SENATE JOINT MEMORIAL 32

50th legislature - STATE OF NEW MEXICO - second session, 2012

INTRODUCED BY

Dede Feldman

A JOINT MEMORIAL

REQUESTING THE HUMAN SERVICES DEPARTMENT TO CONDUCT A STUDY ON THE POTENTIAL BENEFITS AND COSTS OF APPLYING THE ACCOUNTABLE CARE ORGANIZATION MODEL TO THE STATE'S MEDICAID HEALTH CARE DELIVERY AND FINANCE SYSTEM.

     WHEREAS, the accountable care organization is a model of health care delivery and finance whereby health care providers share responsibility for the cost and quality of care for a defined population; and

     WHEREAS, there is no set definition for an "accountable care organization", but most models emphasize that the many different types of health care providers involved in a person's care should monitor and coordinate the person's care to achieve positive health care outcomes and administrative efficiency targets; and

     WHEREAS, unlike the managed care model, which has been criticized for promoting cost efficiencies at the expense of the quality of a person's care, the accountable care organization model is designed to promote efficiency in achieving health care cost efficiencies while achieving health care quality targets; and

     WHEREAS, health care payers', providers' and patients' incentives are aligned in the accountable care organization model both in order to provide the patient with a good quality of life and to achieve cost savings by preventing later decline of the patient's health condition; and

     WHEREAS, the accountable care organization model relies upon health information technology to allow communication among health care providers, patients and payers; and

     WHEREAS, in states such as Colorado, Illinois, North Carolina, Minnesota, North Dakota and South Dakota, there are successful accountable care organization models already working to save health care dollars, improve care and promote administrative efficiencies; and

     WHEREAS, the United States congress has recognized the potential for accountable care organizations to promote accountable, high-quality and efficient health care service delivery by creating in the federal Patient Protection and Affordable Care Act of 2010 the "medicare shared savings program" to promote accountable care organizations; and

     WHEREAS, accountable care organizations nevertheless have the potential to harm consumers if health care providers use their cooperative agreements to increase prices and avoid transparency and quality targets; and

     WHEREAS, while the state's medicaid program health care cost inflation is generally lower than that of the private health care market, the state's single greatest expense is the medicaid program; and

     WHEREAS, the state's medicaid program is based on uncoordinated health care delivery, wherein providers do not share information or coordinate a patient's care; and

     WHEREAS, most health care delivered in the state's current medicaid program is reimbursed under a fee-for-service model that promotes health care utilization rather than health care quality and efficiency; and

     WHEREAS, the accountable care organization model has great potential for addressing the pitfalls in the current medicaid health care delivery and reimbursement model; and

     WHEREAS, the accountable care organization model should be carefully studied in light of the benefit and cost potential that the model presents to the state's medicaid program;

     NOW, THEREFORE, BE IT RESOLVED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO that the human services department be requested to conduct a study of the accountable care organization model as it may be applied to the state's medicaid program to improve health care quality and efficiency; and

     BE IT FURTHER RESOLVED that the study include a review of the different types of payment arrangements, cost-sharing plans, quality incentives and administrative efficiency measures that would best serve the state's medicaid recipients, medicaid providers, taxpayers and state government; and

     BE IT FURTHER RESOLVED that the group the human services department convenes to study accountable care organizations include experts on medicaid, health care finance, health care delivery and existing accountable care organization models as well as stakeholders and medicaid consumer advocates; and

     BE IT FURTHER RESOLVED that the human services department present its findings to the legislative health and human services committee and the legislative finance committee by November 1, 2012; and

     BE IT FURTHER RESOLVED that copies of this memorial be transmitted to the governor, the secretary of human services, the chair of the legislative health and human services committee and the director the legislative finance committee.

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