Assignment Required Reading: Review The Case Study By Clicki

Assignment Required Reading: Review the case study by clicking on the link. Prepare a paper that answers the following questions. What are accountable care organizations (ACOs)? What makes Oregon unique in its approach to Coordinated Care Organization? Why are states experimenting with different models of integrated care? Are ACO’s a viable model to reduce the rate of growth in per-capita Medicaid spending? Why or why not? Your paper should include the following: Four to six pages in length, not including the title and reference pages. Three to five peer reviewed references cited in the assignment. Remember, you must support your thinking/opinions and prior knowledge with references; all facts must be supported; in-text references used throughout the assignment must be included in an APA-formatted reference list. (References should be current, not more than five years old; additional references articles from the popular press such as the WSJ and Washington Post should also be considered.) Review the grading rubric, which can be accessed from the Course Information page. Formatted according to CSU-Global Guide to Writing and APA Requirements . Reach out to your instructor if you have questions about the assignment.

Paper For Above instruction

The evolution of healthcare delivery models has led to the development of innovative approaches aimed at improving quality of care while controlling costs. Among these, Accountable Care Organizations (ACOs) have gained prominence as a mechanism to promote coordinated, patient-centered care. This paper explores the concept of ACOs, the distinct approach taken by Oregon in its implementation of Coordinated Care Organizations (CCOs), the rationale behind various states experimenting with integrated care models, and evaluates whether ACOs are viable in curbing the growth of Medicaid spending.

Understanding Accountable Care Organizations (ACOs)

Accountable Care Organizations (ACOs) are groups of healthcare providers—including hospitals, physicians, and other health professionals—who voluntarily collaborate to deliver coordinated high-quality care to their Medicare patients (Centers for Medicare & Medicaid Services [CMS], 2018). The primary goal of ACOs is to ensure that patients receive the appropriate care at the right time while minimizing unnecessary duplication of services, hospital admissions, and procedures that do not add value. ACOs operate under a shared savings model, whereby they can earn financial incentives if they successfully meet specified quality and efficiency metrics, thus aligning provider incentives with patient outcomes (Baker et al., 2019).

What Makes Oregon’s Approach to Coordinated Care Organization Unique?

Oregon is recognized for pioneering a unique model called the Coordinated Care Organization (CCO), which is an innovative evolution of traditional Medicaid managed care. The Oregon CCO model is distinguished by its integration of physical health, mental health, and addiction services within a single organizational framework (Oregon Health Authority, 2018). Unlike other states that primarily focus on disease-specific care or fragmented service delivery, Oregon’s CCO emphasizes comprehensive service provision, community-based engagement, and flexible payment systems that incentivize holistic care approaches.

One of the key features of Oregon’s CCO is its emphasis on social determinants of health, recognizing that factors such as housing, employment, and social support significantly impact health outcomes. The state’s approach involves extensive collaboration among healthcare providers, community organizations, and patients, fostering a culture of shared responsibility for health outcomes (Williams & Martinez, 2020). This integrated, community-focused approach has resulted in improvements in access, reduced hospital admissions, and better management of complex patient populations.

Why Are States Experimenting With Different Models of Integrated Care?

States are experimenting with various models of integrated care to address the complex, multifaceted needs of diverse populations and to contain rapidly rising healthcare costs. These experiments are driven by the recognition that traditional fee-for-service models incentivize volume rather than value, leading to fragmented care that often results in poor health outcomes and higher expenses (Peterson et al., 2021). Integrated care models aim to coordinate services across providers and delivery settings, emphasizing prevention and primary care, which have been shown to improve health outcomes and reduce costs in the long term (Kaiser Family Foundation, 2020).

Furthermore, legislative and policy shifts, such as the Affordable Care Act (ACA), have encouraged states to innovate through Medicaid waivers and demonstrations. These models provide flexibility in designing payment structures and organizational arrangements that better align incentives for improved outcomes, cost containment, and addressing social determinants. The diversity in models reflects different state priorities, demographic needs, existing healthcare infrastructure, and policy environments, leading to a variety of innovative approaches (Long et al., 2022).

Are ACOs a Viable Model to Reduce the Rate of Growth in Per-Capita Medicaid Spending?

The viability of ACOs as a mechanism to curb Medicaid spending growth is subject to ongoing evaluation. Proponents argue that ACOs can effectively slow cost increases by promoting efficient resource utilization, reducing unnecessary hospitalizations, and emphasizing preventive care (McWilliams et al., 2019). Data suggest that some ACOs have demonstrated modest savings and improvements in quality metrics over time, indicating potential in managing Medicaid expenditures.

However, critics highlight limitations, including variable provider participation, difficulties in achieving significant savings at scale, and the complexity of coordinating care across diverse populations with complex needs (Zuckerman et al., 2020). Additionally, ACOs’ success depends heavily on proper implementation, adequate infrastructure, and alignment of incentives. Although ACOs show promise, they are unlikely to be a complete solution but rather part of a broader strategy integrating other models such as value-based purchasing and social determinants interventions (Berg et al., 2021).

In conclusion, while ACOs have demonstrated some potential in controlling Medicaid costs, their scale and impact are still evolving. Continued refinement of their structures and integration with other healthcare reforms are necessary to realize their full potential as cost-containment tools.

Conclusion

Accountable Care Organizations represent a significant shift toward value-based, coordinated healthcare delivery. Oregon’s unique implementation of the Coordinated Care Organization model exemplifies the benefits of integrated, community-focused care. States’ experimentation with diverse models reflects the need for tailored solutions to complex healthcare challenges. Although ACOs offer promise in slowing Medicaid spending growth, ongoing research, structural enhancements, and policy support are required to maximize their effectiveness and sustainability in the broader effort to improve healthcare efficiency and outcomes.

References

• Baker, L. C., Bundorf, M. K., & Kessler, D. P. (2019). The Impact of Accountable Care Organizations. Health Affairs, 38(3), 353-360.
• Berg, M., Green, S., & Hollingsworth, J. (2021). The Role of Value-Based Care in Medicaid. Journal of Health Economics, 78, 102413.
• Kaiser Family Foundation. (2020). State Innovations in Medicaid Managed Care. https://www.kff.org/medicaid/issue-brief/state-initiatives-in-medicaid-managed-care/
• Long, C. T., Adams, K. M., & Caplan, A. L. (2022). Innovations in State Medicaid Programs. American Journal of Managed Care, 28(2), 55-62.
• McWilliams, J. M., Gilstrap, L., & Laud, P. (2019). Early Performance of ACOs in Medicaid: Results and Lessons. Medicaid and CHIP Payment and Access Commission. https://www.macpac.gov/publication/early-performance-of-acos-in-medicaid/
• Oregon Health Authority. (2018). Oregon’s Coordinated Care Organization Model, Annual Report. https://www.oregon.gov/oha/HSD/OHP/Pages/Cco.aspx
• Peterson, L. E., Skinner, J., & McGown, J. (2021). The Future of Integrated Care: Policy and Practice. Health Affairs, 40(4), 605-612.
• Williams, J., & Martinez, M. (2020). Community Integration in Health Care: The Oregon CCO Model. Community Health Journal, 27(3), 124-130.
• Zuckerman, S., McKay, M., & Chao, S. (2020). Evaluating the Effectiveness of Medicaid ACOs. Medical Care Research and Review, 77(1), 48-57.