Policy Recommendations for States to Promote Accountable Care in Medicaid Programs

by Manatt, Phelps & Phillips, LLP

[authors: Deborah Bachrach, William S. Bernstein, and Anne O'Hagen Karl]

Federal and state health reform efforts present compelling opportunities to advance new payment and delivery system models to improve the quality of healthcare services and reign in costs.  An emerging challenge for policymakers is to create alignment among these initiatives so that proliferation of payment and delivery system models does not lead to conflicting financial incentives and burdensome reporting requirements for providers.

A new report, "High-Performance Health Care for Vulnerable Populations: A Policy Framework for Promoting Accountable Care in Medicaid," prepared for The Commonwealth Fund by Deborah Bachrach, William Bernstein and Anne Karl of Manatt, Phelps & Phillips, LLP, notes that Medicaid can play a significant role in harmonizing the various delivery system reform initiatives and driving change that fosters greater accountability and improved performance across the health system and across payers.  The report focuses on the Medicare Shared Savings Program (MSSP) as an example of how Medicaid might build on reform programs in Medicare, as the Centers for Medicare and Medicaid Services (CMS) has explicitly recognized that the ACO infrastructure can be leveraged to care for Medicaid populations.

ACOs are most likely to succeed if they deploy care management strategies across all patient populations.  This report offers a policy framework for states to establish ACOs in their Medicaid programs by building on the MSSP model and harmonizing Medicaid's policies across Medicaid, both fee-for-service and managed care models as well as with Medicare.  Some of the specific recommendations in the report include:

Getting the strategy right.  States should develop a core strategy for achieving their goals of containing costs and improving quality in Medicaid and decide whether supporting ACO formation is central to this strategy.

Translating strategy into action.  In markets dominated by traditional fee-for-service payment structure, states may want to model their ACO programs on the MSSP.  However, for the large number of states with significant Medicaid managed care programs, relying on the MSSP model does not go far enough.  These states will want to consider strategies to integrate provider accountability (through quality metrics and performance-based payment methodologies) into their managed care program thereby aligning Medicaid managed care and fee-for-service policies.

ACO certification.  States should adopt a streamlined certification procedure that builds on the MSSP certification process and accounts for the needs of the Medicaid program, which provides care to a vulnerable patient population.  States may facilitate certification of Medicaid ACOs by several means, including: deeming ACOs participating in the MSSP certified for the purposes of Medicaid ACO participation; creating a supplemental certification process; or creating a parallel state certification process for providers not applying for certification as a Medicare ACO.  States may also consider working with an outside accreditation body to develop certification criteria that bridge the requirements of both Medicare and Medicaid.

ACO governance and ownership.  States should align any ACO governance and ownership requirements with those set forth in the MSSP in order to avoid imposing conflicting standards on providers participating in both programs.

Assignment to an ACO.  For Medicaid fee-for-service patients, it may make sense to follow MSSP's lead and assign patients retrospectively, based on where they receive a majority of their primary care in each year.  However, states may want to consider prospectively assigning individuals with complex needs to ACOs in order to reach out to and closely manage these individuals.

To access the full list of policy recommendations described within the report, please visit The Commonwealth Fund Web site.

This report is part of Manatt Health Solutions' library of thought leadership relating to the opportunities and challenges that exist for states in implementing federal healthcare reform and addressing issues relating to cost, quality and access to care.  The team recently authored "Toward a High Performance Health Care System for Vulnerable Populations: Funding for Safety Net Hospitals" (March 2012); "Accountable Care Organizations in California: Programmatic and Legal Considerations" (July 2011); and "Considerations for the Development of Accountable Care Organizations in New York State" (June 2011).  For a detailed list of white papers authored by Manatt, please click here.


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.

© Manatt, Phelps & Phillips, LLP | Attorney Advertising

Written by:

Manatt, Phelps & Phillips, LLP

Manatt, Phelps & Phillips, LLP on:

Readers' Choice 2017
Reporters on Deadline

"My best business intelligence, in one easy email…"

Your first step to building a free, personalized, morning email brief covering pertinent authors and topics on JD Supra:
Sign up using*

Already signed up? Log in here

*By using the service, you signify your acceptance of JD Supra's Privacy Policy.
Custom Email Digest
Privacy Policy (Updated: October 8, 2015):

JD Supra provides users with access to its legal industry publishing services (the "Service") through its website (the "Website") as well as through other sources. Our policies with regard to data collection and use of personal information of users of the Service, regardless of the manner in which users access the Service, and visitors to the Website are set forth in this statement ("Policy"). By using the Service, you signify your acceptance of this Policy.

