High-Risk Care Management Impact on Medicaid ACO Utilization and Spending

AJMC July 10, 2025
Kathryn Corelli, MD, Erin Duralde, MD

In Massachusetts’ largest Medicaid accountable care organization (ACO), high-risk care management significantly reduced spending, emergency department visits, and hospitalizations, demonstrating that targeted strategies can manage health care costs amid budget constraints.

ABSTRACT

Objectives: States are experimenting with accountable care organization (ACO) contracts to slow Medicaid spending growth. There is limited information on how ACOs have impacted expenditures in Medicaid, which includes a relatively heterogenous population with less spending compared with Medicare. This study aimed to evaluate the impact of high-risk care management on spending and utilization within Massachusetts’ largest Medicaid ACO.

Study Design: This observational study analyzed Medicaid claims data from Massachusetts’ largest Medicaid ACO utilizing staggered program entry from 2016 to 2021 (n = 158,441 total beneficiaries). It included adults aged...

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