RTI Report Shows Medicaid ACOs, Investments in Behavioral Health Integration Impact Utilization and Expenditures

April 08, 2019

RESEARCH TRIANGLE PARK, N.C. — Between 2014 and 2016, Vermont’s Medicaid Shared Savings Program involving two accountable care organizations (ACOs) yielded $97 million in savings relative to a comparison group, according to a new RTI International report that evaluated health reform efforts in six states. The six states evaluated by RTI —Arkansas, Maine, Minnesota, Massachusetts, Oregon and Vermont — participated in Round 1 of the State Innovation Models (SIM) Initiative, a $250 million effort of the Centers for Medicare & Medicaid Services (CMS) to encourage the implementation of value-based purchasing models in Medicaid.

Key findings from the full RTI evaluation were highlighted in three articles published Monday in The Milbank Quarterly, a peer-reviewed journal covering health care policy.

The evaluation marks the first data available on the impact of statewide Medicaid ACOs in Maine, Minnesota and Vermont relative to a comparison group on utilization and expenditures among Medicaid beneficiaries.

In addition to slower cost growth in Vermont, which may be a product of strong history of multi-payer-supported primary care transformation over the past 10 years and multi-payer alignment around the ACO program, Medicaid ACO models in Maine, Vermont and Minnesota:

  • Reduced the rate of emergency department visits for all beneficiaries relative to an in-state comparison group by 3%, 5% and 7%, respectively.
  • Reduced the rate of emergency department visits for beneficiaries with behavioral health conditions by 2%, 6% and 5%, respectively.

Additionally, beneficiaries with behavioral health conditions served by Medicaid ACOs in Minnesota and Vermont had slower cost growth by $128 (12%) and $62 (7%) per beneficiary per month, respectively, than a comparison group.

The inclusion of behavioral health-related components in new payment and delivery models such as ACOs and Medicaid behavioral health homes is just one strategy states pursued to promote integration of behavioral health and primary care. Under the SIM Initiative, states invested in health information technology and technical assistance to providers, resulting in enhanced communication between different types of providers, informal relationship building and additional learning opportunities.

A review of the overall policy changes and financial investments under the SIM Initiative across all six states shows how states were challenged to meet the goal of aligning Medicaid and commercial payers around a common value-based purchasing model, and did so more often through regulatory or policy change. In contrast, financial investments — not policy alone — can be credited with effecting greater use of health IT and care teams for coordination as reported by providers in states that applied targeted funds toward activities in those areas.

“Our evaluation details the challenges of state-led health reform in terms of aligning value-based payment models across payers, engaging providers and consumers, and implementing health information technology to support delivery system changes,” said Stephanie Kissam, MPH, a senior health services researcher at RTI who served as project director. “However, the experience of these six states offers lessons in how to combine policies with targeted financial investments to effect changes for patients.”

Added Heather Beil, PhD, an associate director of the evaluation: “By identifying state context for positive findings, and where states faced concerns, we hope to inform policymakers’ next steps as more states continue to look for effective ways to reduce health care costs and improve outcomes.”

The SIM Initiative evaluation team included the Urban Institute, the National Academy for State Health Policy and The Henne Group.

To learn more about RTI’s involvement in CMS’ State Innovation Models Initiative, visit: https://www.rti.org/impact/evaluating-state-innovation-models-sim-initiative.