March 18, 2024
The ACO model helps states with expansion implementation
By Casey Korba, Policy Director
Only 10 states have not expanded Medicaid under the Affordable Care Act. Many are concerned about the increase to the state’s budget that expansion might have and on stretching already stretched resources, given primary care shortages. On March 8, Dr. Karen Smith, who runs a family medicine practice in Raeford, North Carolina, and is a Local Medical Director at Aledade, participated in a panel as part of the Congressional State Medicaid Expansion Caucus’ Roundtable to highlight her practice’s experience in caring for patients both pre-and-post Medicaid expansion in North Carolina.
North Carolina recently expanded Medicaid, officially passing legislation last year and implementing expansion beginning December 1, 2023. Studies estimate that approximately 600,000 North Carolina residents could newly qualify for Medicaid because of the expansion. Dr. Smith spoke about the states’ challenges with hypertension, hyperlipidemia, diabetes, and the opioid epidemic, and that while practices are doing their best, there are limits to what they can do for those residents who are uninsured. Now that Medicaid expansion has been implemented, her practice is seeing new patients who previously did not have access to care, and are able to address their chronic conditions.
Other states cite barriers to expansion
Dr. Smith was joined on the panel by Ryan Loke, Chief Policy Officer of Grady Health in Georgia, and Tish Towns, Executive Vice President and Chief Administrative Officer from Regional One Health in Tennessee. Neither Georgia nor Tennessee has expanded Medicaid, though Loke explained that Georgia’s recent partial Medicaid expansion (done through a waiver that enables the state to extend eligibility to a limited number of residents) aimed to expand coverage for more of the state’s low income workers. However, if someone loses their job or their working hours are cut they could lose coverage. Towns focused her remarks on the economic benefits Tennessee would have if it expanded Medicaid, citing studies that quantified the increased productivity from healthier residents and increased federal funding. Studies also show expanding Medicaid coverage reduces the chances that rural hospitals will close. Dr. Smith cited a study that showed expansion in her state would lead to 37,000 new jobs.
How the ACO model helps mitigate cost concerns
While some critics of Medicaid expansion have pointed to increased costs to the state budget, Dr. Smith explained how value-based care and specifically the accountable care organization (ACO) model helps stave off cost concerns by equipping practices with the tools, technology, and data they need to practice population health and hire care coordinator staff – ultimately leading to reduced emergency room use, hospital admissions, and better prevention and chronic care management. Dr. Smith shared that because of her participation in value-based care, she is able to hire another physician in her practice for the first time in 32 years, in part to make room for the influx of Medicaid patients who now have access to care.
Next steps to advocate for expansion
The panelists emphasized strategies such as sharing the studies and statistics on increased productivity from a healthier population and job creation with the business community. Dr. Smith shared that one of the keys to success in North Carolina was the boots-on-the-ground, grassroots approach that many advocates used. She shared that she was part of a small group of Aledade medical directors and member physicians who met with their Congressional representatives and made the case for expansion. It was that kind of advocacy from physicians, clinicians, health care associations, medical societies, and other advocates working in the state that ultimately moved the needle. Though there is a long road ahead for many of the states that have not expanded access to Medicaid, given the flexibility each state has in rolling out and implementing expansion, there is overall optimism that more states will choose to expand access to these vulnerable populations in the coming months.
Learn more about Aledade’s work to ease disruptions for patients and practices from Medicaid redetermination.