Intensive case management and understanding the impact of social needs on health set Medicaid ACOs apart from their counterparts.
We often think of an ACO as a way for providers to coordinate care, improve quality and outcomes for patients, and reduce costs for payers. But applying the ACO framework to Medicaid runs head on into a stubborn challenge: the disproportionate impact of socioeconomic factors on health in the Medicaid population.
“We don’t have the payment structure in Medicaid in any state yet to adequately address those needs,” says Gregory Paulson, executive director of the Trenton Health Team (THT), which operates a New Jersey Medicaid ACO demonstration program. According to the not-for-profit Center for Health Care Strategies (CHCS), nine states have fledgling Medicaid ACO demonstrations serving a total of 2 million beneficiaries (see map below). These include payment models that directly or indirectly encourage coordination with non health care services; highly targeted data analysis; and shared savings for federally qualified health centers (FQHCs). In 2013, FUHN became one of the first of six Medicaid ACOs in Minnesota’s Integrated Health Partnerships demonstration. “It was pretty gutsy, and the fact that we didn’t have a large integrated health care delivery system took people by surprise,” says Jaeson Fournier, FUHN’s board treasurer and immediate past chairman.
Care coordination makes sure that “patients who are moderately or persistently mentally ill are connecting with the medications they need,” says Jaeson Fournier of the Federally Qualified Health Center Urban Health Network (FUHN) in the Twin Cities. Founded in 2006 in response to the closure of one of Trenton’s hospitals, THT was a way for the city’s health department, its FQHC, and its two remaining hospitals to assess community health needs and align efforts.
The ACO’s activities build on THT’s community health assessment, developed from hospital utilization data and 300 one-on-one interviews conducted in the community. FUHN identifies utilization patterns and leverages staff capacity accordingly, using care coordinators to contact patients while there is a window of opportunity to bring them in for follow-up care, says Fournier, “and, more importantly, to engage them about how they can and should be consuming their health care resources.” THT built the Trenton Health Information Exchange (THIE), which connects the vast majority of Trenton-area providers, including labs, behavioral health, and the city’s FQHC, all of whom contribute patient data to the THIE, regardless of payer.
