NYAPRS Note: Accountable Care Organizations (ACOs) are “groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to ensure that patients, especially the chronically ill, get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors.
When an ACO succeeds both in both delivering high-quality care and spending health care dollars more wisely, it will share in the savings it achieves..” (CMS).
While ACOs have been focused on Medicare, here’s a foray by Illinois in adapting the model to Medicaid beneficiaries.
llinois RFP For Medicaid Accountable Care Entities Released; All Populations Included In Future Plans
Open Minds September 4, 2013
Developed by OPEN MINDS, 163 York Street, Gettysburg PA 17325, www.openminds.com. All rights reserved. You may not alter, transform, or build upon this work without written permission from OPEN MINDS
On August 1, 2013, the Illinois Department of Healthcare and Family Services (HFS) released a procurement seeking proposals of organizations interested in becoming “Accountable Care Entities” (ACE) for the Illinois Medicaid program as it shifts all beneficiaries across the state into managed care. Proposals are due by January 3, 2014. An ACE is a new integrated delivery system model created by the state legislature to provide care coordination services. Over the initial three-year contract term, the selected ACEs will implement a full-risk payment structure, moving gradually from the current fee-for-service to shared savings within first 18 months, to partial risk for the next 18 months, and then to full risk capitation after three years.
The ACEs will be organized by provider organizations and coordinates a network of Medicaid services. Each ACE will be large enough to have an impact for a minimum population of least 40,000 clients in Cook County; 20,000 clients in collar counties surrounding Chicago; and 10,000 clients in downstate counties. Additionally, the ACEs:
- Will initially enroll children and their family members, with an option to enroll "newly eligible" adults under Medicaid expansion population authorized by the Patient Protection and Affordable Care Act of 2010 (PPACA).
- Will include at a minimum the following types of provider organizations: primary care, specialty care, hospitals, and behavioral health care
- Will build an infrastructure to support care management functions among the providers in the network, such as health information technology, risk assessment tools, data analytics, and communication with Medicaid members.
The ACE is part of the Illinois Medicaid redesign that launched in 2009 with a demonstration called the Integrated Care Program. That mandatory managed care program enrolled 36,000 older adults and individuals with disabilities in Cook County suburbs and five surrounding counties. In January 2011, the state legislature passed a bill requiring that half of Medicaid beneficiaries be enrolled in some form of care coordination system with risk-based payments.
According to a fact sheet the state released about the ACE concept and the solicitation, Illinois Medicaid also has the following care models:
- Care Coordination Entities for older adults and individuals with disabilities.
- Care Coordination Entities for children with complex care needs.
- Managed Care Community Networks and traditional Managed Care Organizations that both serve older adults and individuals with disabilities, including people eligible for both Medicare and Medicaid services.
The ACE model is a key innovation that the state is incorporating in the State Health Care Innovation Plan, a multi-payer and multi-provider organization planning process called the “Alliance for Health” and funded by the federal Centers for Medicare and Medicaid Innovation. The state plans to use a common set of quality measures to evaluate the performance of all managed care entities.
The RFP notes that there is no pre-determined number of awards. The ACE contracts will start enrollment by July 1, 2014. Organizations selected for an ACE contract will be required to pass an ACE Desk Readiness Review in April in preparation for passing an On-Site Readiness Review in May 2014.
A link to the full text of “Illinois DHS Background & Overview For Accountable Care Entity Solicitation” may be found in The OPEN MINDS Circle Library at www.openminds.com/library/072213ildhsacefaq.htm.
A link to the full text of “Illinois DHS Medicaid Accountable Care Entity Solicitation ACE Program Reference # 2014-24-002” may be found in The OPEN MINDS Circle Library atwww.openminds.com/library/080113ildhsacerfp.htm.
A link to the full text of “Illinois Senate Bill 26 Of 2013 To Create Medicaid Accountable Care Entities” may be found in The OPEN MINDS Circle Library at www.openminds.com/library/072213ilsb26medicaidexp.htm.
OPEN MINDS also reported on this topic and the state’s Care Coordination Entities and Managed Care Community Networks in “Illinois Medicaid Moving Toward Integrated Behavioral Health & Primary Care.” The article is available at www.openminds.com/market-intelligence/premium/omol/2012/040212mhcd4.htm.
OPEN MINDS also reported on this topic in “Illinois Moves Care Management of Consumers With Disabilities to Integrated Care; Aetna & Centene Selected to Manage Program.” The article is available atwww.openminds.com/market-intelligence/premium/omol/2010/092710ds4.htm.
For more information, contact: Amy Harris-Roberts, Procurement Contact Point, Illinois Department of Healthcare and Family Services, 201 South Grand Avenue East, Springfield, Illinois 62763; E-mail:HFS.ACE@illinois.gov; Website: www2.illinois.gov/hfs/PublicInvolvement/cc/ACE/Pages/default.aspx; or Kelly Jakubek, Media Contact, Illinois Department of Healthcare and Family Services, Room 5-500, James R. Thompson Center, 100 W. Randolph, Chicago, Illinois 60601; 312-814-8198; E-mail: email@example.com; Website: www2.illinois.gov/hfs/agency/NewsRoom/Pages/default.aspx.
IIllinois RFP For Medicaid Accountable Care Entities Released; All Populations Included In Future Plans. (2013, September 2). OPEN MINDS Weekly News Wire.