Tatiana "Annie" Gowlovech
Research Assistant
Integrated Health Partnerships—Minnesota’s Medicaid Accountable Care Organization Model
July 23, 2024:
Minnesota's Integrated Health Partnerships (IHPs) have pioneered a new approach to implementing accountable care organizations (ACOs) for the Medicaid population. Initially launched in 2013 by the Minnesota Department of Human Services (DHS), these partnerships are voluntary agreements between health provider groups and DHS. Health provider groups partner directly with DHS in three-year contracts to both improve the quality of and reduce the total cost of care for specified patient populations using a shared savings/shared risk financing model.
When IHPs were first established in Minnesota, there were six provider groups participating. A little more than 10 years later, the number of IHPs in Minnesota has more than tripled, growing to 25 total partnerships covering 530,000 beneficiaries.
Recently, DHS released the 2025 Request for Proposals (RFPs) for IHPs hoping to expand the program to more interested organizations and to allow current partnerships to renew their contracts.
In order to better understand potential expansions and changes that may be implemented through Minnesota’s IHPs, we must first understand the foundation, function, and purpose of these partnerships.
In this blog, SHADAC staff will explore:
- What is the purpose of an Accountable Care Organization (ACO)?
- How do IHPs relate to ACOs?
- How have IHPs been established in Minnesota and how have they evolved?
- How can IHPs advance health equity for included populations?
- What are some future considerations that could help in better understanding the effect of IHPs?
Keep reading to start learning about the IHP program and how it impacts communities in Minnesota.
ACOs in Medicaid
Accountable Care Organizations (ACOs) are groups of health care providers that agree to take financial responsibility for the quality and cost of care they deliver to a defined patient population. There are national, state, and regional ACO models, and they may support multiple insured populations, i.e., Medicare, Medicaid, commercial, and self-insured.
ACOs often operate alongside Managed Care Organizations (MCOs), offering additional avenues for health care reform and focusing increasingly on advancing health equity. ACOs are a pivotal tool in promoting access to care, investing in population health, and addressing social determinants of health that affect health equity.
Since the enactment of the Affordable Care Act (ACA) in 2010, the Center for Medicare and Medicaid Innovation (CMMI) has supported state initiatives like Minnesota's State Innovation Model (SIM) to test and expand ACO models within Medicaid, and Medicaid-specific ACOs have now been established in nearly a dozen states.*
These programs can vary by state in terms of delivery system reform, payment expectations, and in the authorities needed to administer them, but all such Medicaid ACO alternative payment models (APMs) are standardized through classification under Categories 2, 3, and 4 of the Health Care Payment – Learning Access Network (HCP-LAN) APM framework.
IHPs are Minnesota’s Medicaid ACO model. In 2008, the Health Reform Law of Minnesota passed recommendations for statewide quality reporting, payments for coordinated care services provided in health care homes (HCHs), and encouragement to participate in bundled payment demonstrations. The law was then amended in 2011 to require DHS to develop a program to “test alternative and innovative health care delivery systems, including ACOs that provide services to a specified patient population for an agreed-upon total cost of care or risk/gain sharing payment arrangement”, leading to the creation of IHPs.
In 2017, SHADAC had the opportunity to conduct an evaluation of early Minnesota IHP implementation, which documented IHP expansion and evolution, helpful data analytics, and importance of ongoing monitoring of the effects of the IHP program on health care utilization, cost, and quality.
Minnesota's Integrated Health Partnerships Today
As noted earlier, Minnesota’s IHP program began over 10 years ago in 2013. In 2018, the program was updated with various enhancements and changes in order to place a stronger focus and effort on health equity. This led to the implementation of a new overall IHP model (Integrated Health Partnership 2.0) with two possible tracks for Minnesota IHPs to operate under. These two distinct organizational design tracks are tailored to both provider capabilities and population needs.
![Integrated health partnership minnesota program design tracks diagram](https://www.shadac.org/sites/default/files/IHP%20Tracks%20Chart%20FINAL-1.png)
For full details and requirement on IHP design tracks, please reference the Minnesota Department of Human Services 2025 Request for Proposals for IHP Program
On top of improving care quality and reducing the total cost of care, IHPs on both tracks are also required to design interventions that address specific health disparities across their target population. Both tracks are incentivized with a quarterly population-based payment (PBP) for meeting quality, utilization, and health equity standards. This population-based payment is flexible, adjusting to reflect changing numbers of the included population specified by the IHP’s intervention plan, as well as changing risk factors due to medical and social complexities in the population makeup.**
Design of this payment structure is intended to contribute to care coordination and other investments for the served population.
Success for IHPs is measured through quality and data metrics (ex: comparing percent change between performance years), as well as a calculation of standards across five domains - Quality Core Set, Care for Children and Adolescents, Quality Improvement, Closing Gaps, and Equitable Care - a process which is described in further detail in the following section.
