Materials on Accountable Care & ACOs

Our aim at UHPP is to explore the full horizon of opportunity to bring accountable care to Utah Medicaid. This concept may have had an abrupt and politically motivated beginning w/Senate Bill 180 and the Medicaid waiver request which followed.

• Utah’s Medicaid Accountable Care Transformation: Where Do We Go from Here?(February 2013)
• HBXX CHIP & Medicaid ER Use Amendments: First Step is to Improve Access to Patient-Centered Health Homes (January 2013)
• Better Care Conference & Summit (12/14/12)

PDFs of PowerPoint Presentations (click to view/download)
Better Care: Maximizing Opportunity in the ACA and Beyond (Renee Markus Hodin)
Better Care at Lower Cost for Medicaid: What Will It Take? (Brent James, MD)
Transforming Health Care In Oregon (David Labby, MD PhD)
The Camden Model An Integrated Community-led Safety-net Accountable Care Organization (Joseph Fleming)
Patient Incentives in Medicaid (Lydia Mitts)

• Better Care Conference & Summit Reading Materials (Utah Health Policy Project – Friday December 14,2012, 9am-4pm)
• Medicaid Accountable Care Organization Demonstration Project (New Jersey Dept. of Human Services – December 2012)
• One Year Later: The NJ Medicaid Accountable Care Organization Demonstration Project – Governance & Community Engagement An Overview (AARP of New Jersey – August 2012)
• Statement on Utah’s Pathway to Accountable Care (Patient-Centered Medicaid Reforms)
• UHPP Matrix of Comments & Recommendations for ACO Contract Draft
• Draft ACO Contract Language, August 7, 2012 Version  (Source: Utah Department of Health via GRAMMA request from Tribune)
• Bureau of Managed Care Responses to OIG or Office of Inspector General Suggested ACO Contract Provisions (Source: Utah Dept of Health via SL Tribune GRAMMA request).
• Medicaid Office of Inspector General Emergency Audit Memo-ACO/MCO Contract Delay (Source: SL Tribune).

Medicaid Reform & The Medicaid Waiver

Taking its cue from Senate Bill 180 (“Medicaid Reform,” by Senator Dan Liljenquist) the Utah Department of Health submitted an 1115 Waiver proposal on July 1, 2011. The waiver has been introduced as the first step in a multi-year process to modernize the way Medicaid services are paid for and delivered in Utah by organizing providers into accountable care organizations (i). ACOs are groups of health care providers who agree to be held accountable for improving health care quality while lowering costs.

Utah’s waiver proposal needs significant changes—or more in the way of detail—before we can establish whether it is an appropriate first step in the state’s transition to accountable care. For now, the June 1 waiver draft places the “accountability” squarely on the beneficiary in terms of increased cost sharing, penalties for noncompliance (i.e. disenrollment) and drawing clients into private insurance via subsidies. Nothing in the waiver seems to acknowledge the need for certain services, like care coordination, health education, transportation, etc., as necessities to help patients comply with care recommendations.

Over the next several months Utah and CMS will negotiate the terms and conditions of the waiver. Now more than ever advocates and providers will need to be in the driver’s seat, to make sure beneficiaries come out ahead in a reform process fraught with danger but also tremendous opportunity for improved quality, lower costs, and better health outcomes for patients.

Materials on the Proposed Medicaid Waiver

• Revised sign-on letter & waiver recommendations with list of endorsers
• Revised sign-on letter & waiver recommendations
• Better Care for Medicaid Patients: What it Takes Recommendations to Strengthen Utah’s Waiver Proposal (6/20/11)
• Survey Instrument used by MCAC members to rate importance of synthesized recommendations for Medicaid Reform Waiver
• Medicaid Waiver Recommendations: A Synthesis Created by UHPP for the Medical Care Advisory Committee (6/17/11)
• Medicaid Reform Recommendations: Public Informal Survey Results (7/18/11)
• Survey of MCAC members on Medicaid Waiver Proposal (6/22/11)
• UHA Principles to Guide Utah’s Development of a Medicaid Waiver
• Highlights from Community Meeting with Michael Hales, Utah DOH (6/9/11)
• Medicaid Reform Waiver Stakeholders Meetings: Highlights for Advocates

Materials on Accountable Care & ACOs 
Our aim at UHPP is to explore the full horizon of opportunity to bring accountable care to Utah Medicaid. This concept may have had an abrupt and politically motivated beginning w/Senate Bill 180 and the Medicaid waiver request which followed.

• Accountable Care Principles (3/30/12)
• Utah Accountable Care ‘Boot Camp’ Proceedings – with Helpful Links & New Tools (9/12/11)
• Children’s Health Improvement Collaborative Demo (Sum-Dr. Norlin)
• Using the Opportunity of Health Care Reform to Improve Care and Manage Costs for People with Physical Disabilities (Disability Practice Institute)
• A Health Care System Designed to Serve Adults with Disabilities
  (Community Catalyst & Boston Center for Independent Living)
• ACO Boot Camp Slides from Community Catalyst (9/12/11)
• ACO Boot Camp Slies from the Colorado Center on Policy & Law (9/12/11)
• ACO Resources for Bootcamp Attendees (9/12/11)
• Diabetes Prevention Program Results (from ACO Boot Camp Speaker, Dr. Mark Briesacher)

  Sample Principles for Accountable or Better Care

  • Payment Reform: 10 Patient Principles (Campaign for Better Care)
  • Joint ACO Principles of AAP (pediatricians), American Academy of Family Physicians (also adopted by AMA House of Delegates)
  • ACO Principles from the American Medical Group Association

(i) Department of Health (2011). Utah Medicaid Payment and Service Delivery Reform Proposal. http://health.utah.gov/medicaid/stplan/1115%20Waivers.htm.

Mental Health Integration Team

• Mental Health Integration Work Group Meeting Minutes (5/10/12)
• Behavioral/Medical Health Care Integration Blueprint

Medicaid Options

• Flexibility on the Medicaid Expansion: Pros and Cons of Flexibility Scenarios for Utah (3/18/13)