236 - Pediatric Practice Experience in Massachusetts’ Statewide Medicaid Accountable Care Organization

Poster Number: 236
Publication Number: 236.2096

Background: Medicaid Accountable Care Organization (ACO) programs can be geared towards the adult population, but they also include children and affect pediatric practices. Little is known about how pediatric practices experience a one-size-fits-all approach to introducing a statewide Medicaid ACO like the one Massachusetts. Examining the Massachusetts’ statewide Medicaid ACO program that launched in 2018, we describe how participating pediatric practices exhibited different approaches to and experiences with the ACO program, as compared to adult practices.

Objective: To characterize the experiences of pediatric practices with the advent of Massachusetts’ statewide Medicaid Accountable Care Organization (ACO) program, as compared to adult-serving primary care.

Design/Methods: This mixed methods study uses two different sources of data. In the qualitative phase, we conducted 28 interviews across three ACOs in 2018 to describe pediatric practices’ early experience with Medicaid ACOs. We conducted the quantitative phase in 2019, using a survey administered to practice managers to capture practice-level experiences with Medicaid ACOs in a stratified random sample of 353 primary care practices across all 17 MassHealth ACOs (225 respondents; 64% response rate). We used unadjusted ordinary least squares regression to describe differences in the experiences across pediatric vs non-pediatric practices.

Results: Pediatric practices described their rationales for participating in Medicaid ACOs as including their desire to have a voice in system reform and to build on existing efforts to integrate social services. Noted barriers to their thriving in Medicaid ACOs included the unique challenges of addressing family social needs in pediatric contexts and longer timeframes for cost savings. Survey data indicated that compared to practice sites serving adults only, pediatric-focused practices exhibited on average 0.17 points less ACO collaboration (p = 0.03, 95%CI[-0.81, -0.05]) and 0.31 points less standardization change (p = 0.04, 95%CI[-0.61, -0.02]) on 5-point Likert scales.

Conclusion(s): Pediatrics brings a distinct perspective and unique needs to delivery system reform, presenting opportunities for Medicaid ACOs to tailor processes to pediatric contexts.