Medicaid ACOs have the potential to align payment and care delivery incentives to promote high-quality, well-coordinated care and improve population health, according to an issue brief from the Milbank Memorial Fund.
Despite their potential, Medicaid ACOs looking to incorporate population health strategies may face the following five challenges.
It is difficult to establish clear cause-and-effect relationships because the social determinants of health that affect population health outcomes do so through multiple pathways and mechanisms.
There are very few models for ACOs to use that successfully integrate clinical healthcare with social, public health and community-based interventions such as housing assistance, access to food, early childhood education and environmental protection.
The data and strategies Medicaid ACOs need to create mechanisms that can project long-term impacts, construct a business case, measure population health outcomes and improvements and establish accountability are in the early stages of development.
An inherent tension exists between targeting high-need, high-cost patients to achieve a short-term return on investment and targeting a broader population without the likelihood of any immediate cost savings.
Many ACOs lack the authority, expertise, incentives, infrastructure and partnerships needed to assume responsibility for a population broader than their narrowly defined, attributed members, or for a broader set of services than the medical services agreed upon in existing contracts.
The issue brief also included several strategies states use to combat these challenges and establish population health-focused Medicaid ACOs, including developing ACO governance standards to promote population health, leveraging existing data sources to identify population health needs and promoting the use of community health workers and other nontraditional providers in Medicaid ACO teams.
Read the full issue brief here.
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