The Next Step – Medicaid ACOs?

“Leading-edge state Medicaid agencies across the country are exploring the potential of accountable care organizations (ACOs)”

Kip Piper, in The Piper Report, outlines the 10 Core Considerations for Implementing Medicaid ACOs. It is an excellent look at the initial steps needed this if it is to become a reality.

Medicaid ACOs deserve a look. We are in a climate where it is politically unpalatable to “cut” Medicaid funding, yet we are going to be hard pressed to find all the money needed. The difference, as Piper points out, has to be from improvements in quality, delivery, and cost-efficiency. Even though the jury is still deliberating on the overall impact of ACOs, why not test this in Medicaid?

As we  move forward with Medicaid expansion, innovation and risk taking will be what pushes us to achieve Medicaid’s overall goals. Just the fact that Medicaid ACOs are being considered demonstrates the drive toward doing things differently. How this all shakes out is still a mystery. What is known is that a new way for everything in Medicaid is the kind of reform that needs more focus.

~ Richard Yadon

Where will the Medicaid dollars come from?

The Debate is Finally Getting Around to Reform

This is one of the most persistent questions being asked today. If ACA is here to stay AND if Medicaid is going to expand, how do we pay for it? One answer has been to increase tax revenues on the wealthiest Americans. While this has become a popular sentiment, it is more of a political statement then any meaningful enhancement to revenue.

The real answer to the question seems to be coming around to the need for true reform; reform in how we fund Medicaid, in how we reimburse providers, and in how we deliver care to Medicaid members. The money debate has moved on from whether ACA and Medicaid expansion should be done, but in how it will be implemented.

In a recent post on The Health Care Blog, writer Dan Diamond illustrates this shift in focus by describing the change in tone from Florida Governor Rick Scott.  Scott, a staunch opponent of ACA and Medicaid expansion, is described in the post as begrudgingly implementing ACA. It is a dramatic example of how the momentum has swept the issue into a new pool of discussion and thought.

If we were designing a health-reform agenda from scratch, what would it look like?” ~ Avik Roy in National Review (Click to tweet this)

I view this development as the right next step. However, it will be the private sector that has to lead. We can’t generate enough funding to do everything for everyone in Medicaid. The shortfall will need to come from innovation, efficiency and improved health outcomes. The private sector has already been working hard on this and building new ways to meet the demand, and reality, of health care delivery in the post-ACA world. If government can finally agree on the framework, then I believe the private sector can find a way to make it happen.

A better way does not have to be more expensive. The Affordable Care Act is not perfect. It has a lot of flaws that may actually do more harm than good.  At least  now we are talking about what it was intended to do; reform how we deliver health care.


~ Richard Yadon

Top 10 Reasons to Attend the Medicaid Innovations Conference

Top 10 Reasons to Attend this Year’s Medicaid Innovations Forum


Plus $200 Off – Use Code MMTS




  1. Arkansas Department of Human Services will offer a unique case study about their Healthcare Payment Improvement Initiative, focusing on how they are Aligning Payment Incentives for Delivery of High Quality Coordinated Care.
  2. Leaders from EmblemHealth and UnitedHealthcare will discuss Health Insurance Exchanges and Shifting Thinking from Medicaid to Commercial Operations.
  3. Minnesota and Colorado share their first-hand perspectives on establishing an ACO within their Medicaid programs.
  4. Wellpoint will share the key components of the quality initiative that resulted in improved HEDIS scores including promoting preventive care, encouraging and rewarding best practices, creating a lever for medical home-based care, and improving data capture.
  5. Missouri Department of Social Services will address Preventing and Detecting Fraud and Abuse in Medicaid Managed Care Organizations.
  6. L.A. Care will disclose their community partnership approach to reducing unnecessary ER visits and preventable readmissions and Ohio offers the state perspective on reducing ER visits among Medicaid beneficiaries.
  7. The Department of Vermont Health Access will explore the challenges of expansion, and the plan to launch a single, universal payer system.
  8. UnitedHealth Group, the State of Michigan, and CareSource offer their unique strategies for consumer engagement.
  9. EmblemHealth shares how they are preparing for the challenge and opportunity of dual eligible integrated care programs.
  10. UPMC Health Plan will deliver a case study on how they are supporting the Patient Centered Medical Home in Medicaid and CareSource discusses their bridge to home discharge planning program.
To see the agenda, visit

