Increasingly, states are focusing on implementing Medicaid reforms as part of the Affordable Care Act’s (ACA) goal to deliver high-quality care while containing health care costs. Some are authorizing a new kind of Medicaid health care delivery system, accountable care organizations (ACOs). ACOs are integrated health care delivery organizations that not only cover the cost of medical care like a health insurance company, but also offer care coordination for health and social services to address the complex health needs of patients. ACOs consist of networks of health care providers and organizations like hospitals and clinics that work together to coordinate the health care of members. Medicaid payment rates to ACOs are capitated, meaning there is a standard payment rate per member regardless of services utilized. In addition, ACOs keep a share of the savings achieved by spending less than the capitated rate. This is a strong incentive to contain health care spending by investing in preventative care and care coordination to improve the health of members and reduce the need for expensive acute care
Janet Viveiros is a senior research associate at NHC. Janet’s research interests center on the connection between affordable housing and education, health and economic self-sufficiency outcomes.