Many state Medicaid agencies have used the Medicare Shared Savings Program (MSSP) model as a basis for designing accountable care organization (ACO) programs that seek to better align provider incentives to improve care for low-income populations. Medicaid agencies have modified the MSSP methodology to account for differences in the populations served and the structure of their ACO programs, including adjustments for managed care delivery systems.

This technical assistance brief explores the shared savings approaches of Minnesota and New Jersey, which both used MSSP as a foundation for their Medicaid ACO programs. It describes how these states have modified the MSSP approach to: (1) better incentivize providers to treat medically and socially complex, high-cost patients; (2) align with existing programs; and (3) integrate ACOs into managed care programs. The brief outlines how other states can use MSSP to build their own Medicaid shared savings arrangement.

The innovations in Minnesota and New Jersey are particularly relevant for states creating multi-payer alignment through initiatives such as the Center for Medicare and Medicaid Innovations (CMMI) State Innovation Model (SIM) initiative.