Medicaid and Permanent Supportive Housing for Chronically Homeless Individuals: Emerging Practices From the Field. 7. Innovative Models for CARE Coordination, Including Accountable CARE Organizations


Chapter 7 Highlights

The Accountable Care Organization (ACO) concept is fairly new, first appearing in 2007. The Kaiser Commission on Medicaid and the Uninsured describes an Accountable Care Organization as, "…a providerrun 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."

The first ACOs were created to serve Medicare patients. Recently several states have launched initiatives to develop and implement ACO-like models in Medicaid, most of which are in the early stages of development.

Two examples in this chapter--Together4Health in Chicago and Hennepin Health in Minnesota--are developing ACO-like models within Medicaid. The third is a unique approach to integrating housing into health and behavioral health care in Los Angeles launched by the county Department of Health Services.

These three initiatives differ in some ways while working toward similar goals:

  • Auspices: Hennepin Health is a state demonstration project run by the county's Human Services and Health Department; Together4Health is a limited liability for-profit company operating under a contract with the Illinois Medicaid office; Housing for Health is an innovative restructuring of some county Department of Health Services activities, designed from within the department.

  • Funding: Hennepin Health uses state, county, and Medicaid dollars; Together4Health uses Medicaid dollars and support from foundations for start-up costs; Housing for Health uses county general fund dollars and has obtained funding from a foundation for housing subsidies.

  • Target Populations: All serve low-income populations; Hennepin Health serves adults who are newly eligible for Medicaid, homeless and housed; Together4Health serves Medicaid beneficiaries only, homeless and housed, including those eligible for both Medicaid and Medicare; Housing for Health is only for the most vulnerable homeless people served by the Department of Health Services, with the most complex, cooccurring conditions (although the department serves the larger homeless and housed low-income populations in its many other activities).

All three are creating strategies that seek to integrate care for their clients across four critical domains: medical care (both primary and specialty), mental health care, substance use treatment, and housing.

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