Medicaid Accountable Care Organizations: Program Characteristics in Leading-Edge States

As state leaders move beyond their focus on the coverage challenges arising from the Affordable Care Act (ACA), they are paying increasing attention to the payment and delivery system reform opportunities spurred by both the law itself and by changes in the broader health care marketplace. States have been actively pursing innovative care delivery and payment models to improve the capacity of the health system to deliver high value care and increase provider accountability, particularly for high-need populations facing multiple health and social challenges. 
 
The need to foster integrated care delivery and address social determinants of health has led to the development of accountable care organizations (ACOs) in Medicaid. The common goal of these initiatives is to coordinate a wide array of needed services to improve the quality of care and curb costly and avoidable hospitalizations of Medicaid beneficiaries, particularly those with multiple chronic conditions and behavioral health needs. Given these extensive transformation efforts, states are leveraging existing investments in managed care and primary care to guide the development of their Medicaid ACO programs.