Information Collection and Use by JD Supra

JD Supra collects users' names, companies, titles, e-mail address and industry. JD Supra also tracks the pages that users visit, logs IP addresses and aggregates non-personally identifiable user data and browser type. This data is gathered using cookies and other technologies.

The information and data collected is used to authenticate users and to send notifications relating to the Service, including email alerts to which users have subscribed; to manage the Service and Website, to improve the Service and to customize the user's experience. This information is also provided to the authors of the content to give them insight into their readership and help them to improve their content, so that it is most useful for our users.

JD Supra does not sell, rent or otherwise provide your details to third parties, other than to the authors of the content on JD Supra.

If you prefer not to enable cookies, you may change your browser settings to disable cookies; however, please note that rejecting cookies while visiting the Website may result in certain parts of the Website not operating correctly or as efficiently as if cookies were allowed.

Email Choice/Opt-out

Users who opt in to receive emails may choose to no longer receive e-mail updates and newsletters by selecting the "opt-out of future email" option in the email they receive from JD Supra or in their JD Supra account management screen.


JD Supra takes reasonable precautions to insure that user information is kept private. We restrict access to user information to those individuals who reasonably need access to perform their job functions, such as our third party email service, customer service personnel and technical staff. However, please note that no method of transmitting or storing data is completely secure and we cannot guarantee the security of user information. Unauthorized entry or use, hardware or software failure, and other factors may compromise the security of user information at any time.

If you have reason to believe that your interaction with us is no longer secure, you must immediately notify us of the problem by contacting us at info@jdsupra.com. In the unlikely event that we believe that the security of your user information in our possession or control may have been compromised, we may seek to notify you of that development and, if so, will endeavor to do so as promptly as practicable under the circumstances.

Sharing and Disclosure of Information JD Supra Collects

Except as otherwise described in this privacy statement, JD Supra will not disclose personal information to any third party unless we believe that disclosure is necessary to: (1) comply with applicable laws; (2) respond to governmental inquiries or requests; (3) comply with valid legal process; (4) protect the rights, privacy, safety or property of JD Supra, users of the Service, Website visitors or the public; (5) permit us to pursue available remedies or limit the damages that we may sustain; and (6) enforce our Terms & Conditions of Use.

In the event there is a change in the corporate structure of JD Supra such as, but not limited to, merger, consolidation, sale, liquidation or transfer of substantial assets, JD Supra may, in its sole discretion, transfer, sell or assign information collected on and through the Service to one or more affiliated or unaffiliated third parties.

Links to Other Websites

This Website and the Service may contain links to other websites. The operator of such other websites may collect information about you, including through cookies or other technologies. If you are using the Service through the Website and link to another site, you will leave the Website and this Policy will not apply to your use of and activity on those other sites. We encourage you to read the legal notices posted on those sites, including their privacy policies. We shall have no responsibility or liability for your visitation to, and the data collection and use practices of, such other sites. This Policy applies solely to the information collected in connection with your use of this Website and does not apply to any practices conducted offline or in connection with any other websites.

Changes in Our Privacy Policy

We reserve the right to change this Policy at any time. Please refer to the date at the top of this page to determine when this Policy was last revised. Any changes to our privacy policy will become effective upon posting of the revised policy on the Website. By continuing to use the Service or Website following such changes, you will be deemed to have agreed to such changes. If you do not agree with the terms of this Policy, as it may be amended from time to time, in whole or part, please do not continue using the Service or the Website.

Contacting JD Supra

If you have any questions about this privacy statement, the practices of this site, your dealings with this Web site, or if you would like to change any of the information you have provided to us, please contact us at: info@jdsupra.com.

- hide
*With LinkedIn, you don't need to create a separate login to manage your free JD Supra account, and we can make suggestions based on your needs and interests. We will not post anything on LinkedIn in your name. Or, sign up using your email address.