Ultimately, IHPs have proven quite successful in Minnesota, with significant savings and quality improvements. Since their inception, IHPs have yielded an estimated total savings of $595 million.
Emphasis on Advancing Health Equity
In response to evolving health care needs and feedback suggesting that the original IHP program fell short in terms of addressing social determinants of health (SDOH) and incentivizing partners to reduce racial, geographical, and/or other disparities, DHS introduced an improved program, IHP 2.0, enhancing its focus on health equity.
The Minnesota Department of Health describes health equity as “addressing health disparities as part of a broad spectrum of public investments in housing, transportation, education, economic opportunity and criminal justice.” By implementing changes and integrating health equity goals into core operational frameworks, the hope with the IHP 2.0 program is to overcome the limitations of traditional health care approaches in addressing SDOH and health disparities that arise as a result.
In fact, recent case studies on Medicaid payment reforms conducted by the Urban Institute directly referenced and cited Minnesota’s IHPs, describing their influence on health equity along with the overall changes made to the program in 2018 in order to continue to advance equity in Medicaid.
The table below identifies and describes the core features of the IHP 2.0 program designed to both focus on and advance equity for beneficiaries.
![integrated health partnerships IHPs key features minnesota IHP summary on health equity](https://www.shadac.org/sites/default/files/IHP%20equity%20table%204-1.png)
Source: Allen & Willis, “Can Medicaid Payment and Purchasing Strategies Advance Health Equity?” The Urban Institute, December 2023, https://www.urban.org/sites/default/files/2023-12/Can%20Medicaid%20Payment%20and%20Purchasing%20Strategies%20Advance%20Health%20Equity_0.pdf
As described above, the success of IHPs is evaluated based on performance in health care quality, utilization, and health equity standards, which are summed up into five domains.
As a reminder, those domains are as follows:
- Quality Core Set
- Care for Children and Adolescents
- Quality Improvement
- Closing Gaps
- Equitable Care
Two of these domains, “Closing Gaps” and “Equitable Care,” specifically target health equity through tailored clinical and utilization measures aimed at reducing and eliminating disparities among specific Medicaid populations. IHPs can also receive ‘bonus points’ on their overall quality score for creating additional initiatives under the Quality Improvement, Closing Gaps, and Equitable Care domains.
Recent Health Equity Interventions
As a part of the renewed and enhanced focus on health equity in these programs, IHPs are encouraged to create and highlight interventions designed to address targeted populations’ health equity challenges.
Target populations differ by each IHP, with some serving the entire IHP patient population and some serving more specific sub-populations. A summary list of common target populations of Minnesota’s 25 IHPs include:
- Children, adolescents, families, and new moms
- Justice-involved individuals
- Patients with a mental illness or individuals living with a family member with a mental illness
- Patients that are food insecure
- Adults with substance use disorder
- Black, Indigenous, and people of color who have experienced discrimination accessing care
A summary list of common social risk factors across Minnesota’s 25 IHPs include:
- Housing instability
- Food insecurity
- Social isolation
- Transportation
- Difficulty paying bills
- Education
- Employment
- Mental health needs
- Access to care
- Language barriers
- Income
- Childcare
IHPs must first identify the population or populations that they are serving, and then they must design, develop, and implement targeted intervention efforts based on those populations, risk factors, and SDOH to advance equity for those groups. Examples of these efforts include community partnerships, screening initiatives, referrals, and care coordination for social needs. The following is a summary list of common interventions currently being used to address health equity across Minnesota’s 25 IHPs:
![Minnesota inegrated health partnership IHP health equity interventions by type](https://www.shadac.org/sites/default/files/ihp%20interventions%20FINAL-1.png)
For a full list, the Health Equity Interventions Summary at this link provides the specific target population, social risk factors, solution, and milestones/intervention components for each IHP in Minnesota.
Closing Thoughts
As IHPs continue to evolve, their focus on data analytics and population health management remains pivotal for achieving comprehensive care delivery and advancing health equity statewide. IHPs exhibit the importance of translating equity goals into actionable policies and programs. Monitoring and disseminating the outcomes of the health equity initiatives and interventions implemented by IHPs will provide valuable insights into their effectiveness and impact on Minnesota's health care landscape.
One potential dissemination method would be to make the Population Health Reports from IHPs publicly available. This would not only increase transparency around the data collected by IHPs and the lessons learned from putting interventions into practice, but also aid in our understanding of the effectiveness of IHPs in addressing SDOH, improving access to care, and eliminating health disparities.
Continue learning about health equity in Medicaid and beyond with the following SHADAC products:
*States that have established Medicaid ACOs include Arizona, Colorado, Delaware, Idaho, Maine, Massachusetts, Minnesota, Nebraska, New York, Rhode Island, and Vermont.
**For more on risk-adjusted payment decisions within Minnesota’s IHPs, see
this brief produced for State Health & Value Strategies (SHVS) from SHADAC researcher Colin Planalp.