Consumers: The Indispensable North Star for Medicaid ACOs
Last week, the Center for Consumer Engagement in Health Innovation at Community Catalyst published a report, Consumer Engagement in Medicaid Accountable Care Organizations: A Review of Practices in Six States. The Accountable Care Organization (ACO) model of care delivery is intended to incentivize better coordination of care and allow for more flexibility in the types of services provided to members. However, because ACOs also face financial incentives to reduce the total cost of care, there is potential that ACOs may focus on cost reduction at the expense of quality, person-centered care. We believe it is critical that the members served by ACOs have a strong voice in their design, implementation and ongoing oversight in order to ensure the goal of providing quality, person-centered care stays at the fore.
What We Did: We reviewed how six states – Colorado, Maine, Minnesota, New Jersey, Oregon and Vermont – are engaging consumers in the design, implementation and oversight of their Medicaid ACO programs. We reviewed state websites, spoke with consumer advocates in these states and reviewed relevant documents such as federal waiver applications, requests for proposals, model contracts and statutory language.
What We Learned: We found that all six states are engaging consumers at both the state and ACO levels, but the format and extent of this engagement varies widely. Our interviews with 14 consumer advocates across our sampled states illuminated the breadth of factors to consider when engaging consumers, and cautioned that just having consumer engagement requirements is not sufficient to create meaningful participation. Some of the ways state policymakers and health care organizations leaders can improve engagement include being mindful about meeting times and locations; providing adequate time and support for consumers to review and comment on materials; and ensuring appropriate funding and training.
A growing number of states are pursuing Medicaid ACOs and the experience of states that have already implemented them can help inform those that follow. We hope our report will be useful to consumer advocates, state policymakers, and ACO leadership, both in states that are considering Medicaid ACOs and those with programs underway that are looking to improve how they engage consumers. Ultimately, the voices of consumers should be the “north star” guiding the design, implementation and monitoring of the programs meant to serve them.