key Findings and Conclusions: Medicaid ACOs have achieved improvements in health care quality, costs, and, to a lesser degree, equity. Barriers to their adoption include competing policy priorities and local stakeholder resistance. CMS could encourage broader adoption of ACOs in Medicaid by offering greater flexibility to meet local needs and provider capabilities while streamlining the process through which states can introduce new payment models. [ABSTRACT FROM AUTHOR]