Accountable care eases Medicaid pain in Rhode Island

Hospital leaders in Rhode Island raised many of the same complaints as their Illinois counterparts about a foundering Medicaid managed-care program— slow credentialing, poor care coordination, reimbursement woes and more.

“The coordination of services was so fragmented that the most complex patients would default to the highest-cost setting, which is the inpatient unit,” said Dr. Jim Fanale, chief clinical officer at Care New England, a multisite health system in Rhode Island,

But the situation improved last year, he said, following the state’s decision to launch Medicaid accountablecare organizations. Under the model, Medicaid plans oversee groups of providers that are responsible for performing well on quality, outcomes and cost. Providers hitting quality and financial benchmarks are eligible for an incentive payment.

Roughly 27% of Rhode Island residents are eligible for Medicaid; more than 100,000 beneficiaries are part of an ACO, according to the state Office of Health & Human Services.

Fanale said the ACO experiment has improved care for the sickest Medicaid beneficiaries, and that total costs have declined. A study assessing the state program is expected to be published soon.