DHSS authorizes four Medicaid ACOs

NEW CASTLE – The Department of Health and Social Services’ Division of Medicaid and Medical Assistance has authorized four health-care provider groups to serve as Medicaid Accountable Care Organizations (ACOs), according to a news release Tuesday.

According to the DHSS, ACOs are important participants in the state’s effort to innovate around the quality and cost of health care, and to improve health outcomes for Delaware’s Medicaid population.

The four ACOs are:
• Aledade Delaware ACO
• Delaware Care Collaboration, a partnership between Saint Francis Healthcare and the Medical Society of Delaware
• Delaware Children’s Health Network, affiliated with Nemours Children’s Health System
• Delaware Medicaid Quality Partners ACO, affiliated with ChristianaCare

The ACOs are now authorized to negotiate and enter into agreements directly with the state’s two Medicaid managed care organizations (MCOs) – AmeriHealth Caritas Delaware and Highmark Health Options – which provide for the delivery of benefits and services.

Under the program, the contracts are expected to begin July 1, 2021, and run through Dec. 31, 2024, provided that the MCO(s) maintain their own contracts with the Division of Medicaid and Medical Assistance (DMMA) for the term of the agreement.

ACOs, which grew from the federal Affordable Care Act passed in 2010, are groups of health-care practitioners – doctors, hospitals and other providers – who voluntarily agree to share responsibility for the quality, outcomes and cost of health care for a group of patients.

Under Delaware’s Medicaid ACO program, contracts between the ACOs and MCOs require participation by at least 5,000 Medicaid and/or Children’s Health Insurance Program (CHIP) enrollees, excluding individuals in long-term care facilities, those eligible for both Medicaid and Medicare, and those receiving long-term services and supports. Enrollees voluntarily decide to participate in the ACO through their primary care provider or their managed care organization.

Using risk/shared savings models and calculations based on the total cost of providing care instead of fees charged per each service provided, ACOs establish financial incentives for individual providers. These incentives promote the value of care over the volume of services and encourage providers to coordinate care with other providers, address patients’ behavioral health and social needs, and improve patients’ overall experience of receiving care.