State ‘Accountable Care’ Activity Map

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With the support of The Commonwealth Fund, NASHP is tracking state efforts to lead or participate in accountable care models that include Medicaid and Children’s Health Insurance Program populations. Accountable care models aim to address lack of care coordination and wide disparities in cost and quality of care in the U.S. health care system, perpetuated by the prevailing fee-for-service payment method, through shared incentives to manage utilization, improve quality, and curb cost growth.

State efforts to advance accountable care models vary considerably. However, for the purposes of this map, a set of three core characteristics and capabilities, consistent across designs, is needed: 

  1. Organizations or structures should assume responsibility for a defined population of patients across a continuum of care, including across different institutional settings.  
  2. Participants should be held accountable through payments linked to value, emphasizing dual goals of improving quality and containing costs.  
  3. Accountability should be facilitated by reliable performance measurements that demonstrate savings are achieved in conjunction with improvements in care.

State accountable care activity is characterized on this map along seven domains.

  • Project scope refers to a range of model design characteristics, including targeted providers, targeted beneficiary population, scope of services provided, and methodology for assigning beneficiaries to the model.
  • Authority refers to the specific source (e.g. legislation, executive office, cabinet or Medicaid agency) of the model’s authorization. This category also includes regulatory adjustments (e.g. changes to licensure requirements or data confidentiality rules) made by states to facilitate accountable care models.
  • Governance refers to the structures by which policy decisions around the accountable care model are made, and the specific stakeholders (including patients and community stakeholders) who assume responsibility for the project.
  • Criteria for participation in the accountable care activity include specific requirements set forth by the state in regulations, requests for proposals, managed care contracts, and other official policy statements. This includes patient protection requirements around notification and grievance resolution.
  • Payment describes the targeted delivery system (e.g. fee-for-service or managed care) of the initiative and the design of the accountable care payment model.
  • Support for infrastructure refers to a range of supports offered to accountable care projects by the state, including information technology, staff support, data feedback loops, and the convening of learning collaboratives.
  • Measurement and evaluation describes performance measures that are being tracked across providers and independent evaluations of the model.

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Related Resources

For regional accountable care organization information, see:

Why Not The BEST?
Quality improvement resources for health care professionals


For related publications and other resources, see: Accountable Care Resources