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Safety Net Challenges In Delivering Accountable Care


November 1st, 2012
by Stephen Shortell

Editor’s note: In addition to Stephen Shortell (photo and linked bio above), this post is coauthored by Sarah Weinberger, a graduate student at UC Berkeley; Matt Chayt, an associate at Nossaman LLP; and Ann Marie Marciarille, a visiting assistant professor at the University of California Hastings School of Law.

As defined by the Affordable Care Act and subsequent rulemaking, Accountable Care Organizations (ACOs) are accountable for the cost and quality of care for a defined group of patients. In return, ACOs are able to share in savings that may result from providing cost-effective care, and they sometimes bear risk for excessive spending as well. While originally intended for Medicare beneficiaries, public-sector ACOs have drawn considerable attention from many states as a vehicle for potentially providing more accountable, cost-effective care, to Medicaid and uninsured populations. At least ten states have already launched or are scheduled to launch Medicaid ACO initiatives.

The final ACO rules published by the Centers for Medicare and Medicaid Services specify that federally qualified health centers (FQHCs) and rural health centers are eligible for participation. This change in the original rules and regulations makes it potentially easier for these safety net providers to combine Medicaid and Medicare accountable care initiatives targeted to the dually eligible population in addition to serving the uninsured and Medicaid populations.

But in addition to these opportunities, safety net providers also face particular challenges in providing accountable care. With the aid of a survey administered to safety net providers in two California counties, this post examines those challenges and offers some policy responses.

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