What’s an Accountable Entity (AE)?
An Accountable Entity (AE) is Medicaid’s version of an Accountable Care Organization (ACO) where a provider organization is accountable for quality health care, outcomes and the total cost of care of its population. Rhode Island launched its first pilot AE in the spring of 2016. There are six (6) organizations participating in the AE pilot. See below for a list of AEs with provisional certification. The intent of the AE pilot program is to provide guidelines for the Medicaid MCOs and learn from the pilot prior to developing criteria for fully certified AEs. The AE Initiative is one of the initiatives under Reinventing Medicaid of 2015. See Report of the Working Group to Reinvent Medicaid, 7/8/15.
RI's Accountable Entity Initiative
The Guiding Principles of Rhode Island’s AEs include:
- Promoting and supporting multi-disciplinary capacity, a strong foundation in primary care, effective behavioral health integration
- Having the ability to manage the full continuum of care, including “social determinants”
- Having analytic capacity to support data driven decision-making and real time interventions.
- Focusing on high utilizers- Medicaid beneficiaries with complex needs or high costs
Our Approach: MCO Partnerships
- Will build on the existing strengths of the current MCO model and
- Enhance capacity to serve high-risk populations by increasing delivery system integration, improving information exchange, and clinical integration across the continuum.
The AEs contract with the one or both of Rhode Island’s Medicaid managed care plans- Neighborhood Health Plan of RI and UnitedHealthcare Community Plan. The total cost of care analysis is done between the health plan and AE. If costs over a given time period are less than expected, the health plan and the AE share in the savings.
There are two types of AEs: 1) for Medicaid beneficiaries in general and 2)
for Medicaid beneficiaries with SPMI
AEs with Provisional Certification
The pilot program is currently underway based on the application submitted to EOHHS in 2015-2016. There have been three rounds of applicants. Six applicants are designated as provisionally certified AEs. They are:
1. Blackstone Valley Community Health Center’s HealthKey AE
2. Coastal Medical, Inc.
3. Community Health Center ACO (includes: East Bay CAP, Comprehensive Community Action, Thundermist Health Center, Tri-County Community Action Agency, WellOne Primary Medical & Dental Care, and Wood River Health Services.)
4. Integra Community Care Network, LLC
5. Providence Community Health Centers, Inc. (Providence ChoiceCare AE)
6. Prospect Health Services Rhode Island, Inc.
For more information, please contact Sharon Kernan at Sharon.Kernan@ohhs.ri.gov or Debbie Morales at Deborah.Morales@ohhs.ri.gov
Please note: All guidance for the AE Pilot is subject to change when final AE Certification Standards are issued.
AE Pilot Application/Guidelines
Attribution Guidance for the AE Pilot Program, revised 1/22/2016
OHHS Total Cost of Care Guidance for the AE Pilot Program, 1/29/2016
Clarification of Governance Requirements for Pilot Accountable Entities, 2/06/2016
Protocol for Submission of Material Modification Requests by Pilot AEs
AE Round 3 Pilot Opportunity, 5/18/16