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