Accountable Care Goes Rural

This summer the state of Utah plans to extend the range of the state’s Medicaid Accountable Care Organizations (ACOs) to nine more counties, including rural areas for the first time.

Utah rolled out its ACO project in January 2013 with four Wasatch Front counties—Salt Lake, Utah, Davis, and Weber—that collectively account for 70% of the state’s Medicaid population. Consumers can choose among four separate Medicaid ACO providers: Health Choice Utah, Healthy U, Molina Healthcare, and SelectHealth Community Care.

What are ACOs?
Accountable Care Organizations (ACOs), also called a Managed Care Organizations, (MCOs) are a provider-run organization in which the participating providers are collectively responsible for the care of an enrolled population, and also may share in any savings associated with improvements in the quality and efficiency of the care they provide. ACOs typically replace the traditional “fee for service” model for healthcare delivery in which providers are compensated for each test or service they provide. When operating under the ACO system, participating providers and healthcare agencies (ie. hospitals) are “at risk” for both potential savings and losses created by the coordinated care.

After state funding for the extension as approved during the 2015 Utah legislative session, the Utah Dept. of Health announced that ACOs will start offering managed care coverage in these nine counties by July 1, 2015:

• Cache
• Rich
• Morgan
• Box Elder
• Tooele
• Wasatch
• Summit
• Iron
• Washington

The extension will occur in all nine counties starting July 1, 2015. The state will also schedule public hearings on the extension process in May. Follow UHPP’s website, Facebook page, and future issues of Health Matters for the date, time, and location of these hearings.

Medicaid ACO Open Enrollment
In other news, Medicaid open enrollment for the existing ACOs will take place May 15-June 15, 2015. Consumers can change health plans during open enrollment for any reason. Any changes will take effect on July 1, 2015.

Resource:
Minutes from the March 19, 2015 meeting of the Medical Care Advisory Committee (MCAC) 
(See Medicaid ACO Report on page 5)

http://health.utah.gov/mcac/Files/2015Minutes/MCAC_19Mar15Draft.pdf