Safety-Net ACOs Hold Promise to Achieve the Triple Aim

21 Jan 2015

Aligning Forces Alliances in Maine, Minnesota, and Oregon were recently featured in Health Affairs for their efforts in developing safety-net accountable care organizations (ACO). ACO-focused initiatives have early signs of success in delivering cost-effective, patient-centered care while advancing patient engagement, thus achieving Medicaid’s Triple Aim. Safety-net ACOs are collaborative entities of providers, and sometimes payers, that are: 1) accountable for managing the health of their population; 2) assuming upside and/or downside financial risk; and, 3) serving predominantly Medicaid and uninsured patients.

State policies have been critical in launching ACO formation. For example in Maine, policymakers are encouraging the development of health homes, behavioral health integration, and Community Care Teams as conditions for participation in their state-led ACO initiative. In keeping with the desire for better-coordinated care and improved partnerships with regional agencies, Maine's ACO program mandates providers to develop partnerships with local public health entities that address women's health and nutrition.

The Minnesota Alliance has also proven a leader with Integrated Heath Partnerships—a mandate to develop ACOs under Minnesota statute. Building upon Integrated Health Partnerships, the Minnesota Alliance is using State Innovation Model funding to support partnerships between local delivery systems and community agencies to better address the regional population's health needs. Moreover, the Minneapolis-based Hennepin Health has been noted as a leading example of a safety-net ACO for its ability to recognize the importance a patient's socioeconomic environment plays into health. By integrating screening and coordination strategies, Hennepin Health uses risk assessment data to identify patients' social and economic needs, such as housing conditions for patients with complex medical conditions, to deliver more comprehensive care. In fact, Hennepin successfully secured designated housing units for their patients and advocated for increasing county-provided resources.

On the West Coast, the Oregon Alliance has pushed the health home model as a cornerstone of its ACO efforts.  For example, many of Oregon's Coordinated Care Organizations (CCOs) work closely with county health departments and social services agencies. Health Share, Oregon's largest CCO, is currently exploring how to coordinate provision housing services for eligible patients. Additionally, as part its state ACO program, Oregon promotes the training of community health workers as a CCO prevention strategy.

Safety-net ACOs are well-positioned to become integrators of health and community services for the Medicaid population in many states. Because of their commitment to addressing social determinants of health, they have the opportunity to extend this integration upstream to address population health.