Delaware Approves Four Medicaid ACOs
Accountable care organizations have been operating in Delaware for several years, but the state recently authorized its first four Medicaid ACOs. The new ACOs are part of a larger plan to transform the way that healthcare is delivered and paid for in the state.
The four Medicaid ACOs are Aledade Delaware ACO; Delaware Care Collaboration, a partnership between Saint Francis Healthcare and the Medical Society of Delaware; Delaware Children’s Health Network, affiliated with Nemours Children’s Health System; and Delaware Medicaid Quality Partners ACO, affiliated with ChristianaCare.
The ACOs are now authorized to negotiate and enter into agreements directly with the state’s two Medicaid managed care organizations (MCOs) – AmeriHealth Caritas Delaware and Highmark Health Options – which provide for the delivery of benefits and services. Under the program, the contracts are expected to begin July 1, 2021, and run through Dec. 31, 2024, provided that the MCOs maintain their contracts with the Division of Medicaid and Medical Assistance (DMMA) for the term of the agreement.
Under Delaware’s Medicaid ACO program, contracts between the ACOs and MCOs require participation by at least 5,000 Medicaid and/or Children’s Health Insurance Program (CHIP) enrollees, excluding individuals in long-term care facilities, those eligible for both Medicaid and Medicare, and those receiving long-term services and supports. Enrollees voluntarily decide to participate in the ACO through their primary care provider or their managed care organization.
“The Medicaid ACO program advances our efforts to move Delaware’s health care system toward a model that is sustainable and that meets the ongoing needs of the patients we serve,” said Delaware Department of Health and Social Services Secretary Molly Magarik, in a statement. “The program’s value-based purchasing model is a pillar of our work to change how healthcare is delivered and paid for in Delaware, with the goal of reducing the cost of healthcare in the state while improving the overall health of our clients.”
Medicaid ACOs operate in about a dozen states, several of which have reported promising results from their programs. Minnesota, which launched its Medicaid ACO program in 2012, reported that it saved $213 million in healthcare costs, reduced hospital readmissions by 14 percent and reduced emergency department visits by 7 percent in the program’s first four years.
The ACO initiative and Delaware’s healthcare spending and quality benchmarks are centerpieces in Delaware’s Road to Value – a plan to transform the way that healthcare is delivered and paid for in the state. In 2018, Governor John Carney signed an executive order establishing healthcare spending and quality benchmarks as a way to manage the growth of future health care spending, increase transparency into how care is delivered and paid for, and improve the quality and cost of care. That same year, DHSS added value-based purchasing requirements to its Medicaid managed care contracts.
“Our Medicaid beneficiaries typically are among our most vulnerable residents, those who are more likely to face certain challenges to good health than people who receive Medicare or commercial health coverage,” Secretary Magarik said. “These challenges include struggles with income, housing, food, and transportation, and a greater need for behavioral health support. The new Medicaid ACOs address these issues by promoting changes in how care is delivered and by fostering relationships among a variety of health-services organizations.”
