Consumer advocates across the country are increasingly developing expertise in payment reform and new models for health care delivery. The Center for Consumer Engagement in Health Innovation is eager to facilitate the sharing of information between advocates, particularly regarding ways they can participate in conversations in their states about health system transformation. We are, therefore, delighted to share the comprehensive recommendations on Medicaid Accountable Care Organizations (ACOs) developed by Health Care For All (HCFA) in Massachusetts. HCFA submitted these recommendations to MassHealth(Massachusetts’ Medicaid program) in December 2015.*

ACOs represent a new way to pay for and organize health care delivery by bringing together doctors, hospitals and other health care providers to provide coordinated, high quality care to their patients. States across the country are incentivizing the development of ACOs, and while these new structures do represent potential opportunities to improve care, there are also risks. Advocates must quickly get up to speed on both the opportunities and challenges presented by ACOs and identify opportunities to ensure robust consumer protections. HCFA’s recommendations may be helpful to advocates in many states developing and incentivizing ACOs and other new models. In their extensive comments HCFA emphasized: 

  • Member Protections
  • Member Engagement
  • Comprehensive Data Collection and Public Reporting
  • Access to Services
  • Population Health and Prevention
  • Financial Incentives and Payment Methodologies

We encourage you to take a close look at HCFA’s excellent work.

Dr. Ann Hwang, Director of the Center for Consumer Engagement in Health Innovation, also provided brief testimony at a public hearing on Jan. 6, 2016 before the Massachusetts Health Policy Commission (HPC). The HPC, an independent state agency that develops policy to reduce health care cost growth and improve the quality of care, is presently developing standards for voluntary ACO certification for private sector providers in Massachusetts.

ACOs and other payment and delivery reform models provide opportunities to fundamentally transform the way health care is delivered. However, advocates must shape these new models so that they deliver high quality, high value, person-centered care, improve access to needed services, and lead to healthier communities. We hope these tools will help advocates across the country to make the most of these emerging opportunities. 

*Similar comments werer submitted to the Health Policy Commission by HCFA.