Accountable Care Organizations in California: Programmatic and Legal Considerations

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The Affordable Care Act (ACA) authorizes the federal government to test new healthcare payment and delivery models through Accountable Care Organizations (ACOs). New federal rules have been proposed for two ambitious ACO programs – the Medicare Shared Savings Program (MSSP) and the Pioneer program. California policymakers will need to consider how the state’s legal framework for regulating healthcare insurers and providers either supports or inhibits the federal goals.

The California HealthCare Foundation – in a new paper authored by the Manatt Health Solutions team of William Bernstein, Jonah Frohlich, Francis LaPallo, Arun Patel and Martin Thompson – provides an overview of the issues, both programmatic and legal, that will need to be assessed by California policy-makers in considering the development of ACOs in the state. The success of MSSP and Pioneer ACOs in California will be determined by alignment with a number of state activities, including commercial ACO initiatives, Medi-Cal ACO pilots targeting high-cost populations through its managed care program, and emerging health information exchange and health benefit exchange initiatives.

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DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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