Learning from Safety-Net Accountable Care Organizations

Dates: 2014-2015

States: California, Massachusetts, Minnesota

Client(s): Robert Wood Johnson Foundation (RWJF)

Service: Applied Research & Evaluation

Technical Expertise: Health Care Reform, Integrated Care Models, Safety Net

Accountable care organizations (ACOs) represent an important innovation in healthcare delivery and payment reform through their goals and incentive design to improve patient care and quality while controlling costs. Not only is Medicare supporting ACOs, but several states, private payers, and large employers have also placed a high priority on their development and spread across the healthcare system. However, one of the most challenging areas of ACO development involves safety-net providers (e.g., hospitals and community health centers) caring for underserved populations. Vulnerable populations have the potential to benefit significantly from patient-centered medical homes and other care coordination services provided through ACOs; yet, many safety-net patients lack stable Medicaid coverage and have overlapping social and health problems that make it difficult to maintain continuity of care with providers.

In collaboration with Bailit Health Purchasing, LLC, JSI is working with the Robert Wood Johnson Foundation (RWJF) on the project “Accountable Care Organizations: Testing Their Impact.” JSI’s project involves conducting case studies on four emerging ACOs serving safety-net populations in three states: Baystate Health and Commonwealth Care Alliance in Massachusetts; Hennepin Health in Minneapolis; and AltaMed Health Services in Los Angeles. Our overall goals of this project are to: 1) understand the dynamic processes by which safety-net ACOs are being developed; 2) identify the key barriers and facilitators to ACO implementation; 3) elucidate adaptations made to the ACO concept to provide care to underserved populations; and 4) identify any preliminary impact of the ACOs regarding costs, the patient experience of care, population health, and health disparities. This project will be designed to generate relevant information for emerging safety-net ACOs, state Medicaid officials interested in improving care and outcomes for the expanding Medicaid population, and those interested in improving care for vulnerable populations and reducing health disparities.

Read the related Health Affairs blog posts:
Early Observations Show Safety-Net ACOs Hold Promise to Achieve the Triple Aim and Promote Health Equity by James Maxwell, Michael Bailit, Rachel Tobey, and Christine Barron
Community Health Center Strategies For Pursuing Accountable Care by James Maxwell, Rachel Tobey, and Christine Barron


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