Technology Trends in Medicaid

Did you miss last week’s Medicaid Matters Talk Show? Richard Yadon, show host interviewed Gwen Williams VP of Molina Medicaid about the latest trends driving the Medicaid eco-system forward toward 2013. Ms. Williams currently serves as the Chairwomen of the Private Sector Technology Group. Learn more about the PSTG by clicking here.

Listen in to the Medicaid Matters show recording below:

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How will the election change Medicaid?

It is a busy news morning following last nights debate. We wanted to make sure you saw this pre-debate interview with Phil Galewitz from Kaiser Health News. During the interview Mr. Galewitz addressed some of the most frequently asked questions about Medicaid. He also digs into to how Medicaid is factoring into this election season and potential impacts of each candidates proposals. Did you know that 7 out of 10 people in nursing homes are covered by Medicaid and that Medicaid spending represents about 10% of the federal budget.

Read entire article by CLICKING HERE

Most Admired CEO Nomination- Congratulations to Richard Yadon!

Congratulations to our very own Richard Yadon! He has been nominated for one of the Nashville Business Journal’s 2012 Most Admired CEO and Their Companies Awards presented by Chase in the Institution

Richard Yadon, Host Medicaid Matters Talk Show

Awards and Recognition

The Most Admired CEOs and Their Companies Awards presented by Chase awards the top CEO’s in the city by category.

Black Tie Award Ceremony

It culminates to a black tie awards dinner on December 4th at the Schermerhorn Symphony Center where we will recognize the finalists and one winner in each category, plus a lifetime achievement winner.

Check out the 12/7 Nashville Business Journal

In addition to the awards dinner, finalists and winners will be featured in a special insert in the December 7th issue of the Nashville Business Journal.

Mr. Yadon is the President and founder of Managed Medicaid Services and the host of the Medicaid Matters Talk Show, both of which are located in a suburb of Nashville, TN.

Please join us in congratulating Richard by leaving a comment in the box below this post.

Medicaid Video Blog: Penny Wise/ Pound Foolish?

In this week’s Medicaid news an article about cost cutting measures in Maine caught our eye. In an attempt to reduce cost will a “cost effective solution” be thrown out the window?

Click here to read the full article

Celebrating Great Work- Making a Difference for Medicaid Members

We hope you are reading this message from the comfort of your home office or mobile device  as you take time to enjoy family and friends on this well earned day off.

Labor Day was set aside on June 28th, 1894 as a national holiday.  This day was dedicated to the working men, women and children who have become the industrial foundation on which America was built.  It is a day to pay tribute to all of those who contribute to the social and economic success of the nation.

We want to wish you all the happiest of Labor Day’s and extend an extra special “shout out” to all of those who go beyond expectations to make the “work” of bringing Medicaid benefits to thousands of needy Americans their life’s passion. Take a moment and listen to their stories.

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Killing the Medicaid Expansion Controversy

This is the crux of the real debate. No one can doubt that providing health care to the poorest of our population is a worthy, beneficial, and ethical goal. Here is a perspective the looks at that and the very real problem of paying for it.

Read more here

MHPA Letter to Secretary Sebelius

CapitalThomas Johnston, President of the Medicaid Health Plans of America wrote a letter this week to Secretary Sebelius, U.S. Department of Health and Human Services. We feel his message, of support, guidance and urgency is an important one. We applaud his efforts encouraging HHS to continue the improvement/updating of payment models, tracking systems and policies that govern how care management is handled for the “duals”. We have included a link to the letter below.

Click here to read the letter.