Medicare's accountable care push isn't doing enough for the patients who need them the most, said Sen. Ron Wyden (D-Ore.). Wyden, speaking last week at the National Accountable Care Organization Summit in Washington, said the attribution rule under the Patient Protection and Affordable Care Act requires ACOs to “serve everyone coming through the door.” That's intended to prevent them from avoiding expensive patients, but it has hindered ACOs from specializing in coordinating care for chronic conditions, he said. “Our objective should be to make the adverse selection issue disappear, by creating specific consumer protections for seniors in plans that specialize in senior chronic care, while fully retaining the current protections against discrimination for all other seniors under the current law,” said Wyden, a member of the Senate's Special Committee on Aging. He also noted a gap in where providers are forming ACOs and where the highest numbers of the sickest seniors live. For instance, he said ACOs are not being established in Alabama—home to many seniors with poor health—but seniors in Massachusetts have access to six Medicare ACOs. Medicare reimbursement, he said, should be reconfigured to target areas with the highest incidence of chronic illness, and reward practitioners in those areas who improve care and keep costs down. Dr. Mark McClellan, director of the Engelberg Center for Health Care Reform at the Brookings Institution and former CMS administrator, said Wyden's proposals raised important issues and that revisions to Medicare's accountable care rules and terms are likely as officials learn from early results. “People recognize that patient engagement is absolutely crucial to a prevention-oriented, patient-centered health system,” McClellan said.
—Jessica Zigmond and Melanie Evans