Maryland Medicaid To Launch ACO-Like Model For Dual Eligibles

The Maryland Department of Health and Mental Hygiene (DHMH) is planning to launch a pilot Accountable Care Organization-like model (ACO) for individuals dually-enrolled in Medicaid and Medicare who live in Baltimore City.  The Dual Eligible ACO will operate on a shared savings model with savings targets and quality of care benchmarks focused on coordination of primary, acute, and long-term care. The goal is to scale the model statewide after the pilot outcomes are analyzed.

In a March 23, 2015, presentation to the Medicaid Advisory Committee, DHMH provided the following details about the background and plans for the “Dual Eligible ACO” pilot. The pilot was the focus of the state’s State Innovation Model (SIM) design proposal. The Centers for Medicare and Medicaid Services (CMS) awarded SIM funding of $2.5 million in December 2014, but required the state to resubmit the proposal after making revisions.

On May 15, 2015, DHMH released a request for proposals (RFP DHMH/OPASS-15-14550) seeking a contractor to provide support for the Dual Eligible ACO. Proposals are due by July 8, 2015. The contractor selected through RFP DHMH/OPASS-15-14550 will develop the shared savings model, a quality alignment and measurement plan, a provider organization engagement strategy, a dual eligible enrollment strategy, and a lead entity and governance structure. The RFP said bidders must have at least two years of experience within the past five years with innovative health care delivery and financing models. The RFP noted no specifics for managing care for people with serious mental illness.

The ACO-like model the state seeks to develop for the dual eligible pilot is a Medicaid Integrated Delivery Network (IDN); it is part of a broader project the state launched in 2014 to modernize Maryland’s rate setting system for hospital services. For the past 36 years, Maryland has had a Medicare waiver allowing the state to set hospital reimbursement rates. Under the latest waiver agreement effective January 1, 2014 with the federal Center for Medicare and Medicaid Innovation (CMMI), Maryland is seeking to establish an all-payer model to transform Maryland’s health care system to enhance patient care, improve population health, and lower total costs.