The Accountable Care Organization (ACO) model was reviewed by the Task Force. ACOs are organizations under which there is shared responsibility among providers for care. In an enrollees’ ACO model providers have an opportunity to reap the benefits of shared savings. Medicaid ACOs are still in their infancy but a growing number of States are examining this model as a potential management strategy. Review of Initiatives Being Used in Other Medicaid Programs States’ Medicaid agencies around the country are experiencing significant budget constraints. Immediate savings have been realized through traditional strategies aimed at decreasing utilization and restricting reimbursement. Such strategies were reviewed by the Task Force in the context of long-term impact on access to care and cost shifting. Nationwide, longer-term strategies continue to be explored to transform the delivery of care to both improve quality outcomes and realize cost savings. Table 14 provides a summary of recent cost-cutting and quality initiatives being implemented by State Medicaid agencies. Table 14: Nationwide Cost-Containment Trends Strategy Nationwide Trends Recent MaineCare Initiatives Increased FY 2012: 14 states adopted N/A Benefit reductions FY 2012: Eliminate - Smoking cessation products (except & limitations 17 states imposed for pregnant women): 10/1/12 (pending) limits Eliminate - Ambulatory surgical center services: 7 states eliminated 9/1/12 (pending) Use of Prior Authorization Eliminate - STD screening clinic services Concurrent review Limit - Optometry visits for adults (1/3 years) Targeting high cost imaging & Limit - Chiropractic visits (12/year) radiology Limit - Added medical eligibility criteria for Case Common benefits targeted: Management for homeless Home health & Limit - Physical therapy (2 hr./day) personal care Limit - Occupational therapy (2 hr./day & 1 Dental visit/year for palliative or maintenance care Physical, Speech & PA currently required for a multitude of services Occupational Therapy Vision
The Accountable Care Organization (ACO) model was reviewed by the Task Force. ACOs are organizations under which there is shared responsibility among providers for enrollees’ care. In an ACO model providers have an opportunity to reap the benefits of shared savings. Medicaid ACOs are still in their infancy but a growing number of States are examining this model as a potential management strategy. Review of Initiatives Being Used in Other States’ Medicaid Programs Medicaid agencies around the country are experiencing significant budget constraints. Immediate savings have been realized through traditional strategies aimed at decreasing utilization and restricting reimbursement. Such strategies were reviewed by the Task Force in the context of long-term impact on access to care and cost shifting. Nationwide, longer-term strategies continue to be explored to transform the delivery of care to both improve quality outcomes and realize cost savings. Table 14 provides a summary of recent cost-cutting and quality initiatives being implemented by State Medicaid agencies. Table 14: Nationwide Cost-Containment Trends Strategy Nationwide Trends Recent MaineCare Initiatives Increased FY 2012: 14 states adopted N/A Benefit reductions & limitations FY 2012: 17 states imposed limits 7 states eliminated Use of Prior Authorization Concurrent review Targeting high cost imaging & radiology Common benefits targeted: Home health & personal care Dental Physical, Speech & Occupational Therapy Vision Eliminate - Smoking cessation products (except for pregnant women): 10/1/12 (pending) Eliminate - Ambulatory surgical center services: 9/1/12 (pending) Eliminate - STD screening clinic services Limit - Optometry visits for adults (1/3 years) Limit - Chiropractic visits (12/year) Limit - Added medical eligibility criteria for Case Management for homeless Limit - Physical therapy (2 hr./day) Limit - Occupational therapy (2 hr./day & 1 visit/year for palliative or maintenance care PA currently required for a multitude of services