Reports & Analysis

The accountable care organization (ACO) model of health care delivery is rapidly being implemented under government and private-sector initiatives. The model requires that each ACO have a defined patient population for which the ACO will be held accountable for both total cost of care and quality performance. This study examines the two major methods of defining, or attributing, patient populations to ACOs: the prospective method and the performance year method. 

In this paper, the Rockefeller Institute examines the difficulty in implementing the Affordable Care Act in the face of so many uncertainties. It proposes the creation of a new institutional mechanism to monitor and react to changing conditions and to provide feedback to Congress and the president on necessary adjustments to meet the goals of the legislation.

The ACA will expand access to affordable health insurance for millions of Americans. In states that choose to implement the Medicaid expansion for low-income adults, Medicaid will provide an important new pathway to coverage. Yet, even in states that choose to expand Medicaid a significant proportion of the low-income nonelderly adult population will be excluded from the Medicaid expansion due to their immigration status. This brief provides the first state-specific estimates of the number of uninsured low-income adults that will potentially be excluded from the Medicaid expansion because of their immigration status.

This brief prepared by Manatt Health Solutions examines some of the legal, policy and operational issues states should contemplate while considering the possibility of using “premium assistance” to purchase coverage for Medicaid-eligible adults in the Exchange. It provides an overview of the benefits of premium assistance along with the logistical challenges of its implementation.  

This brief explores how states may be able to use CHIP to help meet some of the child-specific requirements for exchanges in the ACA. Options for doing so include: using CHIP as model for pediatric benefits and providers in the exchange; using CHIP funds to provide premium assistance for eligible children to buy exchange coverage that would allow families to be insured by one coverage program; and using CHIP to wrap around Essential Health Benefit benchmark benefits to ensure children’s unique needs are met.

The ACA established a Consumer Operated and Oriented Plan (CO-OP) program to increase competition among plans and improve consumer choice. This policy brief describes the CO-OP program and examines issues related to its implementation and likelihood of success.

Portability, in the context of health insurance, describes the ability of an employee to maintain access to health insurance coverage and comprehensive benefits after leaving a job. It also applies to the ability of those purchasing insurance on their own to drop one insurance policy and buy another. This fact sheet explains how portability is regulated under current law and how the Affordable Care Act will affect portability in 2014. 

The Affordable Care Act (ACA) requires insurers to cover a minimum set of medical benefits, known as “essential health benefits,” and states must select a “benchmark plan” to serve as a reference point. This issue brief examines states' progress in selecting a benchmark plan and the approaches they’ve adopted in making their selection.

On February 28th, 2013, Politico reported that Arkansas Governor Mike Beebe had received approval “to take federal Medicaid expansion money and use it to buy private health coverage for low-income residents through the state’s insurance exchange.” This brief explains the legal basis for this decision, as well as the issues that can be expected to arise in using this approach to coverage.

This brief reports on the lessons and strategies of three states – Colorado, Minnesota, and Vermont – in their innovative health care payment and delivery system reforms. These states are pursuing different models for reform, but they have the same goal of aligning incentives between health care payers and providers to better coordinate care, enhance prevention and disease management, reduce avoidable utilization and total costs, and improve health outcomes.