Restructuring Medicaid through the development of Accountable Care Organizations should be characterized for what it really is: a grand experiment, predicated on an ongoing national experiment, predominantly in Medicare, that has yet to show expected savings and quality improvement. Not only have the results been mixed, but half of Medicare’s original “pioneers” dropped out; significant changes to the next-generation models were needed to entice more players. Furthermore, these ACOs have little experience in Medicaid.
Does this mean Massachusetts should not move ahead with strategies to improve care and reduce costs for the Medicaid population? Absolutely not. Among other reasons, the state cannot afford to risk potentially losing federal resources that will support ACO development.
So, what to do? Proceed with caution and maximum transparency, as the state has promised. Remember the history with other managed care – one could be forgiven for confusing an ACO with an MCO. It can be hard to look under the hood of capitated payments to see if money is really following the person — and their providers — to assure at least comparable, if not better, care.
Anticipated savings are not insubstantial. Watching quality and access closely will be imperative. Assuring that behavioral and community support services are priced right is critical. The planned ombudsman process must work effectively. And stop-loss strategies might be crucial if improving complex people’s care proves to be more expensive.
Massachusetts has a long, successful history with grand experiments in health care; transparency and vigilance can make this another one.
The writer is a professor of practice in Northeastern University’s Department of Health Sciences.