Accountable care organizations (ACO) leaders share perspectives on payment mechanisms used with social service organizations, challenges experienced, and the impacts of these partnerships.
A Flexible Services Program launched by Massachusetts Medicaid in January 2020 and funded under a Section 1115 waiver allows ACOs to address health-related social needs of enrollees with complex care needs or risk factors for housing instability or food insecurity. The ACOs are encouraged to partner with social service organizations to provide needed supports. This study shares ACO leader perspectives on the various types of payment strategies used with social service organizations, challenges experienced, and the impacts of these partnerships.
Four payment mechanisms were used across the partnerships: (1) fee-for-service; (2) prospective payments; (3) retrospective payments; and (4) hybrid models of the aforementioned payment methods. Measuring the impact of these partnerships, as well as patient data sharing, were cited as the most common major challenges due to limited data infrastructure. Referring patients to social service organizations was another major challenge, as integrating social needs support is a large cultural shift in health care settings that can confuse patients. Finally, ACO leaders strongly agreed that partnerships between ACOs and social service organizations offer significant potential to improve patient experience, assist with management of chronic health conditions, and reduce health disparities.
Although further empirical studies are needed to evaluate the outcomes of the Flexible Services Program, this study provides insights on the impact of different payment mechanisms in partnerships between ACOs and social service organizations as well as strategies for helping these partners to overcome challenges.